Disability-Adjusted Life Years, Years Lived With Disability, and Years of Life Lost of Diseases Among Children and Adolescents in National and Subnational Levels of Iran, 1990–2021: A Systematic Analysis for the Global Burden of Disease 2021 Publisher Pubmed



B Gholami BAHAREH ; Mm Bastan Mohammad MAHDI ; S Gholami SAMIRA ; A Nejati AZAR ; S Khosravi SEPEHR ; Mr Malekpour Mohammad REZA ; N Rezaei NAZILA ; S Shahin SARVENAZ ; A Golestani ALI
Source: PLOS ONE Published:2025

Abstract

Introduction The global burden of disease (GBD) is a helpful measure that provides estimations regarding the effect of diseases and injuries on public health. This evidence is vital for making health policies and assessing the progress toward global health targets. Specifically, the burden of disease in children and adolescents can have a massive impact on a society’s health status. In this study, we aim to investigate the trends in years of life lost (YLL), years lost to disability (YLD), and disability-adjusted life years (DALYs) in children and adolescents under the age of 20 in Iran, based on GBD 2021 data. Methods The Global Burden of Disease (GBD) classifies all causes of death and disability into four levels. Level 1 includes three main categories: communicable, maternal, neonatal, and nutritional diseases (CMNNDs), non-communicable diseases (NCDs), and injuries. Level 2 expands these categories into 22 clusters of causes. This study provides a descriptive analysis of the trends in YLLs, YLDs, and DALYs at levels 1 and 2 of the GBD hierarchy, focusing on children and adolescents under the age of 20 in Iran and its 31 provinces from 1990 to 2021. Results All metrics show an overall decline. DALYs rate from all causes decreased by 79.8%, YLDs by 6.2%, and YLLs rate by 89.3%. This reduction was consistent across all metrics of CMNNDs, NCDs, and injuries, with the exception of YLD for NCDs, which showed a rise between 1990 and 2021; from 3733.4 (2742.7 to 5013.2) to 4036.1 (2941.5 to 5436.5) per 100,000 population. Mental disorders have significantly contributed to the upward trend of NCDs. NCDs, with a rate of 5666.2 per 100,000 population, exhibited the highest DALY rate in Iran in 2021. The trend of DALYs, YLLs, and YLDs of injuries and CMNNDs in Iran has been mostly downward. Differences between provinces have declined over thirty years. Following the COVID-19 pandemic, there have been changes in the trend of several diseases, especially the rise of mental disorders, respiratory infections and tuberculosis. Conclusion Despite the overall decline in DALYs, YLLs, and YLDs for most causes of death, there has been an increase in YLDs from NCDs, underscoring the importance of addressing this issue. Reviewing YLLs to YLDs ratios for various diseases and injuries, combined with economic analyses of the cost-effectiveness of various health interventions, yields comprehensive evidence for health policy making. © 2025 Elsevier B.V., All rights reserved.