{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T11:23:14Z","timestamp":1789039394160,"version":"build-2803163510"},"reference-count":41,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T00:00:00Z","timestamp":1776988800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T00:00:00Z","timestamp":1776988800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Science Reports"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>Policymakers require accurate and localized data on the burden of chronic respiratory diseases (CRDs) to allocate resources and design targeted interventions. Our objective was to explore longitudinal patterns in CRD metrics across Iranian provinces over three decades, leveraging recent subnational estimates from Global Burden of Disease (GBD) 2021 to derive actionable public health insights.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We used longitudinal K\u2010means clustering (KmL) to identify provincial\u2010level trends in age\u2010standardized rates (ASRs) of mortality (ASMR), prevalence (ASPR), and incidence (ASIR) attributable to CRDs, including asthma and COPD. Risk\u2010attributed burden estimates were also examined for major environmental and occupational exposures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>CRD\u2010related ASMR, ASPR, and ASIR decreased nationally between 1990 and 2021. Sistan\u2013Baluchestan and South Khorasan provinces showed the highest cluster profiles for ASIR and ASPR, while Kerman province alone formed the highest mortality (ASMR) cluster. Among modifiable exposures, tobacco use dominated male\u2010attributed CRD burden, whereas air quality indicators, particularly particulate pollutants, were more prominent among females. Kerman also had the highest burden of CRD mortality due to occupational risks and air pollution.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Geographical inequalities and distinct risk profiles underline the need for region\u2010specific prevention strategies. National\u2010level interventions to reduce exposure to modifiable risk factors, particularly smoking and air pollution, are essential to further reduce the burden of CRDs in Iran.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hsr2.72305","type":"journal-article","created":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T04:01:16Z","timestamp":1777089676000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["National, Subnational, and Risk\u2010Attributed Burden of Chronic Respiratory Diseases in Iran (1990\u20132021): A Longitudinal Clustering Analysis of Global Burden of Disease 2021 Data"],"prefix":"10.1002","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3934-2345","authenticated-orcid":false,"given":"Mohammad Sadegh","family":"Loeloe","sequence":"first","affiliation":[{"name":"Department of Biostatistics and Epidemiology School of Public Health, Center for Healthcare Data Modeling Shahid Sadoughi University of Medical Sciences Yazd Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3153-8968","authenticated-orcid":false,"given":"Seyyed Mohammad","family":"Tabatabaei","sequence":"additional","affiliation":[{"name":"Department of Medical Informatics Faculty of Medicine Mashhad University of Medical Sciences Mashhad Iran"},{"name":"Applied Biomedical Research Center, Basic Sciences Research Institute Mashhad University of Medical Sciences Mashhad Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2395-8265","authenticated-orcid":false,"given":"Reyhane","family":"Sefidkar","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Epidemiology School of Public Health, Center for Healthcare Data Modeling Shahid Sadoughi University of Medical Sciences Yazd Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7319-3750","authenticated-orcid":false,"given":"Amir Houshang","family":"Mehrparvar","sequence":"additional","affiliation":[{"name":"Occupational Medicine Department Industrial Diseases Research Center Shahid Sadoughi University of Medical Sciences Yazd Iran"},{"name":"Occupational Medicine Department Shahid Rahnemoon Hospital Yazd Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8295-7812","authenticated-orcid":false,"given":"Sara","family":"Jambarsang","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Epidemiology School of Public Health, Center for Healthcare Data Modeling Shahid Sadoughi University of Medical Sciences Yazd Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,24]]},"reference":[{"key":"e_1_2_14_2_1","unstructured":"WHO Chronic Respiratory Diseases(WHO 2021) https:\/\/www.who.int\/health-%0Atopics\/chronic-respiratory-diseases#tab=tab_1."},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-2600(20)30105-3"},{"key":"e_1_2_14_4_1","unstructured":"PHO Chronic Respiratory Diseases(Public Health Ontario 2021) https:\/\/www.publichealthontario.ca\/en\/diseases-and-conditions\/chron%0Aic-diseases-and-conditions\/chronic-respiratory-diseases."},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199906173402406"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/resp.12660"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12931-023-02353-1"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)02751-3"},{"key":"e_1_2_14_9_1","first-page":"104","article-title":"Prevalence of Asthma, COPD, and Chronic Bronchitis in Iran: A Systematic Review and Meta\u2010Analysis","volume":"93","author":"Varmaghani M.","year":"2016","journal-title":"Iranian Journal of Allergy, Asthma and Immunology"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.4103\/ijpvm.IJPVM_478_18"},{"key":"e_1_2_14_11_1","first-page":"31","article-title":"Air Pollution and Chronic Airway Diseases: What Should People Know and Do?","volume":"8","author":"Jiang X.\u2010Q.","year":"2016","journal-title":"Journal of Thoracic Disease"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.1089\/jamp.2019.1576"},{"key":"e_1_2_14_13_1","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00186-2019"},{"key":"e_1_2_14_14_1","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00469-2022"},{"key":"e_1_2_14_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00180-009-0178-4"},{"key":"e_1_2_14_16_1","unstructured":"N. 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