بررسی مقایسه ای روند 30 ساله بار بیماریهای ناشی از عوارض جانبی درمان های پزشکی در ایران، جهان و منطقه مدیترانه شرقی از سال 1372 تا 1401

نوع مقاله : مقاله پژوهشی

نویسندگان
1 مرکز تحقیقات عوامل اجتماعی موثر بر سلامت، دانشگاه علوم پزشکی جهرم، جهرم، ایران
2 مرکز تحقیقات عوامل اجتماعی موثر بر سلامت، دانشگاه علوم پزشکی جهرم، جهرم، ایران.
چکیده
مقدمه: عوارض جانبی درمان‌های پزشکی یکی از چالش‌های مهم ایمنی بیمار و از علل قابل پیشگیری مرگ و ناتوانی در نظام‌های سلامت هستند. این مطالعه با هدف بررسی روند ۳۰ ساله بروز، مرگ و بار بیماری‌های ناشی از این عوارض در ایران و مقایسه آن با جهان و منطقه مدیترانه شرقی انجام شد.
روش کار: این مطالعه اکولوژیک توصیفی با استفاده از داده‌های مطالعه بار جهانی بیماریهای مربوط به سال‌های ۱۳۷۲ تا ۱۴۰۱ انجام شد. شاخص‌های بروز، مرگ و سال‌های عمر تطبیق‌شده بر اساس ناتوانی (دالی) به‌صورت نرخ‌های استانداردشده سنی در هر ۱۰۰ هزار نفر استخراج شدند. تحلیل روند با استفاده از مدل Joinpoint و شاخص میانگین درصد تغییر سالانه انجام گرفت.
نتایج: طی دوره مطالعه، روند دالی، بروز و مرگ ناشی از عوارض درمانی در ایران به‌طور معنی‌داری کاهش یافت . بیشترین کاهش سالانه مربوط به دالی با 80/3- درصد بود (p<0.001). میزان بروز نیز با 56/1- درصد کاهش نشان داد، در حالی که در سطح جهانی تغییر معنی‌داری مشاهده نشد (p= 0.65). مرگ‌ومیر نیز با 54/3- درصد کاهش یافت (p<0.001). ایران از نظر دالی و مرگ از مقادیر بالاتر از متوسط جهانی به سطوح پایین‌تر یا برابر با آن رسید، اگرچه بروز همچنان بالاتر از میانگین منطقه باقی ماند.
نتیجه‌گیری: اگرچه روند کاهشی شاخص‌ها نشان‌دهنده بهبود ایمنی بیمار در ایران است، اما تداوم بروز قابل توجه این عوارض بیانگر نیاز به تقویت سیاست‌های ایمنی، به‌ویژه در حوزه گزارش‌دهی، ایمنی دارویی و بهبود فرآیندهای مراقبت است.
کلیدواژه‌ها

عنوان مقاله English

Comparison of the 30-year trend of the burden of disease caused by adverse effects of medical treatments in Iran, the world, and the Eastern Mediterranean region from 1994 to 2023.

نویسندگان English

Yaser Sarikhani 1
Ali Maranhosseini 2
1 Research center for Social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, Iran.
2 Research center for Social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, Iran.
چکیده English

Background: Adverse effects of medical treatment (AEMT) are a major patient safety concern and a preventable cause of morbidity and mortality worldwide. This study aimed to assess 30-year trends in the incidence, mortality, and burden of these conditions in Iran and compare them with global and Eastern Mediterranean Region (EMR) patterns.
Methods: This ecological descriptive study used data from the Global Burden of Disease study from 1994 to 2023. Age-standardized incidence, mortality, and disability-adjusted life years (DALYs) rates per 100,000 population were analyzed. Trend analysis was conducted using Joinpoint regression and Average Annual Percent Change (AAPC).
Results: Over the study period, DALYs, incidence, and mortality from AEMT declined significantly in Iran. The largest reduction was observed for DALYs (AAPC: −3.80%) (p<0.001). Incidence decreased by −1.56%, with no significant global change (p= 0.56). Mortality declined by −3.54% (p<0.001). Iran shifted from higher-than-global averages to lower or comparable levels in DALYs and mortality; however, incidence remained higher than the EMR average.
Conclusion: Despite substantial improvements in patient safety indicators in Iran, the persistent incidence of adverse events underscores the need for sustained policy efforts, particularly to strengthen reporting systems, medication safety, and quality-of-care processes.

کلیدواژه‌ها English

Adverse effects
Disability-adjusted life years
Global Burden of Disease
Incidence
Mortality
1. World Health Organization. Patient safety: making
health care safer. Geneva: World Health Organization;
2017.
2. Andersson GB, Chapman JR, Dekutoski MB, Dettori
J, Fehlings MG, Fourney DR, et al. Do no harm: the
balance of “beneficence” and “non-maleficence”.
LWW; 20: S2-S8.
3. Nauman J, Soteriades ES, Hashim MJ, Govender R,
Al Darmaki RS, Al Falasi RJ, et al. Global incidence
and mortality trends due to adverse effects of medical
treatment, 1990–2017: a systematic analysis from the
global burden of diseases, injuries and risk factors
study. Cureus. 2020;12 (3):e7265.
4. Nauman J, Soteriades ES, Hashim MJ, Govender R,
Al Darmaki RS, Al Falasi RJ, et al. Global Incidence
and Mortality Trends due to Adverse Effects of
Medical Treatment, 1990-2017: A Systematic
Analysis from the Global Burden of Diseases, Injuries
and Risk Factors Study. Cureus. 2020;12(3):e7265.
5. Insani WN, Whittlesea C, Alwafi H, Man KKC,
Chapman S, Wei L. Prevalence of adverse drug
reactions in the primary care setting: A systematic
review and meta-analysis .PLoS One.
2021;16(5):e0252161.
6. Garzón González G, Alonso Safont T, Zamarrón
Fraile E, Cañada Dorado A, Luaces Gayan A, Conejos
Míquel D, et al. Is primary care a patient-safe setting?
Prevalence, severity, nature, and causes of adverse
events: numerous and mostly avoidable. Int J Qual
Health Care. 2023;35(2):mzad019.
7. World Health Organization. WHO launches global
effort to halve medication-related errors in 5 years
Geneva: World Health Organization; 2017 [Available
from: https://www.who.int/news/item/29-03-2017-
who-launches-global-effort-to-halve-medicationrelated-errors-in-5-years.
8. WHO. WHO calls for urgent action to reduce patient
harm in healthcare: World Health Organization; 2019
[Available from: https://www.who.int/news/item/13-
09-2019-who-calls-for-urgent-action-to-reducepatient-harm-in-healthcare.
9. Wilson RM, Michel P, Olsen S, Gibberd R, Vincent
C, El-Assady R, et al. Patient safety in developing
countries: retrospective estimation of scale and nature
of harm to patients in hospital. Bmj. 2012;344.
10. Schwendimann R, Blatter C, Dhaini S, Simon M,
Ausserhofer D. The occurrence, types, consequences
and preventability of in-hospital adverse events–a
scoping review. BMC Health Serv Res.
2018;18(1):521.
11. Ma X, Du B, Gao S, Yin C, Liu Q, Wu Y. The
current situation and thinking of medical services,
medical quality, and medical safety in China. NEJM
Catal Innov Care Deliv. 2024;5(s1):CAT. 23.0279.
12. Lunevicius R, Haagsma JA. Incidence and mortality
from adverse effects of medical treatment in the UK,
1990-2013: levels, trends, patterns and comparisons.
Int J Qual Health Care. 2018;30(7):558-64.
13. Donaldson LJ, Kelley ET, Dhingra-Kumar N, Kieny
M-P, Sheikh A. Medication without harm: WHO's
third global patient safety challenge. Lancet. 2017;
2017;389(10080):1680-1.
14. Xue Y, Yang J, Zhang J, Luo M, Zhang Z, Liang H.
Motivating physicians to report adverse medical
events in China: stick or carrot? J Patient Saf.
2021;17(5):e455-e61.
15. Kong X, Tao X, Li L, Zhao X, Ren J, Yang S, et al.
Global trends and partial forecast of adverse effects of
medical treatment from 1990 to 2019: an
epidemiological analysis based on the global burden
of disease study 2019. BMC Pub Health.
2024;24(1):295.
16. World Health Organization. Global patient safety
action plan 2021-2030: towards eliminating avoidable
harm in health care. Geneva: World Health
Organization; 2021.
17. Astier-Peña MP, Martínez-Bianchi V, TorijanoCasalengua ML, Ares-Blanco S, Bueno-Ortiz J-M,
Férnandez-García M. The Global Patient Safety
Action Plan 2021–2030: identifying actions for safer
primary health care. Aten Primaria. 2021;53(Suppl
1):102224.
18. Panagioti M, Hodkinson A, Planner C, Dhingra N,
Gupta N. Global burden of preventable medicationrelated harm in health care: a systematic review.
Geneva: World Health Organization; 2024.
19. Wu AW, Papieva I, Sheridan S, Gupta K, Haskell
H, Taha A, et al. Five strategies for how patients and
families can improve patient safety: World Patient
Safety Day 2023. J Patient Saf Risk Manag.
2023;28(4):147-52.
20. Zhang K, Gao Y, Lu Y. Global burden and trends of
adverse effects of medical treatment, 1990–2021: an
analysis from the global burden of disease study 2021.
Front Pharmacol. 2025;16:1655864.
21. Lu H, Cheng X, Xiong J. The global burden of
adverse effects of medical treatment: a 30-year sociodemographic and geographic analysis using GBD
2021 data. Front Big Data. 2025;8:1590551.
22. Soleimanpour H, Karamzad N, Rahmanian M,
Aletaha R, Sanaie S, Sullman MJ, et al. Global Burden
of the Adverse Effects of Medical Treatment From
1990 to 2021. Int J Drug Res Clin. 2025;3(1):e8-e.
23. Kadkhodamanesh A, Dehesh P, Mesgarpour B,
Nejadghaderi SA, Sharifi H. The epidemiology and
socioeconomic associates of adverse effects of
medical treatment in the Eastern Mediterranean
Region from 1990 to 2021. Sci Rep.
2025;15(1):33232.
24. Hibbert PD, Molloy CJ, Schultz TJ, Carson-Stevens
A, Braithwaite J. Comparing rates of adverse events
detected in incident reporting and the Global Trigger
Tool: a systematic review. Int J Qual Health Care.
2023: 35 (3): mzad056.
25. Hanskamp-Sebregts M, Zegers M, Vincent C, van
Gurp PJ, de Vet HC, Wollersheim H. Measurement of
patient safety: a systematic review of the reliability
and validity of adverse event detection with record
review. BMJ Open. 2016;6(8): e011078.
26. Borzecki AM, Rosen AK. Is there a ‘best
measure’of patient safety? BMJ Qual Saf.
2020;29(3):185-8.
27. Makary MA, Daniel M. Medical error—the third
leading cause of death in the US. Bmj. 2016;353.
28. Naseralallah L, Stewart D, Price M, Paudyal V.
Prevalence, contributing factors, and interventions to
reduce medication errors in outpatient and ambulatory
settings: a systematic review. Int J Clin Pharm.
2023;45(6):1359-77
29. Roncal-Redin M, San Jose-Saras D, Pérez CD-A,
Vicente-Guijarro J, Moreno-Nunez P, PardoHernandez A, et al. Impact of patient safety on
hospital prognosis: Association between adverse
events and in-hospital mortality. Clin Med.
2026;26(1):100546.
30. Kamath A, Acharya SD. Burden of death and
disability due to adverse effects of medical treatment
in India: An analysis using the global burden of
disease 2019 study data. Heliyon. 2024; 10(2):e24924.
31. Mistri IU, Badge A, Shahu S. Enhancing patient
safety culture in hospitals. Cureus.
2023;15(12):e51159.
32. Graudins LV, Sheikh A. Reducing medicationrelated harm. Int J Qual Health C.
2025;37(4):mzaf115.