National trends in incidence, prevalence and disability-adjusted life years of invasive aspergillosis in Iran: a systematic review and meta-analysis

ABSTRACT

Objectives: We aimed to study the epidemiology, prevalence, incidence, clinical manifestations, underlying diseases, treatments, outcomes, and societal impact through disability-adjusted life years (DALYs) of IA in Iran.

Methods: A random-effect meta-analytic model was fitted to estimate the prevalence and incidence of IA in Iran. We also calculated DALYs.

Results: Out of 79 published studies during the past 25 years from Iran, 23 met the inclusion criteria. A total of 2947 patients were included, of whom 396 (13.4%) patients were diagnosed with IA according to EORTC/MSG and ICU criteria. The main underlying condition for IA was hematologic disorders (39.4%). A. flavus 86 (43%) was the most common isolate. The pooled prevalence and incidence rates were 20.5 (95% CI 12.5 to 29.9) and 4.8 (95% CI 2.3–8.2) per 100,000 population, respectively. Total DALYs was estimated 164.13 per 100,000 population. YLLs constitute the majority of IA burden compared to YLDs (162.80 YLLs/100,000 population vs 1.33 YLDs per 100,000 population). The highest YLL rates were found in people aged 45–49 (62.9 YLLs/100,000 population) and 30–34 years (45.2 YLLs/100,000 population), respectively.

Conclusion: This study indicates an increasing burden of IA in Iran, despite the extensive use of prophylaxis, challenging the public health, especially immunocompromised patients.

KEYWORDS:

• disability-adjusted life years
• invasive aspergillosis
• meta-analysis

Article Highlights

• We found high heterogeneity among the 23 included studies, so used data under the random-effect model with 95% confidence interval (CIs) to pool the study results.

• A significant variation was observed in the incidence rate of invasive aspergillosis in patients with numerous underlying health conditions including hematological malignancy, transplantation and intensive care from 2005 to 2014.

• The estimation of DALYs in patients with hematological disorders, SOT, ICU, and endocarditis indicates an increasing burden of IA in Iran, of which YLLs constitute the majority of IA burden compared to YLDs.

• A. flavus was the most frequent species and the most lethal species in Iranian patients with IA.

• BAL GM-EIA with a GM index of ≥0.5 had more diagnostic reliability to diagnose IA and was more sensitive compared with the serum GM test.

• Voriconazole has also shown high response and improved survival rate and recommended as the preferred choice for the treatment of IA.

Declaration of interest

D Denning is Chief Executive of the Global Action Fund for Fungal Infections (www.GAFFI.org) which aims to improve the outcome of patients with serious fungal infections across the world. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This study was supported by Mazandaran University of Medical Sciences, Sari (Iran) (fund number: 2386).