Estimating the Years of Life Lost and Mortality Caused By COVID-19 in Mashhad, the Second-Largest City in Iran

Document Type : Research Paper


1 Department of Community Medicine and Public Health, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

3 International UNESCO Center for Health Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran.

4 Department of Biostatistics & Epidemiology, School of Health, Management & Social Determinants of Health Research Center, Mashhad University of Medical sciences, Mashhad, Iran.

5 Deputy of Health, Mashhad University of Medical Sciences, Mashhad, Iran.

6 Brighton & Sussex Medical School, Division of Medical Education, Falmer, Brighton, Sussex BN1 9PH, UK.

7 Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.


Introduction: The disability-adjusted life years (DALY) may provide a better indicator of the burden of disease than mortality. This study provides the estimates of both Years of Life Lost (YLL) and COVID-19 mortality in Mashhad. Methods: This cross-sectional study was carried out in Mashhad, the second-most populous city in Iran. The mortality data in the population served by Mashhad University of Medical Sciences (MUMS) were extracted from the national mortality data system. In this system, all deaths in the whole of the country are recorded based on the International Classification of Diseases, tenth edition (ICD10). The data in the current study comprised all cases of death recorded in the population under the auspices of MUMS from January 21st to April 19th 2019 and 2020 which were transferred to SPSS software after sorting. The method recommended by the World Health Organization (WHO) was used for the estimation of YLL. Results: The YLL per 1000 caused by COVID-19 was 1.2 years and increased with age, and was higher in men (1.6 years) compared to women (0.9 years). The incidence of COVID-19 was higher in the urban area (9.8%) compared to rural areas (4.8%). During the study period, COVID-19 was the fourth most prevalent cause of death in Mashhad after cardiovascular disease (35.4%), cancer (12.9%) and respiratory disease (10.6%). Conclusions: The YLL per 1000 caused by COVID-19 was 1.2 years, increased with age and was greater in males than in females. 


  1. Li H, Liu SM, Yu XH, Tang SL, Tang CK. Coronavirus disease 2019 (COVID-19): current status and future perspectives. Int J Antimicrob Agents. 2020; 55(5):105951.
  2. WHO Director-General's opening remarks at the media briefing on COVID-19 - 3 March 2020 - World Health Organization, March 3, 2020
  3. Banerjee A, Pasea L, Harris S, Gonzalez-Izquierdo A, Torralbo A, Shallcross L, Noursadeghi M, Pillay D, Pagel C, Wong WK, Langenberg C. Estimating excess 1-year mortality from COVID-19 according to underlying conditions and age in England: a rapid analysis using NHS health records in 3.8 million adults. MedRxiv. 2020.
  4. Coronavirus Resource Center. Johns Hopkins University. 2021.
  5. Rafiemanesh H, Rajaei-Behbahani N, Khani Y, Hosseini S. Incidence trend and epidemiology of common cancers in the center of Iran. Glob J Health Sci. 2016; 8(3):146-55.
  6. Saadat S, Yousefifard M, Asady H, Moghadas Jafari A, Fayaz M, Hosseini M. The Most Important Causes of Death in Iranian Population; a Retrospective Cohort Study. Emerg (Tehran). 2015; 3(1):16-21.
  7. World Health Organization. 2020.
  8. Yavarian J, Shafiei-Jandaghi NZ, Sadeghi K, et al. First Cases of SARS-CoV-2 in Iran, 2020: Case Series Report. Iran J Public Health. 2020; 49.8: 1564.‏
  9. Wright R. How Iran became a new epicenter of the coronavirus outbreak. The New Yorker. 2020; 404.‏
  11. Jo MW, Go DS, Kim R, Lee SW, Ock M, Kim YE, Oh IH, Yoon SJ, Park H. The burden of disease due to covid-19 in korea using disability-adjusted life years. J Korean Med Sci. 2020; 35(21):e199.
  12. Nurchis MC, Pascucci D, Sapienza M, Villani L, D’ambrosio F, Castrini F, Specchia ML, Laurenti P, Damiani G. Impact of the burden of COVID-19 in Italy: results of disability-adjusted life years (DALYs) and productivity loss. Int J Env Res Pub He. 2020; 17(12):4233.
  13. GBD 2016 DALYs and HALE Collaborators. Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017; 16; 390 (10100):1260-344.
  14. Alikhani S, Hojat Zadeh A, Ramazani R, Alimadadi M, Bejani S. World Health Organization. Chronic diseases prevention: a vital investment. Trans. Tehran: Seda Publication; 2009.

15- Compendium of Clinical and Health Indicators User Guide Annex 3. National Centre for Health Outcomes Development. Available at: 

16- The Global Burden of Disease concept. WHO Publications. Available at 2021.

  1. Mathers CD, Vos T, Lopez AD, Salomon J, Ezzati M (ed.). National Burden of Disease Studies: A Practical Guide. Edition 2.0. Global Program on Evidence for Health Policy. Geneva: World Health Organization.2001.
  2. Health statistics and information systems, National tools. World Heatth Organization. Available from 2020.
  3. Nurchis MC, Pascucci D, Sapienza M, et al. Impact of the Burden of COVID-19 in Italy: Results of Disability-Adjusted Life Years (DALYs) and Productivity Loss. Int J Environ Res Public Health. 2020; 17(12):4233.
  4. Istituto Nazionale di Statistica & Istituto Superiore di Sanità. Impact of the Covid-19 Epidemic on the Total Mortality of the Resident Population in the First Quarter of 2020. Available online: (accessed on 6 June 2020).
  5. Mitra AK, Payton M, Kabir N, et al. Potential Years of Life Lost Due to COVID-19 in the United States, Italy, and Germany: An Old Formula with Newer Ideas. International journal of environmental research and public health. 2020; 17(12):4392.