Rashidian, Hamideh

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dtftr,/,t',c"i'l'l(+ olfuillcSjS!.X-{+l ,r,--.-.ii cStX, &3- *U ;!!:,ilJ:.,.r* t* ("Srr^ 3 aii;* ."r*-:r);T ot-ii,i,-3 S!; -iJ,,--" tsrt tf)):6.rt=,-:!l ,L <-,-.,1-- J\f1Y-\Y1t C5LdL* -U "U;S jlj-t ;.r +rti-o ,JttJ,-,;lyl ;.r cti- ;ttr*.,,!r*-, oJra.:. : L'...-f:l-i.at3 r$t-lCrru.gJ ,!.= .'(l ,.lc ,lS.lvv(.,:'J.r o.r,; $1S ,S,\ Y1 o- \ Y11 :,rl*,^-: Jl-Kerman University of Medical SciencesFaculty of Public HealthIn Partial Fulfillment of the Requirements for the Degree ofPh.D. in EpidemiologyTitle:Association between opiate use and incidence of bladder cancer in Kermanprovince in year 2014-2A15 and Estimation of the economic burden of bladdercancer in Iran in 2015By:Hamideh RashidianSupervisors:Dr. Ali Akbar HaghdoostDr. Kazem zendehdelYear: 2017c.\-\->& aUf 6E*rl ,,t aiL" 6tb.p, :S1.U.(g,*:S:} 2 $f ,os")6i cili;^i9 .5U-i Gf^ bV sl ,g*al;l.;s ajti" 6tb1,,grLa;!lltr a*b.. gtftf-lYt{ .Sldt"..,.*l ..51^ JL .,, o.r.i pb.l oUtt 6-t .c-l ;lr,-l 1: ef, ..rLf a,l:, ;Uy :ciJ.L,sr* p )l h;y,,*t-,rz bLf Ol;-|.$L ajU^.rLr ,slt $; J-l* ),F. slf u" -3'"-; '-.)y. ,-* ;i. 9s,J"U /;L>+"1; ,L-L".c-l cli ,tLs* )ly ,-tlx" P )l F x,*U ,)z J!>1i : - - -er 'ilf ,+( JS"i. .*r,rr .:s L ;u-rL-l allt" ;19:c c*; 6l aJU- Lril ,+"U.tlrgu i - -U-;-.;l ;Ui:; l.S\.;.-rr- oYlg- a,:l;l .,,-,-<i"t;.-1,--;i ,: I; -r.- *.>1,L gi -t;--*" " J-..: 'cti;ttr- rly\,-,ic,l;':j,^ 9,5\;Llr.-OrLV)rr-ty.jr.!.i$L;:ryaJ'Ll".d--?- );-:--;-'i4 :t..:-l o.r,-rf a-lx. ..1i olr' : " S S\; es* 61y. 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I .-tl;: j-: a..j - -.rlr.r:ial5 .,€f -LE r!;=* *uly.l,;LrS,.5rLoiil.,lr ,o;U uVr- ,ri;L;: ^ , -: --.: : j;i:Abstract:Association between opiate use and bladder cancer incidence in Kermanprovince in years 1393-1394 and estimation of the economic burden ofbladder cancer in IranBackground: bladder cancer is the fifth most common cancer in Iran. Recentstudies have proposed opiate use as a probable risk factor for bladder cancerincidence. Kerman province is a high risk area for opiate use and bladder cancerincidence. This study has two main parts. In the first parl, we did a validationstudy to evaluate opiate use underreporting bias and its sensitivity andconsidering the results of our validation study, we designed a case-control studyto investigate the association between opiate use and bladder cancer incidence.Also u,e calculated population attributable risk fraction for opiate use incidenceand otlier important bladder cancer risk factors. In the second parl we calculatedprevalence and economic burden of bladder cancer and opiate attributedeconomic burden for bladder cancer.\Iethod: first part of the current study consisted of two stages including".,.i.tion study and case-control study. In validation study, we calculated--.:s.:-,+ of self-report opiate use in 186 healthy and 178 patient individuals*s,:: -:,re iests. In our case-control study we individually matched age and sex:. -:,,,S .as.s n;ih 616 neighborhood control and compared their opiate usehistorl" and other risk factors. In order to validate the result of our case-controlstudy we did sensitivity analyses. Also we calculated population attributable riskfraction for opiate use incidence and other important bladder cancer risk factors.In the second part we used prevalence approach to calculate economic burden ofbladder cancer in Iran. In this part we estimated 5-year prevalence of differentstages of bladder cancer using a Markov model. Using Iranian clinical practiceguideline, we estimated economic burden of bladder cancer in Iran for the vear1394 according to public and private sector tariffs.Result: according to validation study result, reported prevalence of opiate use inpatient individuals was significantly more than healthy individuals (36.5 percentversus 19.3 percent) but the sensitivity of self-report opiate use was notsignificantll' different (77.5 percent versus 68.8 percent). According to case-control studl' result. odds ratio of bladder cancer in low and high consumptiongroup rvas 3.2(2-5.1) and 4.3(2.7-6.7) respectively. Also route of opiurn use wasnot different si-enificantly in two groups. Estimated Population attributable riskof opiate use considerin-q crude and corrected odds ratio for underreporting inIran u'as between 0. 3 3 (0.3 0-0.40) ro 0. 1 B(0 .1 2-0.2.3 ) respectively.ri ::e second part of our study, the estimated incident and S-year prevalence:---::e: ci bladder cancer in year 1394 was 5907 and 206g6. Estinated;.::.::i" :,urden of bladder cancer in Iran was I ,741,340 and2,553,213 millionR-.- :cc,,'rains to public and private sector tariffs. About 40 percent of directFmedical cost of bladder cancer was attributed to recurrentcosts' If we can reduce opiate use consumption to zero,bladder cancer will decrease about 1g percent in Iran.cases and fallow upeconomic burden ofconclusion: opiate use could be an important risk factor for bladder cancerincidence' Adjusting for important confounders and biases like temporality,underreporting and selection bias, we validated the association between opiateuse and incidence of bladder cancer. opiate use is the most importantpreventable risk factor for bladder cancer incidence.Bladder cancer is a costly cancer and its economic burden is considerable.Diagnosis of patients in early stages, strict fallow up and early detection ofrecurrent cases can reduce the cost of treatment and fallow up of these patients.Controlling important risk factor of bladder cancer including opiate and smokingwill considerably reduce incidence rate and economic burden of bladder cancer.Keywords: opiate, bladder cancer, economic burden, Kerman, Iran.

بررسی ارتباط  مصرف تریاک و مشتقات آن ( شیره ، سوخته و هروئین ) با بروز سرطان مثانه در استان کرمان طی سال های ۱۳۹۴-۱۳۹۳ و محاسبه بار اقتصادی سرطان مثانه در ایران

بررسی ارتباط مصرف تریاک و مشتقات آن ( شیره ، سوخته و هروئین ) با بروز سرطان مثانه در استان کرمان طی سال های ۱۳۹۴-۱۳۹۳ و محاسبه بار اقتصادی سرطان مثانه در ایران

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