ArticlePopulation health metrics2025
QALY loss associated with unhealthy behaviors: evidence from a multi-center cross-sectional study in Iran.
Article in Population health metrics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundUnhealthy lifestyle behaviors such as poor diet, physical inactivity, smoking, and substance use significantly increase the burden of disease and mortality in Iran. These behaviors pose serious challenges to public health and healthcare systems, making it essential to quantify their impact to guide effective health policies and allocate resources efficiently. This study estimates and compares the health burden of unhealthy behaviors in Iran using quality-adjusted life year (QALY) loss.
methodA cross-sectional study was conducted in 2024-2025 involving 3,518 individuals aged 18 and older, selected through multistage sampling across nine provinces in Iran. Data collection included face-to-face interviews using a self-administered questionnaire alongside the Iranian version of the EQ-5D-5 L and EQ-VAS tools to assess health-related quality of life (HRQoL). Generalize linear model (GLM) with gamma distribution and a log link analyzed the impact of each unhealthy behavior including smoking, physical activity, sleep quantity and quality, oral health practices (such as brushing and flossing), breakfast skipping, and dairy consumption on health utility scores. Annual QALY loss per 100,000 individuals was calculated by combining behavior prevalence and health utility data. All data analyses were performed using Stata/MP version 17.
resultsIn this study, we assessed eight unhealthy lifestyle behaviors among participants: physical activity, smoking status, regular tooth brushing, regular dental flossing, sleep duration, sleep quality, breakfast skipping, and dairy consumption. The prevalence of these behaviors was as follows: 41.79% of participants reported poor physical activity, 25.85% were smokers, 13.19% did not brush their teeth regularly, and 39.57% did not floss regularly. Additionally, 84.22% had insufficient sleep duration (≤ 7 h), 12.48% reported poor sleep quality, 49.81% skipped breakfast, and 25.42% had unsuitable dairy consumption. The study also found that all the unhealthy behaviors were significantly associated with lower EQ-5D-5 L and EQ-VAS scores, with poor sleep quality exhibiting the most substantial negative effect, showing a coefficient of -0.2373 (p < 0.001) for the EQ-5D-5 L score and - 0.1838 (p < 0.001) for the EQ-VAS score. Poor sleep quality also had the largest annual QALY loss per 100,000 individuals at -2961.50 (95% CI: -3407.50 to -2586.52), followed by insufficient sleep duration at -2787.68 (95% CI: -4978.37 to -56.81), breakfast skipping at -2216.55 (95% CI: -3414.74 to -1173.60), and poor physical activity at -2102.04 (95% CI: -3094.81 to -1251.11).
conclusionUnhealthy behaviors significantly reduce HRQoL in Iran, with these findings highlighting the high health burden of sleep-related behaviors. These results emphasize the urgent need for targeted public health interventions and prevention strategies to address these behaviors and improve population health.
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