Background: Tehran, the 22nd most populous city in the world, has the highest mortality rate due to respiratory system diseases (RSDs) in Iran . This study aimed to investigate spatiotemporal patterns of mortality due to these diseases in Tehran between 2008 and 2018 .
Methods: We used a dataset available from Tehran Municipality including all cases deceased due RSDs in this city between 2008 and 2018 . Global Moran ’ s I was performed to test whether the age-adjusted mortality rates were randomly distributed or had a spatial pattern . Furthermore, Anselin Local Moran ’ s I was conducted to identify potential clusters and outliers .
Results: During the 10-year study , 519,312 people died in Tehran , 43,177 because of RSDs, which corresponds to 831.1 per 10,000 deaths and 5.0 per 10,000 population . The death rate was much higher in men (56.8 %) than in women (43.2 %) and the highest occurred in the> 65 age group (71.2 %). Overall, three diseases dominated the mortality data: respiratory failure (44.2 %), pneumonia (15.9 %) and lung cancer (10.2 %). The rates were significantly higher in the central and southeastern parts of the city and lower in the western areas . It increased during the period 2008–2018 and showed a clustered spatial pattern between 2008 and 2013 but presented a random geographical pattern afterwards .
Conclusions: This study provides a first report of the spatial distribution of mortality due to RSDs in Tehran and shows a significant increase in respiratory disease mortality in the last ten years . Effective control of the excess fatality rates would warrant a combination of urban prevention and treatment strategies including environmental health plans.