Gender Disparities in Illegal Drug-Related Mortality: A National Ecological Study in Iran

Background: Illicit drug use is a serious multi-factorial public health challenge globally, especially in the Eastern Mediterranean Region (EMR). In 2019, the disability-adjusted life year rate for drug use disorders in the EMR rose by approximately 40%, whereas the global rate increased by less than 25%. Despite this growing burden, limited data exist on gender patterns of drug-related mortality and its associated socio-economic factors at the national level in Iran. This study evaluated socioeconomic factors contributing to gender disparities in illicit drug-related mortality across provinces of Iran. Study Design: A national ecological study. Methods: A secondary analysis of data from the Iranian Forensic Medicine Organization’s national registry was conducted from March 2022 to March 2024. Descriptive statistics were calculated for socioeconomic indicators (happiness, life satisfaction, literacy rate, unemployment, economic participation, and gross domestic product) across provinces of Iran to assess gender disparities in illicit drug-related mortality. Bivariate and multivariate regression analyses were performed to examine the relationship between these indicators and the sex ratio of illicit drug-related deaths. Results: The sex ratio of illicit drug-related deaths was 7.20, indicating a considerable gender disparity. According to the final model, greater female economic participation (β=-0.517, P=0.018) and higher GDP (β=-1.196, P=0.002) were significantly correlated with a lower gender gap in illicit drug-related mortality across provinces in Iran. Conclusion: At the provincial level, there were noticeable correlations between a narrower gender gap in illicit drug-related mortality and both greater female economic participation and higher GDP in Iran.