INTRODUCTION We aimed to calculate the Population Attributable Fraction (PAF) of cancers due to tobacco use in the Eastern Mediterranean Region (EMRO), where water-pipe smoking is prevalent but its effect was not considered in previous studies. METHODS We applied Levin's formula to estimate PAFs of cancers due to tobacco use (defined as all type tobacco including both cigarette and water-pipe). We also calculated PAF of water-pipe smoking separately. Exposure prevalence data was retrieved from representative national and subnational surveys. Data on cancers incidence and death were also and cancer cases were obtained GLOBOCAN 2020. We also obtained associated relative risks from published meta-analyses. RESULTS Of the total 715,658 incident adult cancer cases that were reported in 2020 in EMRO, 14.6% (n = 104,800) was attributable to tobacco smoking [26.9% (n = 92,753) in men vs. 3.3% (n = 12,048) in women. Further, 1.0% of incident adult cancers were attributable to current water-pipe use (n = 6,825) (1.7% (n = 5,568) in men vs. 0.4% (n = 1,257 in women). CONCLUSION PAFs of cancers due to tobacco smoking in EMRO was higher in our study than previous reports. This could be due to the neglected role of water-pipe in previous studies that is a common tobacco smoking method in EMRO. The proportion of cancers attributable to water-pipe smoking in EMRO might be underestimated due to lack of research on the risk of cancers associated with water-pipe smoking and also less developed cancer registries in EMRO. IMPLICATION In this study, we found higher population attributable fractions (PAFs) for cancers due to tobacco smoking in the Eastern Mediterranean (EMR) region than previous reports. This difference could be due to ignoring the role of water-pipe smoking in previous studies. In 2020, 1% of incident cancers and 1.3% of cancer-related deaths in EMRO were attributable to water-pipe smoking. We also found a big difference in PAFs of cancers due to tobacco and water-pipe smoking across EMRO countries, with Tunisia, Lebanon, and Jordan having the highest, and Djibouti, Sudan and Somalia having the lowest proportions of cancers attributable to tobacco and water-pipe smoking.

Background The current study aimed to investigate the temporal trend of in-hospital and ICU mortality of COVID-19 patients over 6 months in the spring and summer of 2021 in Iran. Methods We performed an observational retrospective cohort study on 14,355 patients who were hospitalized with confirmed COVID-19 for six months from April to September 2021 in Qazvin province, Iran. The trend of overall in-hospital mortality and ICU mortality were the main outcome of interest. We obtained crude and adjusted in-hospital and ICU mortality rates for each month of admission and over surge and lull periods of the disease. Results The overall in-hospital mortality, early mortality, and ICU mortality were 8.8%, 3.2%, and 67.6%, respectively. The trend for overall mortality was almost plateau ranging from 6.5% in July to 10.7% in April. The lowest ICU mortality was 60.0% observed in April, whereas it reached a peak in August (ICU-mortality= 75.7%). Admission on surge days of COVID-19 was associated with an increased risk of overall mortality (OR=1.3, 95% CI= 1.1, 1.5). The comparison of surge and lull status showed that the odds of ICU mortality in the surge of COVID-19 was 1.7 higher than in the lull period (P-value<0.001). Conclusion We found that the risk of both overall in-hospital and ICU mortality increased over the surge period and fourth and fifth waves of SARS-CoV-2 infection in Iran. Lack of hospital resources and particularly ICU capacities to respond to the crisis during the surge period is assumed to be the main culprit.