Introduction
The rapid growth of the aged population has become one of the significant challenges in the 21st century. Like many other countries, Iran has undergone an epidemiological transition and is gradually transitioning into an aged society. The increase in the number of older people can lead to a notable shift in health priorities. Ageing is associated with chronic diseases in older age, which has led to a high death rate among the elderly. Chronic and emerging conditions often result in disability and declining health, making older adults particularly vulnerable. Given the scarcity of updated national data, this study utilizes findings from the global burden of disease (GBD) Study 2021 to examine mortality trends among the elderly in Iran from 1981 to 2021.

Methods & Materials
This cross-sectional study applies secondary data analysis to explore mortality trends among the elderly population in Iran. Data were obtained from the GBD database, accessible via the health data portal of the Institute for Health Metrics and Evaluation (IHME) at the University of Washington. The dataset includes population statistics, including age and sex, as well as mortality data categorized by age, sex, and cause of death, according to the latest GBD classification framework. Causes of death were classified based on the international classification of diseases (ICD-11), and mortality rates were used as comparative indices across gender and age groups. The data were analyzed in Microsoft Excel, with mortality rates assessed through logarithmic calculations.

Results
Iran’s total population increased from 42 million in 1981 to 85.3 million in 2021. During this period, the aged population increased significantly, growing from 1 million to 6 million. In 1981, older adults accounted for 19.4% of total deaths. This rate increased dramatically to 63.5% by 2021. The mortality rate was higher in men than in women, and over 90% of deaths were due to non-communicable diseases, particularly cardiovascular conditions, cancers, and diabetes (Figure1).

A comparative analysis of Iran’s mortality data against the GBD dataset revealed strong alignment, confirming the reliability of our findings. 

Conclusion
This study underscores a striking rise in the rate of deaths among older adults in Iran over the past four decades. Non-communicable diseases are the leading cause of mortality, highlighting the urgent need for targeted healthcare interventions. Addressing the growing rate of chronic conditions among Iran’s aging population requires comprehensive strategies for prevention, early detection, and improved management to enhance longevity and quality of life in Iranians.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of Yazd University, Yazd, Iran (Code: IR.YAZD.REC.1403.105).

Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for profit sectors.

Authors' contributions
Conceptualization, investigation, writing, data analysis, resources, Forough Jamshidi Zarmehri; validation, review & editing, visualization, and project administration: Mohammad Torkashvand Moradabadi.

Conflicts of interest
The authors declared no conflicts of interest.

Acknowledgments
The authors would like to thank the National Civil Registration Organization and the GBD 2021 Study for providing us with the access to population and death data.

References

1. Asiri Sh, Mokhtari N. [Empowering the Elderly (Persian)]. Paper presented at: The First National Conference on Aging, led by Dr. Hakimzadeh, focused on Rehabilitation and Physiotherapy.10 -11 November, 2016; Rasht, Iran. [Link]
2. Economic and Social Commission for Asia and the Pacific. Asia-Pacific Report on Population Ageing 2022: Trends, policies and good practices regarding older persons and population ageing. Bangkok: Economic and Social Commission for Asia and the Pacific ; 2022. [Link]
3. McNicoll G. World Population Ageing 1950-2050. Population and development Review. 2002; 28(4):814-6. [Link]
4. Zanjari N, Sasanipour M. Changes in cause of death among the older adults and its effect on increasing life expectancy in Iran. Iranian Journal of Epidemiology. 2022; 18(1):33-44. [Link]
5. Sayar S, Bababkhanian M. [Comparing the social health status among the older people living at home and those living in old people’s home (Persian)]. Journal of Isfahan Medical School. 2016; 34(400):1128-33. [Link]
6. Torkashvand Moradabadi M, Abbasi M. [The main causes of death of the elderly in the provinces of Iran, 2011 to 2017 (Persian)]. Armaghane Danesh. 2022; 27(1):67-83. [DOI:10.52547/armaghanj.27.1.67]
7. Wilmoth JR, Bas D, Mukherjee S, Hanif N. World social report 2023: Leaving no one behind in an ageing world. New York: United Nations; 2023. [Link]
8. Hajiabbasi S, Rahgozar M, Biglarian A, Jalali A, Azadchehr MJ. [Identifying some risk factors for the time to death of the elderly using the semi-parametric blended model of survival analysis with competing risks (Persian)]. Salmand: Iranian Journal of Ageing. 2018; 12(4):518-27. [DOI:10.21859/sija.12.4.518]
9. Sasanipour M. [Provincial differences in the main causes of years of life lost due to premature death of Iranian Elderly in 2016 (Persian)]. Qom University of Medical Sciences Journal. 2022; 15(10):708-17. [DOI:10.32598/qums.15.10.2503.1]
10. Qu C, Liao S, Zhang J, Cao H, Zhang H, Zhang N,  et al. Burden of cardiovascular disease among elderly: Based on the Global Burden of Disease Study 2019. European Heart Journal - Quality of Care and Clinical Outcomes. 2023; 10(2):143-53. [DOI:10.1093/ehjqcco/qcad033] [PMID]
11. Karaman S, Bahçecioğlu Turan G, Çayır Yılmaz M, Yilmaz Karabulutlu E. Examination of elder abuse and death anxiety in older adults with a chronic disease. Nursing Open. 2025; 12(1):e70092. [DOI:10.1002/nop2.70092] [PMID]
12. Yousefi Afrashteh M, Majzoobi MR, Janjani P, Forstmeier S. The relationship between the meaning of life, psychological well-being, self-care, and social capital, with depression and death anxiety in the elderly living in nursing homes: The mediating role of loneliness. Heliyon. 2024; 10(9):e30124. [DOI:10.1016/j.heliyon.2024.e30124] [PMID]
13. Gohari F, Qamari H, Sheykholeslami A. The effectiveness of computer-based cognitive rehabilitation on the social isolation of the elderly with death anxiety living in elderly centers. Social Psychology Research. 2025; 14(56):15-32. [DOI:10.22034/spr.2025.452125.1942]
14. Lien CW, Lee YH, Lu CW, Chang YC, Lin YS, Cheng HM, et al. Definition, prevalence, and economic impacts of hypertension on the elderly population. Journal of the Formosan Medical Association. 2025; 124 (Suppl 1):S4-S9.[DOI:10.1016/j.jfma.2025.02.020] [PMID]
15. Kim S, Choi S, Kim BH. Analysis of factors affecting pedestrian safety for the elderly and identification of vulnerable areas in Seoul. Accident Analysis & Prevention. 2025; 211:107878. [DOI:10.1016/j.aap.2024.107878]
16. Ahammed E, Islam MA, Akhter FB, Mim AA, Amin F, Nisa NA. Elderly Vulnerability to Infectious Diseases in Bangladesh: An Examination of Comorbidities, Hospital Stay, and Mortality. Asia Pacific Journal of Surgical Advances. 2025; 2(1):10-6. [DOI:10.70818/apjsa.2025.v02i01.014]
17. Wang P, Huang J, Xue F, Abuduaini M, Tao Y, Liu H. Associations of serum vitamin B6 status with the risks of cardiovascular, cancer, and all-cause mortality in the elderly. Frontiers in Immunology. 2024; 15:1354958. [DOI:10.3389/fimmu.2024.1354958] [PMID]
18. Taheri Tanjani P, Sharifi F, Nazari N, Rahim F, Fakhrzadeh H, Arzaghi SM, et al. [Health status of elderly people in Khuzestan: A cross-sectional study (Persian)]. Iranian Journal of Diabetes and Lipid Disorders. 2017; 16(4):191-200. [Link]
19. GBD 2019 Ageing Collaborators. Global, regional, and national burden of diseases and injuries for adults 70 years and older: Systematic analysis for the Global Burden of Disease 2019 Study. BMJ. 2022; 376:e068208. [DOI:10.1136/bmj-2021-068208] [PMID]
20. Ciumărnean L, Milaciu MV, Negrean V, Oră-an OH, Vesa SC, Sălăgean O, et al. Cardiovascular Risk Factors and Physical Activity for the Prevention of Cardiovascular Diseases in the Elderly. International Journal of Environmental Research and Public Health. 2022; 19(1):207. [DOI:10.3390/ijerph19010207] [PMID]
21. Tajvar M, Arab M, Montazeri A. Determinants of health-related quality of life in elderly in Tehran, Iran. BMC Public Health. 2008; 8(1):323. [DOI:10.1186/1471-2458-8-323] [PMID]
22. Shrestha LB. Population aging in developing countries. Health Affairs . 2000; 19(3):204-12. [DOI:10.1377/hlthaff.19.3.204] [PMID]
23. Woo EK, Han C, Jo SA, Park MK, Kim S, Kim E, et al. Morbidity and related factors among elderly people in South Korea: results from the Ansan Geriatric (AGE) cohort study. BMC Public Health. 2007; 7:10. [DOI:10.1186/1471-2458-7-10] [PMID]
24. Hamedanchi A, Rezaie F, Nafei A, Hamzezadeh H. [Causes and trends of mortality among Iranian older adults from 2000 to 2019 (Persian)]. Salmand: Iranian Journal of Ageing. 2025; 19(4):642-63. [DOI:10.32598/sija.2024.3154.3]
25. Tavakoli H, Ahmadi Amoli H, Yaghoubi Notash A, Adelyazdankhah Konari A, Gholkhani F, Khashayar P. [Trauma-Related Morbidity and Mortality in Elderly Patients (Persian)]. Salmand: Iranian Journal of Ageing. 2009; 4(11):30-6. [Link] 
26. Carroll W, Miller GE. Heart Disease among Elderly Americans: Estimates for the U.S. Civilian Noninstitutionalized Population, 2010. Statistical Brief (Medical Expenditure Panel Survey (US)). Rockville (MD): Agency for Healthcare Research and Quality (US); 2001. [Link]
27. Prakash R, Choudhary SK, Singh US. A study of morbidity pattern among geriatric population in an urban area of Udaipur Rajasthan. Indian Journal of Community Medicine. 2004; 29(1):35.[Link]
28. Tootoonchi P. [Chronic diseases and senile changes in the elderly population, Tehran, Iran (Persian)]. Payesh (Health Monitor) Journal. 2004; 3(3):219-25. [Link]
29. Joghataei MT, Nejati V. [Assessment of health status of elderly people in the City of Kashan (Persian)]. Salmand: Iranian Journal of Ageing. 2006; 1(1):3-10. [Link]
30. IHME. GBD Results. Seattle, WA: IHME, University of Washington; 2024. Available from: [Link]
31. United Nations. World Mortality Report 2017: Highlights: Population Division (ST/ESA/SER.A/410). New York: United Nations ; 2019. [Link]
32. Talashi M, Nazari, A, Moeinfar M. [The effectiveness of the Bam earthquake reconstruction plan on the physical transformations of rural housing (Persian)]. Physical Development Planning. 2022; 9(1):33-52. [DOI:10.30473/psp.2022.55077.2356]
33. Hadian M, Zafarani H, Farjoudi J. [Analysis of the Seismic Source Characteristics of the Rudbar and Manjil Earthquakes Using Hybrid Fault Modeling (Persian)]. Journal of Structural And Construction Engineering. 2015; 2(1):5-18. [Link]
34. WHO. World health statistics 2024: Monitoring health for the SDGs, Sustainable Development Goals. Geneva: World Health Organization; 2024. [Link]