Years of Life Lost due to Premature Mortality Following Sulfur Mustard Exposure: A Post-War National Burden of Disease Study (1988-2021)

Background Sulfur Mustard (SM), widely used during the Iran-Iraq war, has caused long-lasting health effects and reduced life expectancy among exposed individuals. This national study aimed to quantify Years of Life Lost (YLL) due to premature mortality among Iranian survivors exposed to SM during the post-war period (1988–2021). Methods Data were obtained from the Veterans and Martyr Affairs Foundation (VMAF). YLL was calculated using both the Iranian Nationwide Life Table and the Coale-Demeny Model Life Table West, incorporating discount rates (0%, 3%, and 6%) and age-weightings (0 and 1). Results A total of 8,956 deaths were recorded among individuals with a history of SM exposure, predominantly in males (98.3%). Depending on methodological assumptions, the total YLL ranged from 87,625.7 to 228,951.1. Using a 0% discount rate and no age-weighting based on the Iranian Nationwide Life Table, males accounted for the vast majority of YLL (188,234.4 years; 98.8%), with the highest burden in the 50–54 age group (38,072.9 years). Females experienced considerably lower YLL (2,342.4 years; 1.2%), with a peak in the 60–64 age group (339.1 years). Under the same assumption, the average YLL per deceased male was 21.4 years, compared to 15.0 years for females. Average YLL increased with the severity of lung injury (from mild to severe), rising from 20.5 to 21.4 years in men and from 15.3 to 34.7 years in women. Survivors with combined lung/skin or lung/eye complications showed the highest average YLL in males (21.4 and 21.2 years, respectively), whereas females with severe lung complications faced an elevated average of 34.7 years. Geographic disparities were observed across provinces, and a statistically significant upward trend in YLL over time was found for both sexes (p < 0.001 for each). Conclusions These findings highlight the critical need for sustained monitoring and targeted care for survivors with lung damages, especially those with multiple or severe pulmonary complications. The rising YLL over time underscore the importance of ongoing research to guide the effective prevention and intervention strategies. Further investigation into geographic disparities is needed to improve regional and population-specific care.