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Volume 16, Issue 3 (2024)
Iran J War Public Health 2024, 16(3): 269-277 |
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Ethics code: IR.ISAAR.REC.1402.002
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Received: 2024/09/25 | Accepted: 2024/10/29 | Published: 2024/11/5
Received: 2024/09/25 | Accepted: 2024/10/29 | Published: 2024/11/5
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Mousavi B, Maftoon F, Asgari M, Minoeeifar J, Sharifan M, Mohammad K. Predicting Age Structure Changes Over 30 Years in the Population of War Survivors; the Past, Present, and Future. Iran J War Public Health 2024; 16 (3) :269-277
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1- Prevention Department, Janbazan Medical and Engineering Research Center (JMERC), Tehran, Iran
2- Population Health Research Group, Health Metrics Research Center, Iranian Institute for Health Sciences Research, Tehran, Iran
3- Biostatistics Department, Janbazan Medical and Engineering Research Center (JMERC), Tehran, Iran
4- Janbazan Medical and Engineering Research Center (JMERC), Tehran, Iran
5- Epidemiology and Statistical Department, Health Faculty, Tehran University of Medical Sciences, Tehran, Iran
2- Population Health Research Group, Health Metrics Research Center, Iranian Institute for Health Sciences Research, Tehran, Iran
3- Biostatistics Department, Janbazan Medical and Engineering Research Center (JMERC), Tehran, Iran
4- Janbazan Medical and Engineering Research Center (JMERC), Tehran, Iran
5- Epidemiology and Statistical Department, Health Faculty, Tehran University of Medical Sciences, Tehran, Iran
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Introduction
Forecasting population growth, changes in the age structure of the population, and the transition to aging have been of interest to policymakers since the 21st century. Changes in the age structure of the world’s population are the result of demographic transition, declining mortality rates, and increasing life expectancy. Population aging is both a significant human achievement and a major challenge in the world today. Failure to pay attention to this phenomenon will present human society with very complex problems in the near future [1]. To achieve comprehensive development and prosperity, countries are compelled to anticipate their needs and capabilities in the short, medium, and long term. Designing and implementing socio-economic planning aims to meet these needs. In this context, changes in age structure and their dynamics are considered the focus of socio-economic planning. Therefore, population dynamics, which examines the determinants and consequences of changes in the distribution structure of population growth, is one of the most important measures used by policymakers for planning [2]. The elderly population in developing countries is expected to increase in the near future [3]. The needs of the elderly, as one of the vulnerable groups, have not received sufficient attention. One of the most significant challenges facing every country is ensuring that individuals remain healthy and active in old age while providing health and medical services to these individuals and their family members with whom the elderly live [1, 3].
Evidence suggests a rapid change in the age composition and a significant increase in the elderly population of Iran in the near future, despite its current young population. According to the 1996 census, approximately 6.6% of the Iranian population was aged 60 years and older, which increased to 8.2% in 2011 [4]. Given the rapid decline in fertility rates over the past two decades, it is predicted that the trend toward population aging will accelerate, and the beginning of the 15th century will mark the start of an increase in the elderly population in Iran. From 2036 onwards, as those born between 1976 and 1991 (the baby boom generation) enter the age group over 60, Iran will face the phenomenon of an “elderly population explosion” [5,6]. The age pyramids of the Iranian population from 1950 to 2100 AD indicate that we will witness an inversion of the age pyramid over the next four decades [7].
There are different methods for population forecasting, which are used depending on the short-term or long-term goals and the available information and resources. The cohort component model divides the population into different age groups and assigns appropriate birth and death rates, as well as immigration and emigration rates. This method can provide very accurate predictions of the population for the next 10 to 20 years when immigration plays a minor role in the growth rate. Another method involves projecting the curve onto a proxy model, which predicts population based on simple linear or polynomial regression analysis; however, their limitations and difficulties in long-term forecasting are noteworthy. The use of exponential growth models as a simple method is only appropriate when the trend is increasing at a constant rate of change each year. This method is typically applicable for five to ten years and can lead to population projections with very high errors in the long term. Other methods include sigmoid and logistic models, which appear to be much more suitable than other methods for cities and regions constrained by limited resources, especially space and housing [8,9]. Some other methods have categorized population forecasting into two general categories: methods that assume levels of change and basic growth rates regardless of population size and growth capacity, and methods that consider the population growth rate as sensitive to feedback from the maximum capacity [10].
The age structure of the population and the higher average age of the war survivors (including veterans, , and the children, wives, and parents of martyrs) compared to the general Iranian society, along with the readiness to respond to their various needs in the future, is one of the important priorities and missions of the relevant institutions. This research provides the first understanding of the current and future population structure of war survivors and the age transition of the population over the next 10 and 20 years. By understanding the elderly population served and becoming familiar with the natural course of aging and the factors affecting diseases among the elderly, especially in the community affected by the imposed war, policymakers will be able to make more accurate policies and plans. This study was conducted to prospectively examine the changes in the population structure of war survivors over the past 30 years, focusing on the past, present, and future of this population.
Instrument and Methods
This descriptive research utilized demographic data of war survivors from 2010 and 2020. The study was conducted in 2021. First, the population growth rate between 2010 and 2020 was calculated, and this rate was used as the basis for predicting the age structure of the war survivors over the next 10 and 20 years. The total population covered since the establishment of the VMAF has been 3,640,489 individuals, and at the time of the study, 477,319 of them (13.24%) had died. The veterans’ community (which includes veterans and families of martyrs) has numbered 1,262,556 since the establishment of the VMAF, with the number of living veterans at the time of the study being 896,635. In total, the number of “martyr families” (including the martyr’s spouse, children, and parents) has been 661,736, of which 315,522 (47.68%) have died.
Data collection methods and tools
To predict the population in different groups of war survivors, we used age distributions in 10-year intervals. Information on the age distribution of the populations of veterans, parents of martyrs, spouses, and children of martyrs in 2010 was available in the booklet “Statistical Selections of Veterans.” This study predicted the age structure of the populations in the aforementioned groups.
In the booklet “Statistical Selections of Veterans,” the age classification within the groups is reported differently. The age classification for veterans and spouses of martyrs is categorized as under 30 years old and then in subsequent ten-year increments. The age classification for martyrs’ children is categorized as under 10 years old and then in subsequent ten-year increments. The age classification for martyrs’ parents is categorized as under 50 years old and then in subsequent ten-year increments. To ensure accurate calculations, each group was first estimated separately and then combined. Thus, the separation of the group and age grouping was considered for four subgroups, including veterans, spouses of martyrs, children of martyrs, and parents of martyrs.
Calculating the growth rate of the last ten years in the age group under ten was done using the following formula, where B1 is the number of war survivors in the age group under ten years in 2020 and A1 is the number of veterans in the age group under ten years in 2010.
Calculating the growth rate of the last ten years in other age groups i (except the first age group) was done using the following formula, where Bi is the number of individuals in age group i in 2020 and Ai-1 is the number of individuals in age group (i-1) in 2010 (number of individuals in the previous age group).
The following formulas were used to predict the population in the next ten years for the first age group, where C1 is the population of martyrs’ parents in the first age group in 2030, D1 indicates the population of martyrs’ parents in the first age group in 2040, B1 is the number of martyrs’ parents in the first age group in 2010 (number of individuals in the same age group), and A1 is the number of martyrs’ parents in the first age group in 2010 (number of individuals in the same age group).
The estimate for the first age group was based on the likelihood of transitioning from one age group to the same age group over the next ten years (from 2020 to 2030) and twenty years (from 2030 to 2040). The likelihood of moving from the first age group in 2010 to that in 2020 was estimated directly (within the same age group). In this age group, the population size was considered to be almost constant.
For the other age groups, the probability of population transition from the lower age group in 2010 to a higher age group in 2010 (the next age group) was estimated. The probability of population transition in each grouping was calculated for the next ten years (from 2010 to 2030) and for the next twenty years (from 2030 to 2040) using the below formulas, respectively (Table 1).
Table 1. Methodology for predicting the war survivors population for the next 10 and 20 years (2030 and 2040)
The total of the main dependent subgroups of war survivors included veterans and families of martyrs (spouses/children/parents of martyrs). To estimate the age structure of this population, the calculated data from the subgroups were utilized. To estimate the number and age structure of the total population, including veterans, spouses, children, and parents of martyrs, the data were predicted according to the age group in each separate group. We then obtained the sum for each age group and, ultimately, the total sum of the age groups. In the final step, to estimate the total number, the sum of the war survivors subgroups across different age groups was calculated.
Findings
In 2020, the VMAF covered 896,635 “war survivors, more than half of them being veterans.
The veteran population in 2020 increased very little compared to the previous ten years (2010), showing an increase of about 1.4%. Considering the calculated growth rate, it is expected that the veteran population will exhibit a decreasing trend by 2030, and this trend will continue into 2040. It is anticipated that 93% of the veteran population in 2040 will be over 60 years of age, and 80.9% will be over 70 years of age (Table 2).
Table 2. Estimated population of veterans in 2030 and 2040 by age group
The population of martyrs’ spouses in 2020 decreased by about 4.4% compared to the previous ten years (2010). In 2020, approximately 36.8% of the population of martyrs’ spouses were over 60 years old, and 9.7% were over 70 years old. It is predicted that the population of martyrs’ wives will decrease in 2030 and 2040; however, in 2030, the percentage of martyrs’ wives over 60 is expected to increase to 82.1%, and those over 70 to 31.1%. Additionally, it is projected that 90% of the population of martyrs’ wives in 2040 will be over 60, and 74.2% will be over 70 (Table 3).
Table 3. Estimated population of martyrs’ spouses in 2030 and 2040 by age group
The population of martyrs’ children in 2020 did not change significantly compared to the previous ten years (2010), showing a decrease of 0.15%. In 2020, the percentage of martyrs’ children over 60 years old was 5.5%, and those over 70 years old were 1.1%, while in 2010, these figures were 1.7% and 0.5% of the population, respectively. It is expected that by 2020, the population of martyrs’ children will show a decreasing trend, with their number reaching 166,232, a decrease of about 6.5% compared to 2010. It is predicted that by 2030, the percentage of martyrs’ children over 60 years old will reach 15.4% (over 25,000 elderly individuals), and those over 70 years old will reach 4.2%. The decreasing trend in the population of martyrs’ children is expected to continue in 2040, with their number projected to reach 144,413, a decrease of about 18.8% compared to 2020. By 2040, it is predicted that the population of martyrs’ children over 60 years of age will reach 40.6% (over 58,000 elderly individuals), and those over 70 years of age will reach 11.4% (Table 4).
Table 4. Estimated population of martyrs’ children in 2030 and 2040 by age group
The population of martyrs’ parents in 2020 showed a decreasing trend compared to the previous ten years (2010), declining by about 100,000 (approximately a 43.2% decrease). In 2020, the population of martyred parents over 60 years of age comprised 92.5% (over 120,000 elderly individuals), while those over 70 years of age accounted for 79% of the population. It is expected that by 2030, the declining trend in the population of martyred parents will continue, with their number projected to reach 45,816, a decrease of about 64.9% compared to 2020. By 2030, the population of martyred parents over 60 years of age is expected to reach 82% (over 37,000 elderly individuals), and those over 70 years of age will reach 63.4%. Furthermore, it is anticipated that by 2040, the declining trend in the population of martyred parents will persist, with their number expected to reach 27,848, a decrease of about 78.6% compared to 2020. By 2040, the population of martyred parents over 60 years of age is projected to reach 75% (over 20,000 elderly individuals), and those over 70 years of age will reach 49.1% (Table 5).
Table 5. Estimated population of martyrs’ parents in 2030 and 2040 by age group
The population of martyrs’ families (the total of spouses, parents, and children of martyrs) decreased by about 100,000 in 2020 compared to ten years ago (2010), representing a decline of 21.7% (from 472,543 to 370,193). In 2020, the population of martyrs’ families over 60 years old was 58.6% (216,000 elderly individuals), and those over 70 years old accounted for 29.9% (110,000). It is expected that the declining trend in the population of martyrs’ families will continue in 2030, decreasing by about 28% compared to 2020, and reaching 210,248 people in 2040, which represents a decrease of 43.2%. It is anticipated that in 2030 and 2040, the population of martyrs’ families over 60 years of age will reach 107,000 and 113,000 elderly individuals, respectively, while those over 70 years of age will reach 53,000 and 58,000 individuals, respectively (Table 6).
Table 6. Estimated population of the martyrs' families covered by the Foundation of Martyrs and Veterans Affairs by age group
The prediction of the population of war survivors, who constitute the main community covered by the, was made using the algebraic sum estimate of the aforementioned groups (including veterans and families of martyrs) and is shown in Table 7. The population of war survivors in 2020 decreased by about 100,000 people compared to the previous ten years (2010), representing a decrease of approximately 9.6%. In 2010, the population over 60 years old was 26.5% (over 237,000 seniors), and those over 70 years old accounted for 14.3%. In 2020, these rates were 26% and 16.7%, respectively. It is expected that the decreasing trend in the population of war survivors will continue, with their number projected to reach 735,586 people, a decrease of about 18% compared to 2010. It is predicted that by 2030, the population of war survivors over 60 years of age (over 506,000 elderly individuals) will reach 68.8%, while those over 70 years of age will account for 15.4%. Furthermore, it is anticipated that in 2040, the declining trend in the population of war survivors (including veterans and families of martyrs) will continue, with their number expected to reach 587,485 people, a decrease of about 34.5% compared to 2020. By 2040, the population of war survivors over 60 years of age is projected to reach 79.1% (over 464,000 elderly individuals), and those over 70 years of age will reach 61.9% (Table 7).
Table 7. Estimated population of war survivors (including veterans and the total number of spouses, parents, and children of martyrs in 2030 and 2040 by age group
Discussion
This study aimed to prospectively examine the changes in the population structure of war survivorsover the past 30 years. Here, for the first time in 40 years, we predicted the future of the population of survivors of the Iraq-Iran war, who have multiple types of chronic injuries resulting from eight years of war and approximately 45 years of post-war effects. The findings showed that the veteran population in 2020 was relatively stable compared to the previous ten years (2010); however, over the next ten years (i.e., by 2030), it is expected to decline by about 11%. This downward trend will continue until 2040 when the veteran population is projected to decrease by about one-third compared to 2010. Despite the overall decrease in the veteran population in the near future, the number of elderly veterans (over 60 years old) is expected to increase fourfold by the years 2030 and 2040. Veterans aged 70 and over will also increase by about fourfold in the first ten years and then by 17-fold in the subsequent decade. It is essential for organizations responsible for maintaining and promoting the health of war survivors to be prepared to provide services to 469,060 veterans, of whom more than 390,000 will be elderly in 2030. In 2040, there will be 377,237 veterans, with more than 350,000 classified as elderly.
The 30-year changes in the population of martyrs’ families indicate that more than half are now over 60 years old, and the total population has decreased by about 20% compared to the past ten years. It is expected that the declining trend in the population of martyrs’ families will continue in 2030 and 2040, with their numbers projected to reach 266,526 and 210,248 people, respectively, representing a decrease of nearly 45% compared to 2020. Additionally, it is predicted that in 2030, the population of martyrs’ families over 60 years of age will reach 107,000, and this figure will increase to 113,000 in 2040. The number of elderly martyrs’ families in 2040 is expected to remain almost the same as in 2030.
At the time of the study, the war survivors population, which included all veterans and families of martyrs (parents, spouses, and children), had decreased by about 100,000 (approximately a 9.6% decrease) compared to ten years ago (2010). Additionally, 26.5% (over 237,000 elderly individuals) of the war survivors were classified as elderly (60 years and over), and 14.3% (n=128,403) were over 70. This rate has not changed significantly compared to 2010. The aging rate in Iran is reported to be around 8%, while the aging ratio of war survivors is currently more than three times the national aging ratio [11]. The number of war survivors (including veterans and families of martyrs) is projected to decrease in 2030 and 2040, initially reaching around 750,000 and then close to 600,000. In 2030, the population over 60 is expected to reach 68.8% (over 506,000 elderly individuals), and those over 70 are expected to reach 15.4% (n=113,283). Furthermore, in 2040, the population over 60 is anticipated to reach 79.1% (over 464,000 elderly individuals), while those over 70 are expected to reach 61.9% (n=363,479). The aging rate of war survivors will be much faster than the aging rate of the country’s population [11].
However, overall, it is predicted that the war survivors population will decline by 34% by 2040. The elderly population (over 60 years old) is expected to increase threefold between 2030 and 2040. This rate will be significantly higher than that of the national elderly population [11]. The population aged 70 and over will remain almost constant in the first ten years and then increase by 2.8 times in 2040 compared to 2020. This increase in the elderly population aged over 70 will occur at a much faster rate than its growth in Iran and even in other countries around the world [11, 12].
To achieve prosperity in society, it is an undeniable necessity to anticipate the needs and capabilities of responsible organizations regarding their ability to provide appropriate services in the short, medium, and long term for socio-economic planning that meets the needs of the society under their coverage. In this regard, changes in the age structure and community dynamics are central to socio-economic planning and represent the most important actions for policymakers to undertake for effective planning. The findings of this study emphasize the necessity of policymaking to prepare for meeting the needs of war survivors and providing services that are appropriate for the different groups within the population covered [2].
It is predicted that the elderly population in Iran will reach about 12% by 1420 [11]. This study showed that the rate of aging in the war survivors group will be more than six times the growth rate of the country. In addition, the total population of war survivors in 2040 is expected to exceed 370,000 people. It is predicted that in 2030, approximately 85% of veterans will be elderly, and by 2040, this figure will rise to about 93%. The rate of elderly among veterans will grow significantly, with an increase of 79% in the war survivors population and up to 93% among elderly veterans. In 2030, a serious challenge will arise in the age group of 60 years and above. This rate will be much higher than the national and global aging statistics [11]. In 2040, there will be significant challenges in both the 60-70 age groups and especially in the group aged 70 and older, as the higher the age of the elderly, the greater the need for various types of services. The need to focus on the current middle-aged group and empower them to achieve a successful and healthy old age, particularly as they approach the age of 70 and above, is of particular importance.
The results of this study indicate that the population shift to an aging demographic will occur in the near future. The 20-year outlook for 2040 is alarming due to the aging burden resulting from this demographic transition, which is expected to be accompanied by an increase in various morbidities, diseases, and disabilities among war survivors. In the meantime, it will be crucial to pay attention to the population aged 40 to 60 (who are still considered middle-aged) and empower them to achieve successful aging. Additionally, although all older adults require care and attention, some individuals among the elderly are more vulnerable than others and need special care. Veterans have borne the burden of health issues caused by war. This group of vulnerable elderly individuals has been assessed in health monitoring programs and plans; however, there has not yet been a comprehensive strategy to maintain and improve the health of the elderly, particularly for this group. The population covered by the VMAF in 2040 will likely be at least 600,000 people. The average age of this population will also be higher than that of the general Iranian population. Given the forecast of a majority elderly population, the future management of this covered population requires careful policymaking and planning to achieve the best results in maintaining and improving their health.
The need to focus on the current middle-aged group and empower them to achieve a successful and healthy old age, by utilizing the successful experiences of countries that have already undergone population aging, can lead to more successful outcomes [11, 12].
Policies that can be adopted to support the veteran and martyrs’ families community include providing education to promote health literacy and lifestyle modification, implementing screening and early diagnosis of diseases, reducing the overhead costs of the health system, reforming the health system to meet the needs of the elderly population at the first, second, and third levels, expanding health and treatment infrastructure in line with population growth and their needs, planning and policymaking to reduce the elderly’s reliance on hospital services, training and empowering families who care for the elderly, establishing special centers to provide outpatient and hourly or daily hospitalization services for the elderly, and training various groups that provide services to war survivors (including employees, personnel, and doctors contracted with theVMAF on aging issues [12].
In addition to the above, contracting with centers that provide home services for single or single-parent elderly individuals, establishing daycare centers to offer recreational services for this demographic, providing geriatric education to interested groups, paying attention to the balance between resources and costs resulting from the aging population in insurance organizations while providing the necessary funding, predicting socio-economic and cultural needs, conducting future research on the health services required in war survivors groups, and evaluating the costs necessary to maintain and promote health in the war survivors community are among the solutions that can help improve conditions.
To achieve a successful old age, it is necessary to focus on empowerment in areas including healthy aging, maintaining efficiency in old age, preserving independence, sustaining social status and participation, realizing inner talents and abilities, upholding dignity and self-esteem, preventing or postponing diseases in the elderly, giving special attention to preventing or delaying disabilities, preventing loneliness and isolation, avoiding or delaying dependency, preventing hopelessness, apathy, and stagnation, and preventing humiliation and discrimination among the elderly. In this regard, attention to vulnerable elderly individuals is particularly important. This group includes elderly women, older elderly individuals (specifically those aged 70-79 and over 80), rural elderly, elderly individuals living on the outskirts of cities, those in care centers and institutions, destitute elderly individuals, and lonely elderly individuals [13-24].
One of the most important strengths of this study is that, for the first time, it examines the future of the population affected by the consequences of the Iraq-Iran war. We estimated the current and future age structure of war survivors (including veterans’ and martyrs’ families), who are the primary recipients of services from the Foundation of Martyrs and Veterans Affairs. This prediction represents the first step toward developing appropriate policies and providing targeted services to this community. It is worth noting that this study did not address the future forecast of the population of veterans’ spouses and children (in other words, veterans’ families), which consists of approximately 2,227,161 individuals. Although this population does not directly receive services, as they are dependents of veterans, they are indirectly covered by the Foundation of Martyrs and Veterans Affairs. It is recommended that an estimate of the future age structure of this population be made to obtain a more complete picture of the future of the entire covered population. This research highlights the significant demographic challenge posed by this demographic shift and underscores the necessity for policymaking to prepare for the provision of the types of elderly services needed for this population shift among veterans under the auspices of the Foundation of Martyrs and Veterans Affairs.
Conclusions
The number of veterans in the next 20 years will reach two-thirds of the current number, with the majority being over the age of 70. Also, the number of martyrs in 2040 will reach two-thirds of the current number, resulting in a decrease, but nearly 80% of them will be elderly (460,000), with the majority being 70 years of age and older (approximately 360,000).
Acknowledgments: The authors express their appreciation and gratitude to all officials and experts of the Foundation of Martyrs and Veterans Affairs, particularly the General Directorate of Statistics and Information Technology, including Mr. Mehran Ranjbar and the esteemed director of the center, Dr. Kourosh Mohammad Hosseini. The authors are thankful for the assistance, support, and cooperation of their respected colleagues in the Office of Studies and Research, headed by Dr. Majid Modi and Dr. Farhad Rajabi, as well as the esteemed director of the Institute of Engineering and Medical Sciences for Veterans, Dr. Abbas Vali. Special thanks are extended to Dr. Davood Rahimpour, Dr. Zohreh Ganjparvar, Ms. Shirin Abdolkarimi, and other colleagues for their invaluable contributions.
Ethical Permissions: Code of ethics: IR.ISAAR.REC.1402.002.
Conflicts of Interests: The authors declared no conflicts of interests.
Authors' Contribution: Mousavi B (First Author), Introduction Writer/Methodologist/Main Researcher/Discussion Writer/Statistical Analyst (30%); Maftoon F (Second Author), Methodologist/Assistant Researcher/Discussion Writer/Statistical Analyst (20%); Asgari M (Third Author), Introduction Writer/Methodologist/ Assistant Researcher/Discussion Writer/Statistical Analyst (20%); Minoeeifar J (Fourth Author), Introduction Writer/Methodologist/Original or Assistant Researcher/Discussion Writer/Statistical Analyst (10%); Sharifan M (Fifth Author), Introduction Writer/Methodologist/ (10%); Mohammad K (Sixth Author), Methodologist/ Assistant Researcher/ /Statistical Analyst (10%)
Funding/Support: Nothing has been reported.
Keywords:
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