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Authors
Khalili, Davood
Molaeipour, Leila https://orcid.org/0000-0002-1086-0907
Etemad, Koorosh https://orcid.org/0000-0002-4005-9563
Hezaveh, Alireza Mahdavi
Yousefi, Elham
Hadaegh, Farzad
Kazemi, Tooba
Masoudkabir, Farzad https://orcid.org/0000-0001-8098-7121
Rahimi, Kazem https://orcid.org/0000-0002-4807-4610
Heshmat, Ramin
Ostovar, Afshin https://orcid.org/0000-0001-8670-5797
Azizi, Fereidoun https://orcid.org/0000-0002-6470-2517
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Funding
Funding for this research was provided by:
WHO office in Iran
Iranian Ministry of Health and Medical Education
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Article History
Received: 7 February 2026
Accepted: 13 May 2026
First Online: 25 May 2026
Declarations
Ethical approval and consent to participate: In this ecological and cross-sectional study, we evaluated the performance of the health system using aggregated population-level data. Individual-level data were obtained through secondary analysis of routinely collected health system registries. All data were fully de-identified prior to analysis, and no identifiable personal information was accessible to the research team. The requirement for informed consent to participate was waived by the Research Ethics Committees of Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, in accordance with national research ethics regulations, due to the retrospective use of anonymized registry data. The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Research Ethics Committees of Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences (IR.SBMU.ENDOCRINE.REC.1402.050).
Consent for publication: Not applicable.
Competing interests: The authors declare no competing interests.
