One of the legal commitments for executive systems in the Law of the Fourth Development Plan of Iran is to have a 2.5 percent gain in the total factor productivity. This Law expressly enforces the executive systems to take the productivity circle, which measuring productivity indexes is one of the most important parts of it. In this article, we evaluate the efficiency of manufacturing industries by data envelopment analysis and after that we use the DEA Malmquist Productivity Index to measure the efficiency change, technology change and productivity growth of Iran’s manufacturing industries, during the third developing plan. Also, we use the super efficiency technique for ranking the efficient units. The results show that, coke and refined petroleum industry and non metallic mineral industry are efficient in the all five years of the third developing plan and have the first and second rank in these years.

Stroke mortality remains a significant public health challenge in the United States, with persistent geographic disparities. While previous studies have documented the rural-urban gap in stroke outcomes, limited attention has been paid to the role of the "stroke belt," a region with historically high stroke mortality rates. Understanding how these disparities evolve over time and interact with regional factors provides important insights into health equity and resource allocation. This study investigates trends in age-adjusted stroke mortality, focusing on differences between rural and urban areas, and examining how these trends vary within and outside the stroke belt region.
We conducted a cross-sectional analysis using data from the Centers for Disease Control and Prevention (CDC)-WONDER database from 1999 to 2022. This dataset includes county-level mortality data across the United States. For this analysis, we extracted stroke mortality rates for individuals aged 55 and older. Stroke mortality was identified using International Classification of Diseases, Tenth Revision (ICD-10) codes. County-level socioeconomic data, including per capita income and unemployment rates, were obtained from the Area Health Resources File (AHRF). Counties were classified as rural or urban based on the U.S. Department of Agriculture Rural-Urban Continuum Codes, and further categorized as being within or outside the stroke belt region. Age-adjusted stroke mortality rates per 100,000 population were calculated using the 2000 U.S. standard population. Analytical techniques included weighted regression models with county fixed effects to examine trends and disparities, adjusted for county-level socioeconomic characteristics.

Nationally, stroke mortality rates declined substantially between 1999 and 2022. However, the rural-urban gap widened over time. In 2022, stroke mortality in the rural stroke belt remained notably higher compared to other regions, with rates approximating those of urban non-stroke belt areas in the early 2000s (around 40–45 deaths per 100,000 population). Similarly, rural non-stroke belt areas in 2014 had stroke mortality rates comparable to those observed in urban stroke belt areas nearly a decade earlier. Urban non-stroke belt counties exhibited the fastest declines, maintaining the lowest mortality rates throughout the study period. Adjusting for socioeconomic characteristics partially narrowed these disparities but significant gaps persisted, particularly in rural stroke belt areas.

While stroke mortality rates have declined nationwide, disparities remain stark, with rural stroke belt counties lagging significantly. The observed trends suggest that rural areas, particularly within the stroke belt, are on a slower trajectory of improvement, maintaining mortality rates similar to urban non-stroke belt areas from 10–15 years prior. These findings underscore the need for targeted policy interventions to address geographic inequities in stroke prevention, acute care, and rehabilitation services. Strengthening healthcare infrastructure and access in rural and stroke belt regions is crucial to achieving equitable health outcomes.