Scorpion sting stratification in Iran: A systematic review of epidemiological patterns, determinants, and climate change impacts.

This systematic review provides a comprehensive synthesis of the epidemiology of scorpion sting stratification across Iran's geography, a critical public health concern in its arid and semi-arid regions. Conducted in accordance with PRISMA 2020 guidelines, the review analyzes the spatial and temporal patterns of envenomations, identifies key ecological, climatic, and anthropogenic determinants, and evaluates the growing evidence for climate change as a driver of increased risk. The study confirms hyperendemic levels of scorpion stings in the southwestern and western provinces, with species from the genera Hemiscorpius and Androctonus presenting the most severe medical threat. A meta-analysis of national data yields a pooled incidence rate of 92.7 per 100,000 population per year (95% CI: 68.4-117.0), with extreme heterogeneity (I² = 98.9%) reflecting stark regional disparities. The primary determinants of scorpion distribution and human-scorpion conflicts include climatic variables (temperature, precipitation, and humidity), land-use practices, unplanned urbanization, and occupational exposure. Recent evidence from species distribution modeling strongly suggests that climate change is expanding suitable habitats for scorpions, prolonging their active seasons, and increasing human-scorpion conflicts. This review highlights the critical need for improved surveillance, predictive spatial risk models, and climate-adaptive public health strategies to address this growing threat.