Causes and predictors of premature death in the pars cohort study, Iran: a cohort study.
Cardiovascular disease
Noncommunicable disease
Pars cohort study
Premature mortality
Prevention
Protective factor
Risk factor
Journal
BMC public health
ISSN: 1471-2458
Titre abrégé: BMC Public Health
Pays: England
ID NLM: 100968562
Informations de publication
Date de publication:
27 Sep 2024
27 Sep 2024
Historique:
received:
26
04
2024
accepted:
25
07
2024
medline:
28
9
2024
pubmed:
28
9
2024
entrez:
28
9
2024
Statut:
epublish
Résumé
While death in old age is inevitable, premature death at younger ages is within our control. Premature mortality (death < 70 years) is a crucial indicator of health status and access to healthcare, with variations observed across regions. In North Africa and the Middle East, ischemic heart disease (IHD), road injuries, stroke, and chronic kidney disease are projected to be the main causes of premature mortality. Unfortunately, few studies have been conducted on premature mortality worldwide. This study aimed to analyze the causes of premature death and associated risk factors within the Pars Cohort Study. The Pars Cohort Study is a prospective cohort study conducted in Fars Province, Iran, involving 9,264 individuals aged 40-75 years, 53.8% of whom were women. We assessed participants from baseline (2012-2014) to 2021. The data were gathered through interviews, biological samples, and physical examinations. The causes of premature mortality, hazard ratios (HRs), and population attributable fraction (PAF) with 95% confidence intervals (95% CIs) for the variables were calculated. Out of 388 deaths, 54% were premature. The most common causes of premature death included IHD (40%), stroke (11%), road traffic injuries (6%), lower respiratory infections (5%), and COVID-19 (3%). The predictive factors [adjusted HRs (95% CIs)] associated with premature mortality included age [year, 1.07 (1.04, 1.10)], tobacco [1.43 (0.96, 2.11)], opium [2.12 (1.39, 3.24)], hypertension [1.52 (1.10, 2.12)], waist circumference [cm, 1.03 (1.00, 1.05)], female sex [0.30 (0.19, 0.47)], education [> 8 years vs. no formal schooling, 0.46 (0.24, 0.88)], being married [0.60 (0.37, 0.97)], physical activity [3rd vs. 1st tertile, 0.38 (0.26, 0.57)], hip circumference [cm, 0.96 (0.92, 0.99)], estimated GFR [mL/min/1.73 m², 0.99 (0.978, 0.999)], and wealth score [4th vs. 1st quartile, 0.54 (0.32, 0.90)]. The PAF (95% CI) for all modifiable predictors was 0.83 (0.62, 0.92). The predominant causes of premature mortality were IHD and stroke. To mitigate premature deaths, it is recommended to address both socioeconomic and behavioral factors simultaneously.
Sections du résumé
BACKGROUND
BACKGROUND
While death in old age is inevitable, premature death at younger ages is within our control. Premature mortality (death < 70 years) is a crucial indicator of health status and access to healthcare, with variations observed across regions. In North Africa and the Middle East, ischemic heart disease (IHD), road injuries, stroke, and chronic kidney disease are projected to be the main causes of premature mortality. Unfortunately, few studies have been conducted on premature mortality worldwide. This study aimed to analyze the causes of premature death and associated risk factors within the Pars Cohort Study.
METHODS
METHODS
The Pars Cohort Study is a prospective cohort study conducted in Fars Province, Iran, involving 9,264 individuals aged 40-75 years, 53.8% of whom were women. We assessed participants from baseline (2012-2014) to 2021. The data were gathered through interviews, biological samples, and physical examinations. The causes of premature mortality, hazard ratios (HRs), and population attributable fraction (PAF) with 95% confidence intervals (95% CIs) for the variables were calculated.
RESULTS
RESULTS
Out of 388 deaths, 54% were premature. The most common causes of premature death included IHD (40%), stroke (11%), road traffic injuries (6%), lower respiratory infections (5%), and COVID-19 (3%). The predictive factors [adjusted HRs (95% CIs)] associated with premature mortality included age [year, 1.07 (1.04, 1.10)], tobacco [1.43 (0.96, 2.11)], opium [2.12 (1.39, 3.24)], hypertension [1.52 (1.10, 2.12)], waist circumference [cm, 1.03 (1.00, 1.05)], female sex [0.30 (0.19, 0.47)], education [> 8 years vs. no formal schooling, 0.46 (0.24, 0.88)], being married [0.60 (0.37, 0.97)], physical activity [3rd vs. 1st tertile, 0.38 (0.26, 0.57)], hip circumference [cm, 0.96 (0.92, 0.99)], estimated GFR [mL/min/1.73 m², 0.99 (0.978, 0.999)], and wealth score [4th vs. 1st quartile, 0.54 (0.32, 0.90)]. The PAF (95% CI) for all modifiable predictors was 0.83 (0.62, 0.92).
CONCLUSIONS
CONCLUSIONS
The predominant causes of premature mortality were IHD and stroke. To mitigate premature deaths, it is recommended to address both socioeconomic and behavioral factors simultaneously.
Identifiants
pubmed: 39334044
doi: 10.1186/s12889-024-19583-7
pii: 10.1186/s12889-024-19583-7
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2601Informations de copyright
© 2024. The Author(s).
Références
Chen JT, Rehkopf DH, Waterman PD, Subramanian SV, Coull BA, Cohen B, et al. Mapping and measuring social disparities in premature mortality: the impact of census tract poverty within and across Boston neighborhoods, 1999–2001. J Urban Health. 2006;83(6):1063–84.
doi: 10.1007/s11524-006-9089-7
pubmed: 17001522
pmcid: 3261292
Razeghian-Jahromi I, Ghasemi Mianrood Y, Dara M, Azami P. Premature death, underlying reasons, and preventive experiences in Iran: a narrative review. Arch Iran Med. 2023;26(7):403–10.
doi: 10.34172/aim.2023.61
pubmed: 38301100
pmcid: 10685823
Peto R, Lopez AD, Norheim OF. Halving premature death. Science. 2014;345(6202):1272.
doi: 10.1126/science.1259971
pubmed: 25214609
Ellis J, Dowrick C, Lloyd-Williams M. The long-term impact of early parental death: lessons from a narrative study. J R Soc Med. 2013;106(2):57–67.
doi: 10.1177/0141076812472623
pubmed: 23392851
pmcid: 3569022
Noncommunicable diseases World Health. Organisation2023 [ https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases
Ziamanesh F, Mohajeri Tehrani MR, Hemmatabadi M, Sharghi S, Fallahi B, Haghpanah V, et al. Design and implementation of a national quality registry of thyroid cancer in Iran: study protocol. Journal of Diabetes & Metabolic Disorders; 2023.
Foreman KJ, Marquez N, Dolgert A, Fukutaki K, Fullman N, McGaughey M, et al. Forecasting life expectancy, years of life lost, and all-cause and cause-specific mortality for 250 causes of death: reference and alternative scenarios for 2016-40 for 195 countries and territories. Lancet. 2018;392(10159):2052–90.
doi: 10.1016/S0140-6736(18)31694-5
pubmed: 30340847
pmcid: 6227505
Global regional. National incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the global burden of Disease Study 2016. Lancet. 2017;390(10100):1211–59.
doi: 10.1016/S0140-6736(17)32154-2
Nalini M, Oranuba E, Poustchi H, Sepanlou SG, Pourshams A, Khoshnia M, et al. Causes of premature death and their associated risk factors in the Golestan Cohort Study, Iran. BMJ Open. 2018;8(7):e021479.
doi: 10.1136/bmjopen-2018-021479
pubmed: 30021753
pmcid: 6059279
Muller DC, Murphy N, Johansson M, Ferrari P, Tsilidis KK, Boutron-Ruault M-C, et al. Modifiable causes of premature death in middle-age in Western Europe: results from the EPIC cohort study. BMC Med. 2016;14:1–11.
doi: 10.1186/s12916-016-0630-6
Eslami A, Naghibi Irvani SS, Ramezankhani A, Fekri N, Asadi K, Azizi F, et al. Incidence and associated risk factors for premature death in the Tehran lipid and glucose study cohort, Iran. BMC Public Health. 2019;19(1):1–7.
doi: 10.1186/s12889-019-7056-y
Gandomkar A, Poustchi H, Moini M, Moghadami M, Imanieh H, Fattahi MR, et al. Pars cohort study of non-communicable diseases in Iran: protocol and preliminary results. Int J Public Health. 2017;62(3):397–406.
doi: 10.1007/s00038-016-0848-2
pubmed: 27349480
Global Physical Activity Surveillance World Health Organisation2017 [updated 24. May 2017. http://www.who.int/chp/steps/GPAQ/en/
Vinyoles E, Tafalla M, Robledo V, Marco M, Porta I, Muñoz M-A, et al. Interarm blood pressure measurement and the reference-arm assignment variability. Blood Press Monit. 2019;24(5):259–63.
doi: 10.1097/MBP.0000000000000394
pubmed: 31425157
Hypertension: World Health Organization. 2023 [ https://www.who.int/news-room/fact-sheets/detail/hypertension#:~:text=Overview,get%20your%20blood%20pressure%20checked
Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L, et al. 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J. 2020;41(1):111–88.
doi: 10.1093/eurheartj/ehz455
pubmed: 31504418
Pencina KM, Thanassoulis G, Wilkins JT, Vasan RS, Navar AM, Peterson ED, et al. Trajectories of Non-HDL cholesterol across midlife: implications for Cardiovascular Prevention. J Am Coll Cardiol. 2019;74(1):70–9.
doi: 10.1016/j.jacc.2019.04.047
pubmed: 31272554
pmcid: 7346311
Islami F, Kamangar F, Nasrollahzadeh D, Aghcheli K, Sotoudeh M, Abedi-Ardekani B, et al. Socio-economic status and oesophageal cancer: results from a population-based case-control study in a high-risk area. Int J Epidemiol. 2009;38(4):978–88.
doi: 10.1093/ije/dyp195
pubmed: 19416955
pmcid: 2720396
Doganer YC, Rohrer JE, Aydogan U, Barcin C, Cayci T, Saglam K. Association of renal function, estimated by four equations, with coronary artery disease. Int Urol Nephrol. 2015;47(4):663–71.
doi: 10.1007/s11255-015-0935-y
pubmed: 25749988
Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150(9):604–12.
doi: 10.7326/0003-4819-150-9-200905050-00006
pubmed: 19414839
pmcid: 2763564
AZIZI F, Khalili D, Aghajani H, Esteghamati A, Hosseinpanah F, Delavari A, et al. Appropriate waist circumference cut-off points among Iranian adults: the first report of. the Iranian National Committee of Obesity; 2010.
AZIZI F, Hadaegh F, KHALILI D, Esteghamati A, HOSSEIN PF, Delavari A, et al. Appropriate definition of metabolic syndrome among Iranian adults. report of the Iranian National Committee of Obesity; 2010.
Khademi H, Etemadi A, Kamangar F, Nouraie M, Shakeri R, Abaie B, et al. Verbal autopsy: reliability and validity estimates for causes of death in the Golestan Cohort Study in Iran. PLoS ONE. 2010;5(6):e11183.
doi: 10.1371/journal.pone.0011183
pubmed: 20567597
pmcid: 2887437
International Statistical Classification of Diseases and Related Health Problems 10th Revision. World Health Organization [updated 25 My 2017. http://apps.who.int/classifications/icd10/browse/2016/en
WHO methods and. data sources for country-level causes of death 2000–2019 2020 [ https://cdn.who.int/media/docs/default-source/gho-documents/global-health-estimates/ghe2019_cod_methods.pdf
Nalini M, Sharafkhah M, Poustchi H, Sepanlou SG, Pourshams A, Radmard AR, et al. Comparing Anthropometric indicators of visceral and General Adiposity as determinants of overall and Cardiovascular Mortality. Arch Iran Med. 2019;22(6):301–9.
pubmed: 31356096
Naghavi M, Abajobir AA, Abbafati C, Abbas KM, Abd-Allah F, Abera SF, et al. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the global burden of Disease Study 2016. Lancet. 2017;390(10100):1151–210.
doi: 10.1016/S0140-6736(17)32152-9
Moradi-Lakeh M, Sepanlou SG, Karimi SM, Khalili N, Djalalinia S, Karimkhani C, et al. Trend of Socio-Demographic Index and Mortality Estimates in Iran and its neighbors, 1990–2015; findings of the Global Burden of diseases 2015 study. Arch Iran Med. 2017;20(7):419–28.
pubmed: 28745903
Organization WH. Global status report on road safety 2015. World Health Organization; 2015.
Bazargan-Hejazi S, Ahmadi A, Shirazi S, Ainy E, Djalalinia S, Fereshtehnejad S-M et al. The burden of road traffic injuries in Iran and 15 surrounding countries: 1990–2016. Arch Iran Med. 2018;21(12).
Schumacher AE, Kyu HH, Aali A, Abbafati C, Abbas J, Abbasgholizadeh R et al. Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the global burden of Disease Study 2021. The Lancet. 2024.
WHO. Cardiovascular diseases fact sheet. WHO Geneva; 2017.
Yusuf S, Joseph P, Rangarajan S, Islam S, Mente A, Hystad P, et al. Modifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low-income countries (PURE): a prospective cohort study. Lancet. 2020;395(10226):795–808.
doi: 10.1016/S0140-6736(19)32008-2
pubmed: 31492503
O’Donnell MJ, Chin SL, Rangarajan S, Xavier D, Liu L, Zhang H, et al. Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study. Lancet. 2016;388(10046):761–75.
doi: 10.1016/S0140-6736(16)30506-2
pubmed: 27431356
Yusuf S, Hawken S, Ôunpuu S, Dans T, Avezum A, Lanas F, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364(9438):937–52.
doi: 10.1016/S0140-6736(04)17018-9
pubmed: 15364185
Khademi H, Malekzadeh R, Pourshams A, Jafari E, Salahi R, Semnani S et al. Opium use and mortality in Golestan Cohort Study: prospective cohort study of 50 000 adults in Iran. BMJ. 2012;344.
Nalini M, Shakeri R, Poustchi H, Pourshams A, Etemadi A, Islami F, et al. Long-term opiate use and risk of cardiovascular mortality: results from the Golestan Cohort Study. Eur J Prev Cardiol. 2021;28(1):98–106.
doi: 10.1093/eurjpc/zwaa006
pubmed: 33624066
Kamangar F, Shakeri R, Malekzadeh R, Islami F. Opium use: an emerging risk factor for cancer? Lancet Oncol. 2014;15(2):e69–77.
doi: 10.1016/S1470-2045(13)70550-3
pubmed: 24480557
Malekzadeh F, Gandomkar A, Poustchi H, Etemadi A, Roshandel G, Attar A et al. Effectiveness of polypill for primary and secondary prevention of cardiovascular disease: a pragmatic cluster-randomised controlled trial (PolyPars). Heart. 2024.