Causes of premature death and their associated risk factors in the Golestan Cohort Study, Iran.

Abstract

OBJECTIVES:

To examine the causes of premature mortality (<70 years) and associated risk factors in the Golestan Cohort Study.

DESIGN:

Prospective.

SETTING:

The Golestan Cohort Study in northeastern Iran.

PARTICIPANTS:

50 045 people aged 40 or more participated in this population-based study from baseline (2004-2008) to August 2017, with over 99% success follow-up rate.

MAIN OUTCOME MEASURES:

The top causes of premature death, HR and their 95% CI and population attributable fraction (PAF) for risk factors.

RESULTS:

After 444 168 person-years of follow-up (median of 10 years), 6347 deaths were reported, of which 4018 (63.3%) occurred prematurely. Ischaemic heart disease (IHD) accounted for 33.9% of premature death, followed by stroke (14.0%), road injuries (4.7%), stomach cancer (4.6%) and oesophageal cancer (4.6%). Significant risk/protective factors were: wealth score (HR for highest vs lowest quintile: 0.57, PAF for lowest four quintiles vs top quintile: 28%), physical activity (highest vs lowest tertile: 0.67, lowest two tertiles vs top tertile: 22%), hypertension (1.50, 19%), opium use (1.69, 14%), education (middle school or higher vs illiterate: 0.84, illiterate or primary vs middle school or higher: 13%), tobacco use (1.38, 11%), diabetes (2.39, 8%) and vegetable/fruit consumption (highest vs lowest tertile: 0.87, lowest two tertiles vs top tertile: 8%). Collectively, these factors accounted for 76% of PAF in men and 69% in women.

CONCLUSION:

IHD and stroke are the leading causes of premature mortality in the Golestan Cohort Study. Enhancing socioeconomic status and physical activity, reducing opium and tobacco use, increasing vegetable/fruit consumption and controlling hypertension and diabetes are recommended to reduce premature deaths.

• Authors: Mahdi Nalini, Ebele Oranuba, Hossein Poustchi, Sadaf G Sepanlou, Akram Pourshams, Masoud Khoshnia, Abdolsamad Gharavi, Sanford M Dawsey, Christian C Abnet, Paolo Boffetta, Paul Brennan, Masoud Sotoudeh, Arash Nikmanesh, Shahin Merat, Arash Etemadi, Ramin Shakeri, Amir Ali Sohrabpour, Siavosh Nasseri-Moghaddam, Farin Kamangar, Reza Malekzadeh
• Journal: BMJ open (BMJ Open) Vol. 8 Issue 7 Pg. e021479 (07 18 2018) ISSN: 2044-6055 [Electronic] England
• PMID: 30021753 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, N.I.H., Intramural, Research Support, Non-U.S. Gov't)
• Copyright: © Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Topics

• Accidents, Traffic (mortality)
• Adult
• Aged
• Diet
• Educational Status
• Female
• Health Education
• Humans
• Iran (epidemiology)
• Male
• Middle Aged
• Mortality, Premature (trends)
• Myocardial Ischemia (mortality)
• Neoplasms (mortality)
• Prospective Studies
• Reproducibility of Results
• Risk Factors
• Stroke (mortality)
• Substance-Related Disorders (mortality)