Causes of premature death and their associated risk factors in the Golestan Cohort Study, Iran. Issue 7 (18th July 2018)

• Record Type: Journal Article
• Authors: Nalini, Mahdi; Oranuba, Ebele; Poustchi, Hossein; Sepanlou, Sadaf G; Pourshams, Akram; Khoshnia, Masoud; Gharavi, Abdolsamad; Dawsey, Sanford M; Abnet, Christian C; Boffetta, Paolo; Brennan, Paul; Sotoudeh, Masoud; Nikmanesh, Arash; Merat, Shahin; Etemadi, Arash; Shakeri, Ramin; Sohrabpour, Amir Ali; Nasseri-Moghaddam, Siavosh; Kamangar, Farin; Malekzadeh, Reza
• Is Part Of: BMJ open. Volume 8:Issue 7(2018)
• Publication Date: 2018-07-18
• Subjects: premature mortality -- cause of death -- risk factor -- Iran; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2018-021479
• Languages: English
• ISSNs: 2044-6055

Abstract

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.