@article{ref1,
title="Causes of premature death and their associated risk factors in the Golestan Cohort Study, Iran",
journal="BMJ open",
year="2018",
author="Nalini, Mahdi and Oranuba, Ebele and Poustchi, Hossein and Sepanlou, Sadaf G. and Pourshams, Akram and Khoshnia, Masoud and Gharavi, Abdolsamad and Dawsey, Sanford M. and Abnet, Christian C. and Boffetta, Paolo and Brennan, Paul and Sotoudeh, Masoud and Nikmanesh, Arash and Merat, Shahin and Etemadi, Arash and Shakeri, Ramin and Sohrabpour, Amir Ali and Nasseri-Moghaddam, Siavosh and Kamangar, Farin and Malekzadeh, Reza",
volume="8",
number="7",
pages="e021479-e021479",
abstract="OBJECTIVES: To examine the causes of premature mortality (<70 years) and associated risk factors in the Golestan Cohort Study. <br><br>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. <br><br>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. <br><br>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.<br><br>© 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.<p /> <p>Language: en</p>",
language="en",
issn="2044-6055",
doi="10.1136/bmjopen-2018-021479",
url="http://dx.doi.org/10.1136/bmjopen-2018-021479"
}