TY  - JOUR
PY  - 2018//
TI  - Causes of premature death and their associated risk factors in the Golestan Cohort Study, Iran
JO  - BMJ open
A1  - Nalini, Mahdi
A1  - Oranuba, Ebele
A1  - Poustchi, Hossein
A1  - Sepanlou, Sadaf G.
A1  - Pourshams, Akram
A1  - Khoshnia, Masoud
A1  - Gharavi, Abdolsamad
A1  - Dawsey, Sanford M.
A1  - Abnet, Christian C.
A1  - Boffetta, Paolo
A1  - Brennan, Paul
A1  - Sotoudeh, Masoud
A1  - Nikmanesh, Arash
A1  - Merat, Shahin
A1  - Etemadi, Arash
A1  - Shakeri, Ramin
A1  - Sohrabpour, Amir Ali
A1  - Nasseri-Moghaddam, Siavosh
A1  - Kamangar, Farin
A1  - Malekzadeh, Reza
SP  - e021479
EP  - e021479
VL  - 8
IS  - 7
N2  - 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>
LA  - en
SN  - 2044-6055
UR  - http://dx.doi.org/10.1136/bmjopen-2018-021479
ID  - ref1
ER  -