National and subnational mortality effects of metabolic risk factors and smoking in Iran: a comparative risk assessment
Open accessAbstract
Background: Mortality from cardiovascular and other chronic diseases has increased in Iran. Our aim was to estimate the effects of smoking and high systolic blood pressure (SBP), fasting plasma glucose (FPG), total cholesterol (TC), and high body mass index (BMI) on mortality and life expectancy, nationally and subnationally, using representative data and comparable methods. Methods: We used data from the Non-Communicable Disease Surveillance Survey to estimate means and standard deviations for the metabolic risk factors, nationally and by region. Lung cancer mortality was used to measure cumulative exposure to smoking. We used data from the death registration system to estimate age-, sex-, and disease-specific numbers of deaths in 2005, adjusted for incompleteness using demographic methods. We used systematic reviews and meta-analyses of epidemiologic studies to obtain the effect of risk factors on disease-specific mortality. We estimated deaths and life expectancy loss attributable to risk factors using the comparative risk assessment framework. Results: In 2005, high SBP was responsible for 41,000 (95% uncertainty interval: 38,000, 44,000) deaths in men and 39,000 (36,000, 42,000) deaths in women in Iran. High FPG, BMI, and TC were responsible for about one-third to one-half of deaths attributable to SBP in men and/or women. Smoking was responsible for 9,000 deaths among men and 2,000 among women. If SBP were reduced to optimal levels, life expectancy at birth would increase by 3.2 years (2.6, 3.9) and 4.1 years (3.2, 4.9) in men and women, respectively; the life expectancy gains ranged from 1.1 to 1.8 years for TC, BMI, and FPG. SBP was also responsible for the largest number of deaths in every region, with age-standardized attributable mortality ranging from 257 to 333 deaths per 100,000 adults in different regions. Discussion: Management of blood pressure through diet, lifestyle, and pharmacological interventions should be a priority in Iran. Interventions for other metabolic risk factors and smoking can also improve population health.
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Similar national comparative risk assessments were done in Australia, Iran, Japan, Mexico, South Africa, Thailand, the USA, and Vietnam.
“National comparative risk assessments (including in Australia, Iran, Japan, Mexico, South Africa, Thailand, USA, and Vietnam) have also been undertaken with similar approaches.11–16”
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Self-citation
- Authors
- Farzadfar, F., Danaei, G., Namdaritabar, H., Rajaratnam, J. K., Marcus, J. R., Khosravi, A., Alikhani, S., Murray, C. J., & Ezzati, M.
- Affiliations
- Non-Communicable Diseases Research Center (IR)
- Harvard University (US)
- Ministry of Health and Medical Education (IR)
- University of Washington (US)
- Imperial College London (GB)
- Corresponding author
- Ezzati, Majid
- Venue
- Population Health Metrics
- Published
- 2011-10-11
- Volume
- 9
- Issue
- 1
- Pages
- S47-S47
- ISSN
- 0099-5355 (ISSN-L)
- 1478-7954
- PMC
- PMC3229448
- OpenAlex
- W1854299688
- Cited by
- 12
- References
- 42
- Citations by year
- 2023: 1 · 2022: 1 · 2021: 1 · 2020: 1 · 2019: 2 · 2018: 2 · 2017: 2 · 2016: 1 · 2015: 1
- FWCI
- 0.00
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- The Lancet (publishedVersion)
- Population Health Metrics (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Epidemiology › Healthcare Systems and Public Health
- Keywords
- metabolic risk factors, smoking, systolic blood pressure, fasting blood glucose, total cholesterol, body mass index, cardiovascular mortality, life expectancy loss, attributable mortality, regional variation in mortality, Iran, non-communicable diseases
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