Volume 33, Issue 229 (1-2024)
J Mazandaran Univ Med Sci 2024, 33(229): 27-39 |
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Karamitanha F, Ahmadi F, Fallahabadi H. The Trend of Incidence and Mortality of Ischemic Heart Disease in the Provinces of Iran from 1990 to 2019. J Mazandaran Univ Med Sci 2024; 33 (229) :27-39
URL: http://jmums.mazums.ac.ir/article-1-19920-en.html
URL: http://jmums.mazums.ac.ir/article-1-19920-en.html
Abstract: (282 Views)
Background and purpose: Ischemic heart disease (IHD) is a major public health problem and in 2019 it was the leading cause of years of life lost due to premature death. Knowing its incidence and mortality rates can help in designing and implementing preventive interventions in different regions of the country. In this study, the incidence and mortality pattern of IHD during the years 1990-2019 was investigated in the provinces of Iran.
Materials and methods: In the current ecology study (ethics code IR.ZUMS.REC.1402.216), age-standardized incidence and mortality rate (per 100,000 population) of ischemic heart disease for 31 provinces of Iran from the Global Burden of Disease Database (GBD) in 1990, 1995, 2000, 2005, 2010, 2015 and 2019 were extracted. Also, the incidence and mortality rates in the age groups below 44, 45-54, 55-64, 65-74, 75-84, and above 85 years in the studied years were investigated. In men and women, in different age groups and overall, the mortality-incidence ratio (MIR) was also calculated. To identify provinces with similar trends in incidence, mortality, and MIR in the studied years, model-based clustering analysis was used. A finite mixture of multivariate t-distributions was used in the clustering method. Bayesian Information Criterion (BIC) was used to determine the number of clusters (number of different trends). To determine the number of clusters, different clusters were considered and BIC was calculated. The number of clusters with the lowest BIC value was considered as the final number of clusters in each index. Analyzes were performed in R 4.2.0 software.
Results: During the years 1990 to 2019, the incidence rate of IHD in women has decreased by 6% and men by 4%, the mortality rate of IHD in women by 35% and men by 40%, and MIR in women by 69% and men by 62%. The results showed that from 1990 to 2019, in Khorasan Razavi province, we saw a 13% decrease in the total incidence of the disease, and in Ardabil province, we saw only a 1% decrease in the total incidence of the disease. The lowest rate of IHD in 2019 was in Tehran province. Also, in both genders, Tehran province had the lowest mortality rate and the lowest MIR. North Khorasan province has the highest incidence and Golestan province has the highest mortality rate and the highest MIR of the disease in 2019. Based on the results of clustering analysis, the incidence rate is 3, the mortality rate is 2 and MIR has 2 trends (clusters) in 31 provinces. The IHD incidence rate in Ardabil, Golestan, South Khorasan, Qazvin, Qom, Sistan, and Baluchistan, Tehran, and Yazd, the mortality rate in Ardabil, Bushehr, Chaharmahal and Bakhtiari, Hormozgan, Ilam, Kurdistan, Lorestan, Qazvin and Semnan, and MIR in West and East Azerbaijan, Bushehr, Chaharmahal and Bakhtiari, Fars, Gilan, Golestan, Hormozgan, Ilam, Isfahan, Kerman, Kermanshah, Khorasan Razavi, Khuzestan, Kurdistan, Lorestan, Markazi, Mazandaran, Semnan and Yazd had a similar trend and a higher value than other provinces.
Conclusion: The incidence and mortality rate and MIR have decreased during the 30 years of study in Iran, but this decrease in the incidence rate was less than the decrease in the other two indices. This shows the need for health system planners to pay attention and focus on first-level preventive programs. Also, the observed difference in incidence and mortality rate according to different provinces, and planning according to different regions is noted.
Materials and methods: In the current ecology study (ethics code IR.ZUMS.REC.1402.216), age-standardized incidence and mortality rate (per 100,000 population) of ischemic heart disease for 31 provinces of Iran from the Global Burden of Disease Database (GBD) in 1990, 1995, 2000, 2005, 2010, 2015 and 2019 were extracted. Also, the incidence and mortality rates in the age groups below 44, 45-54, 55-64, 65-74, 75-84, and above 85 years in the studied years were investigated. In men and women, in different age groups and overall, the mortality-incidence ratio (MIR) was also calculated. To identify provinces with similar trends in incidence, mortality, and MIR in the studied years, model-based clustering analysis was used. A finite mixture of multivariate t-distributions was used in the clustering method. Bayesian Information Criterion (BIC) was used to determine the number of clusters (number of different trends). To determine the number of clusters, different clusters were considered and BIC was calculated. The number of clusters with the lowest BIC value was considered as the final number of clusters in each index. Analyzes were performed in R 4.2.0 software.
Results: During the years 1990 to 2019, the incidence rate of IHD in women has decreased by 6% and men by 4%, the mortality rate of IHD in women by 35% and men by 40%, and MIR in women by 69% and men by 62%. The results showed that from 1990 to 2019, in Khorasan Razavi province, we saw a 13% decrease in the total incidence of the disease, and in Ardabil province, we saw only a 1% decrease in the total incidence of the disease. The lowest rate of IHD in 2019 was in Tehran province. Also, in both genders, Tehran province had the lowest mortality rate and the lowest MIR. North Khorasan province has the highest incidence and Golestan province has the highest mortality rate and the highest MIR of the disease in 2019. Based on the results of clustering analysis, the incidence rate is 3, the mortality rate is 2 and MIR has 2 trends (clusters) in 31 provinces. The IHD incidence rate in Ardabil, Golestan, South Khorasan, Qazvin, Qom, Sistan, and Baluchistan, Tehran, and Yazd, the mortality rate in Ardabil, Bushehr, Chaharmahal and Bakhtiari, Hormozgan, Ilam, Kurdistan, Lorestan, Qazvin and Semnan, and MIR in West and East Azerbaijan, Bushehr, Chaharmahal and Bakhtiari, Fars, Gilan, Golestan, Hormozgan, Ilam, Isfahan, Kerman, Kermanshah, Khorasan Razavi, Khuzestan, Kurdistan, Lorestan, Markazi, Mazandaran, Semnan and Yazd had a similar trend and a higher value than other provinces.
Conclusion: The incidence and mortality rate and MIR have decreased during the 30 years of study in Iran, but this decrease in the incidence rate was less than the decrease in the other two indices. This shows the need for health system planners to pay attention and focus on first-level preventive programs. Also, the observed difference in incidence and mortality rate according to different provinces, and planning according to different regions is noted.
Type of Study: Research(Original) |
Subject:
Epidemiology
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