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Hasani WSR, Muhamad NA, Hanis TM, Maamor NH, Chen XW, Omar MA, Cheng Kueh Y, Abd Karim Z, Hassan MRA, Musa KI. The global estimate of premature cardiovascular mortality: a systematic review and meta-analysis of age-standardized mortality rate. BMC Public Health 2023; 23:1561. [PMID: 37587427 PMCID: PMC10429077 DOI: 10.1186/s12889-023-16466-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 08/07/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is a significant cause of premature mortality worldwide, with a growing burden in recent years. Despite this, there is a lack of comprehensive meta-analyses that quantify the extent of premature CVD mortality. Study addressed this gap by estimating the pooled age-standardized mortality rate (ASMR) of premature CVD mortality. METHODS We conducted a systematic review of published CVD mortality studies that reported ASMR as an indicator for premature mortality measurement. All English articles published as of October 2022 were searched in four electronic databases: PubMed, Scopus, Web of Science (WoS), and the Cochrane Central Register of Controlled Trials (CENTRAL). We computed pooled estimates of ASMR using random-effects meta-analysis. We assessed heterogeneity from the selected studies using the I2 statistic. Subgroup analyses and meta regression analysis was performed based on sex, main CVD types, income country level, study time and age group. The analysis was performed using R software with the "meta" and "metafor" packages. RESULTS A total of 15 studies met the inclusion criteria. The estimated global ASMR for premature mortality from total CVD was 96.04 per 100,000 people (95% CI: 67.18, 137.31). Subgroup analysis by specific CVD types revealed a higher ASMR for ischemic heart disease (ASMR = 15.57, 95% CI: 11.27, 21.5) compared to stroke (ASMR = 12.36, 95% CI: 8.09, 18.91). Sex-specific differences were also observed, with higher ASMRs for males (37.50, 95% CI: 23.69, 59.37) than females (15.75, 95% CI: 9.61, 25.81). Middle-income countries had a significantly higher ASMR (90.58, 95% CI: 56.40, 145.48) compared to high-income countries (21.42, 95% CI: 15.63, 29.37). Stratifying by age group indicated that the age groups of 20-64 years and 30-74 years had a higher ASMR than the age group of 0-74 years. Our multivariable meta-regression model suggested significant differences in the adjusted ASMR estimates for all covariates except study time. CONCLUSIONS This meta-analysis synthesized a comprehensive estimate of the worldwide burden of premature CVD mortality. Our findings underscore the continued burden of premature CVD mortality, particularly in middle-income countries. Addressing this issue requires targeted interventions to mitigate the high risk of premature CVD mortality in these vulnerable populations.
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Affiliation(s)
- Wan Shakira Rodzlan Hasani
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia.
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Setia Alam 40170, Selangor, Malaysia.
| | - Nor Asiah Muhamad
- Sector for Evidence-Based Healthcare, National Institutes of Health, Ministry of Health, Shah Alam, Selangor, Malaysia
| | - Tengku Muhammad Hanis
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia
| | - Nur Hasnah Maamor
- Sector for Evidence-Based Healthcare, National Institutes of Health, Ministry of Health, Shah Alam, Selangor, Malaysia
| | - Xin Wee Chen
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, 47000, Selangor, Malaysia
| | - Mohd Azahadi Omar
- Sector for Biostatistics and Data Repository, National Institutes of Health, Ministry of Health Malaysia, Setia Alam 40170, Selangor, Malaysia
| | - Yee Cheng Kueh
- Biostatistics and Research Methodology Unit, Kubang Kerian, 16150, Kelantan, Malaysia
| | - Zulkarnain Abd Karim
- Office of The Manager to Biomedical Research Policy & Strategic Planning Unit, Institutes for Medical Research, Setia Alam 40170, Selangor, Malaysia
| | | | - Kamarul Imran Musa
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia
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Razeghian-Jahromi I, Ghasemi Mianrood Y, Dara M, Azami P. Premature Death, Underlying Reasons, and Preventive Experiences in Iran: A Narrative Review. ARCHIVES OF IRANIAN MEDICINE 2023; 26:403-410. [PMID: 38301100 PMCID: PMC10685823 DOI: 10.34172/aim.2023.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/03/2023] [Indexed: 02/03/2024]
Abstract
Premature mortality (PM) has emerged as a global health challenge. This is of eminent importance in low- and middle-income countries, where nearly three fourths of the deaths occur. The concerning issue is the early occurrence of fatal events in productive age. Fatal events before the age of 70 are called PM, which mainly result from cardiovascular diseases (CVDs). Iran as a middle- income country greatly suffers from the cardiovascular burden, which accounts for almost 50% of all PM. Despite substantial success in reducing mortality due to communicable diseases across different age ranges, urbanization and pervasiveness of cardiovascular risk factors have increased the death rate in adults in recent years. Undoubtedly, such lifestyles have imposed heavy costs on the healthcare system; it is possible that PM reduction, as one of the fundamental elements of sustainable development goals defined by the World Health Organization (WHO), would not be reached by the due date. Recently, researchers have introduced a cost-effective fixed-dose drug combination, the so-called polypill, in order to attenuate the detrimental effects of hypertension and hyperlipidemia, as two strong cardiovascular risk factors. PolyIran and PolyIran-Liver studies are two pivotal clinical trials that revealed the feasibility of primary and secondary prevention of premature cardiovascular mortality, both in an urban and a rural population. In the present narrative review, we tried to present a comprehensive appraisal on PM status, its underlying reasons, and the impact of polypill strategy on PM prevention in Iran.
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Affiliation(s)
| | | | - Mahintaj Dara
- Stem Cells Technology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Pouria Azami
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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