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Scientific Webinars

Scientific Webinars. National and subnational mortality effects of major metabolic risk factors and smoking in Iran: a comparative risk assessment. Farzadfar et al PHM 2011. Presented by Goodarz Danaei. May 11 2012. What is the most common cause of death and disabilities in Iran in men?

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Scientific Webinars

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  1. Scientific Webinars National and subnational mortality effects of major metabolic risk factors and smoking in Iran: a comparative risk assessment Farzadfar et al PHM 2011 Presented by GoodarzDanaei May 11 2012

  2. What is the most common cause of death and disabilities in Iran in men? • Ischemic heart disease • Stroke • Lung cancer • Road traffic injuries

  3. What is the most common cause of death and disabilities in Iran in women? • Ischemic heart disease • Stroke • Lung cancer • Road traffic injuries

  4. What is the most important NCD risk factor for mortality in Iran? • Overweight/obesity • High blood pressure • Smoking • High serum cholesterol • Diabetes and high blood glucose

  5. Outline • Background • Data sources and methods • Findings • Conclusion and future directions

  6. Outline • Background • Data sources and methods • Findings • Conclusion and future directions

  7. Global epidemiological transition Lopez et al. Lancet 2006

  8. Cardiovascular mortality in high-income countries Male Female Vital registration data from WHO

  9. Regional trends in blood pressure North America Male North America Female Danaei et al. Lancet 2011

  10. Regional trends in blood pressure North Africa and Middle East North America Male North America North Africa and Middle East Female Danaei et al. Lancet 2011

  11. Male Trends in CVD risk factors in Iran TC BMI SBP Female Farzadfar et al. Lancet 2011, Finucane et al. Lancet 2011, Danaei et al. Lancet 2011

  12. Selected risk factors • Systolic blood pressure (SBP) • Body mass index (BMI) • Fasting plasma glucose (FPG) • Total cholesterol (TC) • Smoking

  13. Outline • Background • Data sources and methods • Findings • Conclusion and future directions

  14. Data sources Risk factor exposure: Non-communicable diseases surveillance survey (2005) Relative risks: Danaei et al 2009 Law 2003 Prospective Studies Collaboration 2007 Mortality: Death registration system (2005) Tehran cemetery

  15. Non-communicable diseases surveillance survey 2005 • Multistage systematic cluster sampling • 89,400 adults aged 15-64 years • Questionnaire and physical measurements • 50,200 adults aged 25-64 years • lab data including fasting blood sample

  16. Analytical framework Relative risks Risk factor exposure Optimal exposure level

  17. Analytical framework Relative risks Risk factor exposure Optimal exposure level Population attributable fraction

  18. Analytical framework Relative risks Risk factor exposure Optimal exposure level Population attributable fraction Disease-specific attributable deaths Disease-specific deaths Correction for incompleteness Redistribution of deaths with unspecified cause

  19. Analytical challenges • Risk factor exposure: No exposure data in older age groups • Disease-specific deaths: Incompletenessof death registration system Redistribution of deaths with unspecified cause • Uncertainty in estimates: Sampling uncertainty Etiological effects uncertainty Uncertainty in the model for missing older age groups Completeness estimation uncertainty Uncertainty in proportional redistribution of deaths with unspecified cause

  20. Analytical challenges • Risk factor exposure: No exposure data in older age groups Insufficient data on smoking history • Disease-specific deaths: Incompletenessof death registration system Redistribution of deaths with unspecified cause • Uncertainty in estimates: Sampling uncertainty Etiological effects uncertainty Uncertainty in the model for missing older age groups Completeness estimation uncertainty Uncertainty in proportional redistribution of deaths with unspecified cause

  21. Smoking Impact Ratio • The accumulated hazards of smoking depend: • the age at which smoking began • number of cigarettes smoked per day • and cigarette type • These data are extremely rare. • Estimation of Disease Burden • CLC= Age-sex specific lung cancer mortality rate in a population • NLC= Age-sex specific lung cancer mortality rate of never-smokers in the • same population • S*LC and N*LC = Age-sex specific lung cancer mortality rates for • smokers and never-smokers in a reference population (Cancer Prevention Study II (CPS-II) )

  22. Analytical challenges • Risk factor exposure: No exposure data in older age groups Insufficient data for smoking history • Disease-specific deaths: Incompletenessof death registration system Redistribution of deaths with unspecified cause • Uncertainty in estimates: Sampling uncertainty Etiological effects uncertainty Uncertainty in the model for missing older age groups Completeness estimation uncertainty Uncertainty in proportional redistribution of deaths with unspecified cause

  23. Analytical challenges • Risk factor exposure: No exposure data in older age groups Insufficient data for smoking history • Disease-specific deaths: Incompletenessof death registration system Redistribution of deaths with unspecified cause • Uncertainty in estimates: Sampling uncertainty Etiological effects uncertainty Uncertainty in the model for missing older age groups Completeness estimation uncertainty Uncertainty in proportional redistribution of deaths with unspecified cause

  24. Selected regions for subnational analysis

  25. Outline • Background • Data sources and methods • Findings • Conclusion and future directions

  26. Exposure to selected risk factors in 2005, by region and sex SBP (mmHg) Southeast North-Northeast West Central National

  27. Exposure to selected risk factors in 2005, by region and sex SBP (mmHg) Southeast North-Northeast West Central National FPG (mmol/L) Southeast North-Northeast West Central National

  28. Exposure to selected risk factors in 2005, by region and sex SBP (mmHg) Southeast North-Northeast West Central National FPG (mmol/L) Southeast North-Northeast West Central National BMI (Kg/m^2) Southeast North-Northeast West Central National

  29. Number of deaths attributable to each risk factor in 2005, by sex (in thousands)

  30. Risk-deleted life expectancy in 2005, by risk factor and region

  31. Risk-deleted life expectancy in 2005, by risk factor and region

  32. Conclusions • Few metabolic risk factors account for a substantial loss of life from non-communicable diseases in Iran • Non-optimal blood pressure was the most important risk factor and accounted for almost 1 in 6 deaths in adults • The selected risk factors did not account for much of the variation in longevity across gender or region.

  33. Future directions • Conducting a comprehensive burden of disease study including estimation of role of a wider set of risk factors • Evaluating the determinants of exposure to risk factors • Designing interventions to reduce exposure to risk factors • Conducting experimental studies to evaluate the effectiveness of interventions • Implementing interventions and monitoring and evaluation

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