{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T00:46:29Z","timestamp":1781311589627,"version":"3.54.1"},"reference-count":44,"publisher":"BMJ","issue":"7","funder":[{"DOI":"10.13039\/501100000289","name":"Cancer Research UK","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000289","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Tehran University of Medical Sciences"},{"name":"NGIMS\/NIH"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"published-print":{"date-parts":[[2018,7]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>To examine the causes of premature mortality (&lt;70 years) and associated risk factors in the Golestan Cohort Study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Prospective.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>The Golestan Cohort Study in northeastern Iran.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>50 045 people aged 40 or more participated in this population-based study from baseline (2004\u20132008) to August 2017, with over 99% success follow-up rate.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>The top causes of premature death, HR and their 95% CI and population attributable fraction (PAF) for risk factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>After 444\u2009168 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2018-021479","type":"journal-article","created":{"date-parts":[[2018,7,18]],"date-time":"2018-07-18T16:44:48Z","timestamp":1531932288000},"page":"e021479","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":30,"title":["Causes of premature death and their associated risk factors in the Golestan Cohort Study, Iran"],"prefix":"10.1136","volume":"8","author":[{"given":"Mahdi","family":"Nalini","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ebele","family":"Oranuba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hossein","family":"Poustchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sadaf G","family":"Sepanlou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akram","family":"Pourshams","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masoud","family":"Khoshnia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdolsamad","family":"Gharavi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanford M","family":"Dawsey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian C","family":"Abnet","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Boffetta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Brennan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masoud","family":"Sotoudeh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arash","family":"Nikmanesh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahin","family":"Merat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arash","family":"Etemadi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramin","family":"Shakeri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amir Ali","family":"Sohrabpour","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siavosh","family":"Nasseri-Moghaddam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farin","family":"Kamangar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reza","family":"Malekzadeh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2018,7,18]]},"reference":[{"key":"2020050713385891000_8.7.e021479.1","doi-asserted-by":"publisher","DOI":"10.1007\/s11524-006-9089-7"},{"key":"2020050713385891000_8.7.e021479.2","first-page":"1742","article-title":"Continuing with \"\u2026a heavy heart\" - consequences of maternal death in rural Kenya","volume":"12 Suppl 1","author":"Pande","year":"2015","journal-title":"Reprod Health"},{"key":"2020050713385891000_8.7.e021479.3","doi-asserted-by":"publisher","DOI":"10.1177\/0141076812472623"},{"key":"2020050713385891000_8.7.e021479.4","first-page":"1742","article-title":"Intergenerational impacts of maternal mortality: Qualitative findings from rural Malawi","volume":"12 Suppl 1","author":"Bazile","year":"2015","journal-title":"Reprod Health"},{"key":"2020050713385891000_8.7.e021479.5","unstructured":"World Health Organization. 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