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Trends of mortality and years of life lost due to cardiovascular diseases in West Azerbaijan province, Iran, 2013-2024

This study analyzing 12 years of data from West Azerbaijan Province, Iran, reveals that while cardiovascular diseases caused a high and persistent burden of premature mortality with no significant change in Years of Life Lost trends, the majority of deaths occurred among men, underscoring the urgent need for sustained public health interventions.

Original authors: Najaf Ahmadi Aghziarat, Morad Ali Zareipour, Ehsan Rikhtegar, Fahim Bani, Keyvan Mollarahimi, Saeedeh Moharrek, Mojtaba Norouzi

Published 2026-07-27

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CC BY 4.0

Original authors: Najaf Ahmadi Aghziarat, Morad Ali Zareipour, Ehsan Rikhtegar, Fahim Bani, Keyvan Mollarahimi, Saeedeh Moharrek, Mojtaba Norouzi

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

Imagine the human body as a bustling city, with the heart acting as the central power plant that keeps the lights on and the traffic flowing. Sometimes, this power plant gets clogged or breaks down, leading to a condition known as cardiovascular disease (CVD). When this happens, it doesn't just stop the heart; it cuts short the "story" of a person's life. Scientists have a special way of measuring this lost story called "Years of Life Lost" (YLL). Think of YLL not just as counting dead bodies, but as counting the missing chapters of books that never got written. If a 20-year-old passes away, that's a huge pile of missing chapters compared to someone who lived to 90. Understanding these missing chapters helps communities figure out where to send their best firefighters and doctors to save the most stories before they end too soon.

Now, let's zoom in on a specific corner of the map: West Azerbaijan province in Iran. A team of researchers decided to look at the "missing chapters" caused by heart and blood vessel problems in this region over a 12-year stretch, from 2013 to 2024. They didn't just count the total number of people who passed away; they calculated exactly how many years of life were lost because these deaths happened too early. They treated the province like a giant library, sorting through 74,771 records of books that were closed too soon. Their goal was to see if the library was getting better at keeping stories going, or if the "power plant" failures were getting worse, and whether this was happening more to men or women, or to young people or older folks.

Here is what the researchers found when they opened the books. Over those 12 years, a total of 74,771 people in West Azerbaijan died from cardiovascular diseases. The story wasn't the same for everyone. Men lost more chapters than women; in fact, about 62% of these premature deaths happened to men, while 48% happened to women. When they looked at the "Years of Life Lost" (YLL), the numbers were staggering: men lost a total of 165,737 years of life, while women lost 118,632 years. To put that in perspective, for every 1,000 people in the province, men lost about 8 years of life on average, and women lost about 6 years.

The most interesting part of the story is how the numbers changed over time. You might expect that after 12 years of trying to fix things, the number of lost years would go down significantly, like a leaky roof finally getting patched. However, the researchers found that the roof was still leaking at about the same rate. The trend of lost years was remarkably stable. They used a special mathematical tool called "Joinpoint regression" to look for any sharp turns or sudden improvements in the data, but they didn't find any. The average annual change was a tiny, almost invisible drop of -0.33%, which wasn't statistically significant. In plain English, the burden of these diseases didn't get better, but it also didn't get dramatically worse; it just stayed stubbornly high.

The researchers also noticed some patterns in who was losing the most years. While the total number of deaths went up and down a bit (peaking in 2020), the proportion of deaths caused by heart issues remained a huge chunk of the total, hovering between 33% and 44% of all deaths. The "missing chapters" were most concentrated in middle-aged and older adults. For men, the biggest loss of years happened between ages 55 and 64. For women, the peak was a bit later, between 65 and 74. This suggests that while heart disease affects everyone, it is particularly ruthless in stealing the productive middle years of life, especially for men.

So, what does this mean for the future? The authors suggest that while the numbers haven't exploded, they haven't improved either. The stability of the data is actually a warning sign. It means that without new, targeted efforts, the problem will likely continue to weigh heavily on the community. The researchers point out that as the population gets older, even if the risk for each individual stays the same, the total number of deaths will naturally rise. They argue that to stop the "missing chapters" from piling up, the community needs to focus on specific groups, particularly men and middle-aged adults, and tackle the root causes like high blood pressure, diabetes, and lifestyle habits. The study concludes that the current situation is a call to action: the problem isn't going away on its own, and it needs a sustained, multi-pronged approach to finally start closing the gap on those lost years.

Technical Summary: Trends of Mortality and Years of Life Lost Due to Cardiovascular Diseases in West Azerbaijan Province, Iran (2013–2024)

Problem Statement
Cardiovascular diseases (CVDs) represent the leading cause of mortality globally and a primary contributor to the disease burden in Iran, accounting for approximately 30% of all deaths and nearly 15% of disability-adjusted life years (DALYs) as of 2021. While national-level data provides a macroscopic view, it often obscures critical regional disparities essential for tailoring public health interventions. Specifically, the province of West Azerbaijan in northwestern Iran faces unique challenges shaped by its ethnic diversity, geography, and socioeconomic factors, including limited rural access to specialized care and high rates of tobacco use. Prior to this study, comprehensive, longitudinal assessments of CVD mortality and its impact on population health (specifically Years of Life Lost, or YLL) were absent from the scientific literature for this region. The lack of granular trend data hampers evidence-based planning and resource allocation, particularly regarding how mortality patterns evolve across sex and age groups over time.

Methodology
This research employed a retrospective, population-based historical cohort design to analyze mortality trends and YLL attributable to CVDs in West Azerbaijan Province from 2013 to 2024.

Data Sources: The study utilized 74,771 death records extracted from the Iranian Ministry of Health and Medical Education's electronic population-based death registration system. This system integrates data from the Legal Medicine Organization, hospitals, cemeteries, and health centers.
Data Processing: Records were linked using national identification numbers to ensure accuracy. A multi-step quality assurance protocol was applied to remove duplicates and verify causes of death.
Classification: Causes of death were coded according to the International Classification of Diseases, 10th Revision (ICD-10). Records with insufficient documentation to confirm CVD as the underlying cause were excluded.
Statistical Analysis:
- YLL Calculation: YLL was computed using a standard formula incorporating the number of deaths ( $N$ ), standard life expectancy ( $L$ ), a discount rate ( $r = 0.03$ ), an age-weighting constant ( $\beta = 0.04$ ), and a modified constant ( $C = 0.1658$ ). The calculation adjusted for age and sex, using standard population data from 2013 for low- and middle-income countries.
- Trend Analysis: Joinpoint regression analysis was used to identify statistically significant change-points and estimate the Annual Percent Change (APC) and Average Annual Percent Change (AAPC).
- Metrics: The study calculated crude mortality rates (per 10,000), age-standardized mortality rates (ASMRs per 100,000), and YLL rates (per 1,000 population).

Key Results

Mortality Volume: Over the 12-year period, 74,771 deaths due to CVDs were recorded. The majority (62.0%) occurred in men, and the highest absolute numbers were observed in urban areas, though rural areas also showed significant burden.
Temporal Trends: The proportional mortality rate due to CVDs fluctuated between 33% and 44%, peaking in 2013 and 2020. While the Age-Standardized Rate (ASR) showed a relative decrease in recent years, the crude number of deaths increased in certain years, a phenomenon attributed to population aging.
Years of Life Lost (YLL):
- Total YLL over the period was 284,369 years (165,737 for men; 118,632 for women).
- Men experienced higher YLL across most age groups compared to women. The peak YLL for men occurred in the 55–59 and 60–64 age groups, while for women, it peaked in the 65–69 and 70–74 age groups.
- The YLL rate was approximately 7 to 9 per 1,000 population.
Statistical Significance: Joinpoint analysis revealed no statistically significant change in YLL trends over the full 12-year period.
- The Average Annual Percent Change (AAPC) for total YLL was −0.33% (95% CI: -2.57 to 1.96, $p=0.774$ ).
- Segment 1 (2013–2017) showed a non-significant decreasing trend (APC: −4.09%).
- Segment 2 (2017–2024) showed a non-significant increasing trend (APC: 1.88%).
- Overall, the data indicates a relative stability in the YLL indicator, with no significant upward or downward trajectory.

Significance and Claims
The authors claim that this study provides the first longitudinal assessment of CVD-related mortality and YLL trends specifically for West Azerbaijan Province. The findings highlight that CVDs continue to impose a high and persistent burden of premature mortality in the region, with no significant improvement in YLL trends over the last decade.

Key contributions and claims include:

Gender Disparity: The study confirms a significantly higher burden of CVD mortality and YLL in men compared to women, likely driven by higher prevalence of risk behaviors (tobacco, hypertension, poor diet) in males. This underscores the need for gender-sensitive prevention programs.
Aging Population Impact: The divergence between decreasing ASR and increasing or stable crude death counts is identified as a reflection of the "paradox of aging," where population growth in elderly demographics offsets improvements in age-specific mortality rates.
Policy Implications: The authors argue that the relative stability of the indicators should not be interpreted as a success but rather as a warning. Given the ongoing aging of the population and the persistence of metabolic risk factors, the burden is poised to increase without sustained intervention.
Strategic Recommendations: The paper advocates for multisectoral approaches that extend beyond clinical care to include environmental improvements (e.g., air pollution control), early screening for middle-aged populations, and the strengthening of primary care and electronic disease registration systems to better inform local policy.

The study concludes that while some indicators suggest relative control, the lack of significant reduction in YLL trends necessitates urgent, targeted, and sustained public health interventions to prevent a future escalation in the disease burden.

Technical Summary: Trends of Mortality and Years of Life Lost Due to Cardiovascular Diseases in West Azerbaijan Province, Iran (2013–2024)

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