Secular trends in cardiovascular mortality in Iran, with special referenceto Isfahan

Objective - There has been a general decline in mortality from cardiovascul ar diseases (CVDs) in most of the developed countries since the beginning o f the 1970s. Sti II, in recent years developing countries have seen an incr easing frequency in CVD mortality. However, mortality rate studies in these populations are scarce. Here we report all-cause and CVD mortality rates f or men and women aged 25-74 years over a 16-year period in 24 cities in Ira n with special reference to the city of Isfahan. Methods and results - The study was based on national death records using t he ninth international classification of diseases and age standardization w as performed using the total population of Iran in 1985 as a standard. Due to limitations in available data, mortality rates for the specific categori es of CVD for the whole country could not be provided. The in-hospital deat h rates following myocardial infarction in coronary care units (CCUs) and c ardiology departments in Isfahan hospitals we re also assessed. The complet ed medical records from hospitals or the relatives of decedents were review ed by physicians certified in internal medicine, cardiology and neurology t o assess the reliability of death certificate data regarding CVD by determi ning the sensitivity and specificity of the death certificates against the standard of the reviewers. The official circulatory diseases proportional m ortality ratio continues to rise since 1981 with a steep increase since 198 7, constituting 26.6% and 47.3% of all deaths in 1981 and 1995, respectivel y. Age-adjusted all-cause and CVD mortality data were decreasing since 1981 and increasing since 1990. During those years age-adjusted CVD, stroke and other CVD mortality rates were decreasing in Isfahan with a slight increas e in ischaemic heart disease (IHD) death rates in both sexes. Mortality rat es based on sex showed a 38% and 24.8% decline in all-cause and CVD mortali ty in men between 1981 to 1995, and a 35% and 34.9% decline for female mort ality rates for the same period, respectively. The in-hospital death rate f ollowing myocardial infarction in Isfahan was increasing between 1993 and 1 995 with a slight decrease thereafter. The results of death certification a ssessment showed a specificity of 0.89 and a sensitivity of 0.43 with the p ositive and negative predictive values of 0.82 and 0.57, respectively. Conclusion - These data indicate that circulatory diseases remain a serious public health threat in Iran. It suggests the ongoing need for more regula r, systematic and innovative surveillance data to improve the capability of measuring, explaining and predicting the disease trend on which the nation al public health policy depends.