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ABSTRACT Objective: Asthma is a globally important non-communicable disease with major public health consequences. The aim of this study was to determine the mortality rate and years of life lost (YLL) due to asthma in southern Iran. Methods: All deaths due to asthma in Fars province from the electronic population-based death registration system (EDRS) were obtained. Crude mortality rate, age-standardized mortality rate, YLL and YLL rate data were calculated. The JoinPoint Regression method was used to examine the trend. Results: During the 16-year study period (2004-2019), 1167 deaths due to asthma occurred in Fars province among which 54.7% (638 cases) were men and 29.6% (346 cases) were in the age group of 70-79 years. Crude mortality rate of asthma had decreased by 121% and 84% in males and females, respectively from 2004 to 2019. The total years of life lost due to asthma during the 16-year study period were 7697 (0.24 per 1000 people) in men, 6882 (0.22 per 1000 people) in women. According to the join point regression analysis, the 16-year trend of YLL rate due to premature mortality was decreasing: the annual percent change (APC) was -5.6% (95% CI −8.2 to −2.9, P = 0.001) for males, −4.4% (95% CI −7.3 to −1.4, P = 0.008) for females. Conclusion: The trend of mortality and years of life lost due to asthma has decreased significantly during the years of study, although in some age groups, especially the age group of 45-59 years which has the highest number of years of life lost, this trend has been constant and unchanged. It is necessary to conduct other studies to investigate the possible reasons for this unchanged trend in vulnerable age groups.

Background: Traditionally, mortality rates are used to estimate public health problems and determine the relative significance of different causes of mortality, but they cannot necessarily determine the burden of premature death.  We aimed to investigate the 16-year trend of burden of premature mortality in Southern Iran. Methods: In this cross-sectional study, all deaths due to various causes of death in Fars Province from the electronic population-based death registration system (EDRS) were obtained. Crude and age-standardized mortality rate, Years of Life Lost (YLL) and YLL rate data were calculated and to examine the trend, joinpoint regression was used.   Results: During the study period, 281,903 deaths occurred, of which, 59.85% (n=168,735) occurred in men. Also, 42.18% of these deaths (n=118,610) occurred due to cardiovascular diseases (CVDs). The total number of YLLs due to premature death was 4,154,828 years. Of these, 2,591,564 years (62.37%) were in men. The highest number of YLL was due to CVDs, external causes of death and cancer. Trend of YLL rate due to premature mortality was decreasing: the annual percent change (APC) was -2.1% (95% CI -2.6 to -1.6, P<0.001) for males, -0.9% (95% CI -1.4 to -0.4, P=0.002) (P=0.002) for females. Conclusion: Although the trend of premature death has been decreasing during the years of study, but the seven major causes of premature death in 2004 to 2019 were non-communicable diseases, especially ischemic heart diseases, stroke, external cause of morbidity, and cancer.  Furthermore, our findings indicate a change in the role of non-communicable diseases in premature mortality in recent years.

Background Diabetes mellitus (DM) had one of the highest global disease burdens and is associated with premature morbidity, mortality, and reduced life expectancy. There has been little study regarding mortality and years of life lost attributable to DM in low-and-middle income countries. Methods In this cross-sectional study, mortality rate and years of life lost (YLL) due to diabetes and its complications were examined during the years 2004–2019. Death statistics were collected through electronic registration of death of ministry of health and medical education for Fars province. Age standardized mortality rate (ASR) and joinpoint regression analysis carried out. Results A total of 6,403 deaths due to diabetes and its complications were recorded. Of these, 53.11% (3,401 cases) were women. The total YLL during the same period was 35,664 (1.13 per 1000 people) in men, and 42,459 (1.37 per 1000 people) in women. Diabetes resulted in a total of 78,123 YLL with an average 12 years of life lost per person with diabetes. According to the joinpoint regression, the 16-year trend in the YLL due to diabetes and its complications was increasing. The APC (annual percent change) was 4.7% (95% CI 1.9–7.5, p =0.002) for men, and 4.5% (95% CI 2.9–6.1, p <0.001) for women. Conclusions In this study, we found that from 2004 to 2019, the crude mortality rate, age standardized rate, and years of life lost due to diabetes were on the rise. We found obvious sex differences in diabetes-related deaths. The highest YLLs were in the age range 50–64. An accurate estimation of diabetes mortality could provide empirical support for future diabetes prevention and control strategies, determine priorities in health protection, and provide a basis for accurate prevention and control of diabetes in different regions and groups.

Background: Although the incidence of leukemia’s is not high, many of these cancers lead to death over a short period. This is a cross-sectional study on leukemia deaths in southern Iran. Methods: All deaths due to leukemia in the Fars province were obtained from the population-based electronic death registration system (EDRS). Crude and age-standardized mortality rate (ASMR), YLL, and YLL rate data were calculated, and joinpoint regression was used to examine the trend. Results: Totally, 3141 deaths from leukemia occurred in the Fars province during the study period (2004-2019). Of these, 61.5% (1933 cases) pertained to men. The crude mortality rate was 6.1 (95% CI: 5.8 to 6.4) in men and 3.9 (95% CI: 3.7 to 4.2) in women. Also, ASMR was 6.6 (95% CI: 6.3 to 6.9) and 4.2 (95% CI: 4.0 to 4.4) in men and women, respectively. The total YLLs due to leukemia were 32804 in men and 23064 in women. The joinpoint regression analysis demonstrated that the trend of YLL rate due to premature mortality was stable: the annual percent change (APC) was -1.2% (95% CI: -2.5 to 0.2, P=0.090) for males, and -1.0% (95% CI: -2.9 to 0.9, P=0.274) for females. Conclusion: The mortality and YLL due to leukemia had a stable trend. However, this trend has been decreasing or increasing in some age groups. Determining and controlling essential risk factors, especially the environmental factors of leukemia, may reduce its burden in the Fars province.

Background: Unintentional falls are one of the main causes of death and a significant burden on victims, families, and communities. This study aimed to determine the trend analysis of mortality rate and years of life lost (YLL) due to unintentional falls in Fars Province, Iran. Methods: All deaths due to unintentional fall in Fars Province, central Iran from the electronic population-based death registration system (EDRS) were obtained. Crude and age-standardized mortality rate, YLL and YLL rate data were calculated and to examine the trend, joinpoint regression was used. Results: During the 16-year study period (2004-2019), 1816 deaths due to falls occurred in Fars Province. Crude mortality rate had stable trend in men and increasing trend in women. The total years of life lost due to falls, were 25,437 in men and 5,720 in women. According to the joinpoint regression analysis, the 16-year trend of YLL rate due to premature mortality was decreasing in males. The annual percent change (APC) was -2.8% (95% CI -4.5 to -1.0, P=0.005). However, there were stable trends for females, APC was 3.5% (95% CI -1.8 to 9.1, P=0.181). Conclusion: Due to the increase in mortality caused by falls in women and stable trend in men, there is an urgent need to plan and implement preventive strategies to reduce the incidence of injuries caused by falls. Home and behavioral modifications such as increasing home lighting, providing handrails on stairs and bathrooms, and educating the people may play an important role in reducing fall deaths.

Background: There is an increase in the incidence of breast and gynecologic cancers in Iran during the last three decades. Literature is inadequate about the Years of Life Lost (YLL) attributed to these cancers in Iran. Methods: Mortality data due to these cancers amongst females aged >20 yr from 2004 to 2019 was acquired from “Electronic Death Registry System”, Fars Province, Iran. Using local health centers’ databases and national census reports from 1996 to 2016, the age-standardized incidence rate (ASR) per 100,000 people were estimated. YLLs were calculated using the WHO’s 2015 “YLL template”. Results: During 2004–2019, 1886 and 829 deaths occurred due to breast and gynecologic cancers, respectively. The ASR due to breast and gynecologic cancers showed a significant increasing trend (P<0.001 for each). The total YLL due to breast, cervical/uterine/vaginal/vulvar, and ovary cancers’ deaths in the 16-year period were 33,077, 7,172 and 6,584 yr, respectively. The highest YLLs were observed in 50-59-year-old females, followed by 40-49- and 60-69-year-old females. The 16- year trend of YLL rate due to premature mortality in breast cancer, ovary cancer and cervix cancer was increasing: annual percent change (APC) was 7.6% (95% CI: 5.5-9.7, P<0.001), 19.0% (95% CI: 12.2-26.1, P<0.001) and 9.2% (95% CI: -9.2 to 31.3, P>0.05, respectively. Conclusion: Mortality rate and YLLs due to breast and gynecologic cancers have been increased in southern Iran during the last twenty years. Early detection programs and allocating treatments at early stages should be prioritized.

Background: We aimed to determine the mortality rate and Years of Life Lost (YLL) due to lung cancer in Fars, Iran, during the period from 2004 to 2019. Methods: All deaths due to lung cancer in Fars Province, Iran from the electronic population-based death registration system (EDRS) were obtained. Crude mortality rate, age-standardized mortality rate, YLL and YLL rate data were calculated and trends examined. Results: During 2004-2019, 3346 deaths occurred due to lung cancer in Fars Province, which was 10.8% (3346/30936) of the total cancer deaths in this period. Crude mortality rate of lung cancer had increased 70% and 53% in male and female respectively from 2004 to 2019. The total YLL of lung cancer during the 16-year study period was 28,094 (0.9 per 1000) in men, 14,174 (0.5 per 1000) in women, and 42,268 (0.8 per 1000) in both sexes (sex ratio male/female=2). According to the join point regression, the 16- year trend of YLL rate due to premature mortality was increasing: APC was 2.5% (95% CI 0.9 to 4.2, P=0.005) for males, 1.4% (95% CI 0.3 to 2.6, P=0.017) for females. Conclusion: The mortality rate and YLL due to lung cancer in Fars Province is increasing, although the standardized mortality has a constant trend. Tobacco control is the most effective and least expensive way to reduce the number of lung cancer patients worldwide. National and local media can also play an important role in informing people about the risk factors.

Background: According to the Global Burden of Disease Study (GBD), cerebrovascular diseases are the second leading cause of death in the world. This is a cross-sectional study on deaths due to cerebrovascular diseases in southern Iran. Methods: In this cross-sectional study, data on all deaths caused by cerebrovascular diseases in the Fars province between 2004 and 2019 was extracted from the Electronic Death Registry System (EDRS). To eliminate or minimize the influence of age composition, standardized mortality rate was used based on the 2013 Segi standard populations of low- and middle-income countries. In order to measure the years of life lost (YLL) from cerebrovascular diseases, the standardized life table was considered. The Joinpoint Regression method was used to examine the trend of the crude and standardized mortality rate and the YLL rate. Results: Over the study period, 24,051 deaths occurred due to cerebrovascular diseases in Fars with 12,586 cases in men (52.3%). The trend of standardized mortality rate in males and females was decreasing (P value=0.001 and<0.001 for males and females, respectively). All YLL due to premature mortality from cerebrovascular disease during the 16-year study period were 119,436 (3.8 per 1000 persons) in men, and 111,172 (3.6 per 1000 persons) in women. Based on the joinpoint regression, the 16-year trend of YLL rate due to premature death was decreasing: annual percent change (APC) was -1.6% (95% CI -3.4 to 0.3, P=0.098) for males, and -2.0% (95% CI -3.6 to -0.4, P=0.017) for females. Conclusion: The trend of mortality rate and YLL caused by cerebrovascular diseases has decreased in our study. Necessary measures, mainly primary and secondary prevention, should be taken to continue the diminishing trend of cerebrovascular diseases.

Background: Gastrointestinal cancers can cause major health problems globally since their burden is increasing in many countries. We aimed to investigate the trend of years of life lost due to gastrointestinal cancers in Fars Province, southern Iran during the 2004-2019.                                     Methods: In this cross-sectional survey study, we obtained the information regarding all deaths due to gastrointestinal cancers in Fars Province from the electronic population-based death registration system (EDRS). Years of Life Lost (YLL) was calculated using the YLL template of 2015 by the WHO. To examine the trend for different years, join point regression based on the log-linear model was used. Joinpoint regression analysis describes changing trends over successive periods of time and the increasing or decreasing rate within each period.   Results: During the years of 2004-2019, 9742 deaths due to gastrointestinal cancers occurred in Fars Province. 6013 (61.72%) cases were male and 3729 (38.28%) cases were female (Male / Female Sex Ratio: 1.61). Overall, 4152 cases (42.63%) were due to gastric cancer and 2112 cases (21.68%) were due to liver cancer. Total years of life lost due to premature death from gastrointestinal cancers during the 16-year study period was 73565 yr (2.33 per 1000 persons) in men, 52766 yr (1.71 per 1000 persons) in women, and 126331 yr (2.02 per 1000 persons) in both sexes.                                                                                                                                       Conclusion: Among all cancers, the highest mortality rates in both sexes belong to gastric cancer. This study showed the trend of YLL rate of malignant neoplasms of liver and intrahepatic bile ducts, esophagus, oral cavity, and colon cancer were increasing in both sexes, however, the trend of YLL rate for malignant neoplasms of the small intestine was decreasing in both sexes. Variation of GI cancers patterns and trends around the Fars Province indicated that a more comprehensive control plan is needed to control these variations.