Temporal Trends of cardiovascular disease Mortality in Central Iran between 2001 and 2018: The Impact of Isfahan Healthy Heart Program (IHHP)

Background: Cardiovascular diseases (CVD) death, principally ischemic heart disease (IHD) and stroke, is the most common cause of mortality worldwide. We aim to determine the temporal trends in CVD mortality in two large districts that consist the intervention and control areas of the Isfahan Healthy Heart Program (IHHP) over a period of 18 years (2000-2018). Methods: : The Iran Death Registration System (DRS), cemetery databank in Isfahan, and the population of the two areas based on housing censuses of Iran were used for this study. IHHP was a comprehensive community-based intervention program for non-communicable disease (NCD) prevention and control using population and high-risk approaches. It was performed in 2000-2007 in Isfahan and Arak districts as an intervention and control areas, respectively. Using interpolating approach, the population was estimated between census years. Incompleteness, misalignment, and misclassification in the DRS were considered and addressed accordingly. Direct method was applied to calculate age-, gender-, and residency-standardized mortality rates (SMR) based on reference population. Results: The overall age-, gender-, and residency-standardized CVD mortality rate decreased from 586.28 (95% confidence interval [CI]: 559.39-615.76) to 410.67 (95% CI: 394.62-427.51) per 100,000 in intervention area between 2002 and 2011, a reduction of approximately 29.95%. The similar trend was observed for IHD and stroke standardized mortality rate (SMR) by 44.62% and 40.68% reduction, respectively. Control area and national data showed a rise in SMR in the first years of study followed by slight reduction from 2006. However, SMR showed increasing trend after 2011 in all regions. Nevertheless, the control area witnessed higher SMR compared with intervention area. The SMR was higher among individuals aged >75 years and among men during the study period. Conclusion: A decreasing trend in the SMR over a period of 2002-2011 could be likely related to the IHHP comprehensive interventions that were implemented in intervention areas. These findings assert the significant role of performing such preventive strategies at the population level and high risk groups that could lead to decreasing the risk factors of CVD and ultimately impact it’s mortality.