Years of Life Lost Due to Main Causes of Deaths in Yazd Province,Iran

Abstract

Aim

One approach to measure the demographic impacts of death is to examine the number of lost years of life. The present paper aims to estimate the “Years of Lost Life” (YLL) due to the main causes of death in Yazd province of Iran.

Method

The present study is an epidemiological examination for which the statistical population included all the death incidents in Yazd province (excluding stillbirth cases) over two time periods of 2011 and 2016 with a 5-year distance. The required data were obtained based on the Comprehensive System of Mortality Registration maintained by the Ministry of Health and Medical Education; while the standard life expectancy data were based on the World Health Organization standards using standard life table, level 26 of the West model (Coale and Demeny) for Japanese men and women. The standard YLL was calculated according to the WHO standard using a 0.03 relaxation rate for the future time and weighting coefficient for various ages and life years through the formula using the Microsoft Excel software.

Results

The findings of the present study suggest that two main causes of YLL in Yazd province during the year of 2011 were cardiovascular difficulties with the rates of 31.6 per 1000 persons for women and 27.1 per 1000 persons for men, and cancers with the rates of 14.9 per 1000 persons for women and 16.2 per 1000 persons for men. While the above numbers in 2016 were, respectively 22.5 per 1000 persons for women and 25.5 per 1000 persons for men due to cardiovascular difficulties; and 18 per 1000 persons for women and 15.5/1000 for men due to various types of cancers.

Conclusions

Our findings suggest that cardiovascular diseases and cancers are the main factors leading to Years of Lost Lifetime for the residents of Yazd province in Iran.

Keywords

years of lost lifetime mortality life expectancy epidemiology

Background

Prioritization of the health factors is considered as one of the challenges within the field of general health in societies. Certain and distinctive policies and strategies need to be developed in order to provide and promote health. Health policy-makers need to have access to accurate data and indices, so they can make proper decisions (Akbarpour, 2012; Tjepkema, 2011).

Mortality is amongst the main factors in demography which its fluctuations would lead to essential changes within healthcare, social and economic priorities of any population. Death is not just a biological phenomenon. Various mortality cases are different in terms of death type, mortality cause and amount of lifetime (Khosravi, 2007).

The concept of Disability-Adjusted Life Year (DALY) according to viewpoints of the WHO is defined as: total number of potential lifetimes which is lost because of early mortality (YLL) plus the lost years of life disability (YLD) (Tjepkema, 2011).

The YLL index can be implemented when identifying and prioritizing the causes of early mortality and evaluating the planning activities (Aragón, 2008). YLL is a measure which helps us with assessment of the mortality impacts. This index depends on two factors of “number of deaths” and “age of the deceased at the time of death”; so that a higher weight is associated with younger ages of death (early deaths). YLL plays an important role in prioritization of healthcare interventions and evaluation of social costs of the diseases. This index can even be implemented for older ages; although it leads to small values of life expectancy but the amount does not reach the zero value (Kamel, 2012; Leonard, 2019)

The studies on the global expense of diseases in 2013 showed that overall global “life expectancy at birth” has changed from 65.3 years in 1990 to 75.5 years in 2013. In fact, the life expectancy at birth has raised 6.2 years. Meanwhile the amount of DALY is reduced by 3.6% and the standardized DALY rate per 100,000 people is reduced by 26.7% during this period (Murray, 2015).

The rates of non-contagious diseases have risen significantly all over the world (Islam, 2014). An estimation in 2015 showed that 422.7 million cases of cardiovascular difficulties as well as 17.9 deaths had occurred in the world. Meanwhile various types of cancers have claimed the life of 8.7 million people worldwide (Torre, 2016). The highest rates of cancer cases are observed in the countries with higher income, but it is predicted that the number of cancer cases would increase due to population growth and changes in life style especially in low- or middle-income countries (Wang et al., 2015).

Considering the importance of calculating mortality rates and YLL in every society for the heath planning purposes on one hand and increasing rates of non-contagious diseases on the other hand, the present study aims to determine the share of main mortality factors of Yazd province in the YLL on order to assist the health policymakers with more effective prevention of danger factors and paying more attention to principal death factors within the province and eventually the whole country.

Methods

Study Design

The present study is a epidemiological examination for which the statistical population is consisted of all cases of death in Yazd province of Iran (excluding the stillbirth cases) at two time periods of 2011 and 2016 with the distance of 5 years. The required data were gathered from the healthcare department of the Yazd Medical Sciences and Healthcare and Treatment Services” based on the Comprehensive System of Mortality Registration of the Ministry of Health and Medical Education covering the data from all the counties in Yazd province.

The Yazd province (latitude: 31.8974° N; longitude: 54.3569° E) is located in the central part of the plateau of Iran. It's neighbor provinces from north, south, east and west are Semnan, Kerman and Fars, South Khorasan and Isfahan respectively. Population of the province was 1,138,533 people based on the national individual and house census of 2016 (Figure 1) (Dehghan, 2010). The Yazd province has a relatively homogenous population with a very low rate of ethnic, lingual and religious diversity. Also, regarding the language, the majority of the residents speak Persian and ethnic minorities are rare in the province. Moreover, although the province is considered an industrial hub based on economic and social indices and it is amongst the developed provinces of the country, many of the traditional family, culture and religion characteristics are still preserved within it while containing a unique combination of modern and traditional elements (Abbasi Shawazi, 2008).

Figure 1.

Location of the Yazd Province in Iran.

Data Quality Assessment

The collected data regarding the mortality rates were assessed in terms of “lack of registration” and “miss-registration” of the death causes in order to increase the accuracy of disease costs based on the Brass Growth Balance Method and the Bennett-Horiuchi Method (Adair & Lopez, 2018). This assessment included the possible cases of not registering or wrongly reporting the age of people. The data were partitioned into two categories of under an over five years old in light of the initial assumptions of those methods. In order to examine the extent of lack of registration regarding the child mortality (under the age of five), the data were estimated according to other existing data and comparisons were made considering the expected situation. First, the cases of stillbirth were omitted from the data. Mortality cases for which the age or gender of the deceased person was unknown were redistributed in relation with provincial mortality rates of Yazd province. Also, illogical codes (such as suicide at the age of less than five years old for both genders) and unlikely or very low-possibility codes (such as prostate cancer in females) were controlled for within the Yazd province mortality data. Accordingly, no impossible or very unlikely causes of death could be spotted within the data of 2011 and 2016.

Classification of ICD-10 Cause-of-Death Lists

For the purpose of this study, disease types were considered based on the version 10 of the ICD classification according to instructions of the ministry of health regarding the country of Iran. The codes for cancers (C00-D48), endocrine, nutrition and metabolic disorders (E00-E90), cardiovascular diseases (I00-I99), respiratory system deficiencies (J00-J99) and traffic incidents (V00-V99) were considered in the present study.

Definition and Calculation of the YLL

According to the viewpoints of the World Health Organization, the concept of YLL refers to the total number of potential years of life which are lost due to early mortality (Tjepkema, 2011).

In other words, YLL indicates the extent of loss incurred by the society due to losing its human capitals as the result of early deaths. The concept of lost life is related to the concept of life expectancy (LE). Life Expectancy is a demographic index and refers to: the average lifespan within a population assuming the stability of the current conditions in terms of birth and mortality status (Murray, 2015). In our study, the YLL measure was calculated according to the standards provided by the WHO and considering a relaxation rate of 0.03 for the future time while applying weight coefficients for various age groups (Mathers et al., 2001). As it is suggested by the WHO, the life expectancy of Japan was considered as the golden standard; moreover the standard life expectancy from the standard life table, level 26 of the West model of Coale and Demeny was used which shows the life expectancy of 80 years for men and 82.5 years for women (Coale et al., 1989).

The values of YLL were calculated according to the following formula using the Microsoft Excel software (Microsoft Inc., Seattle, WA-USA) (Mathers et al., 2001).

\begin{array}{l} Years of Lost Life (YLL) \\ = {N Ce}^{(ra)} / {(β + r)}^{2} [e^{- (} {^{β}}^{+ r) (L + a)} [- (β + r) (L + a) - 1] \\ - e^{- (} {^{β}}^{+ r) a} [- (β + r) a - 1]] 1 \end{array}

In which:

N: Number of deaths in terms of age and gender

β: Parameter of the weighting function for the age with the standard value of 0.04

r: relaxation rate with the standard value of 0.03

a: age at the time of death (illness or death).

c: correction coefficient for the weight of age which is considered as a fixed value of 0.1658

Results

The YLL (the number of lost years of life due to early death) with six causes of early death in Yazd Province of Iran during 2011 and 2016 has been calculated through the present study. The values of YLL per 1000 persons for 2011 and 2016 were obtained as 31.6 and 22.5 for women and 27.1 and 25.5 for men respectively. The highest values of YLL per 1000 persons in 2011 and 2016 for women and men were observed for the age group of 80+ and at the second level, the age group of 79-80 years old. The YLL per 1000 persons which were caused by cancer in Yazd province during 2011 and 2016 were 14.9 and 18.0 for women and 16.2 and 15.5 for men, respectively. The highest values of YLL per 1000 persons during the years of 2011 and 2016 for women were observed in the age group of 79-80 years old and the age group of 80+ as the second rank. Also, the highest values of YLL per 1000 persons during 2011 and 2016 for men were observed respectively for the age groups of 80+ and 79-80 years old (Table 1).

Table 1.

Years of Lost Life Due to Cardiovascular Diseases and Various Types of Cancer by Age Group and Gender in Yazd Province (2011 and 2016).

The cause of death	Age group	Female				Male
		2011		2016		2011		2016
		YLL	YLL (per 1000 persons)	YLL	YLL (per 1000 persons)	YLL	YLL (per 1000 persons)	YLL	YLL (per 1000 persons)
Cardiovascular diseases	0–4	86	1.7	869	14.9	398	7.8	324	5.3
	5–14	81	1	77	0.8	220	2.6	76	0.8
	15–29	450	2.8	390	2.9	541	3.1	529	3.7
	30–44	1062	9.4	460	3.2	1383	11	1483	9.6
	45–59	2320	35	1300	17.5	3044	41.5	3564	43.3
	60–69	2827	125.6	1708	64	2671	127.3	2872	104.7
	70–79	4302	274.3	2807	191.3	3556	238.3	2408	173.1
	≥80	5301	651.7	4845	545	3168	429	3073	364.3
	Total	16430	31.6	12456	22.5	14980	27.1	14329	25.5
Cancers	0–4	342	6.9	433	7.4	474	9.3	160	2.6
	5–14	559	6.9	639	6.9	360	4.2	372	3.9
	15–29	398	2.4	655	4.8	942	5.4	420	2.9
	30–44	1062	9.4	2212	15.6	1220	9.7	942	6.1
	45–59	2149	32.4	2361	31.7	2297	31.3	2791	33.9
	60–69	1332	59.2	1617	60.6	1380	65.8	2095	76.3
	70–79	1273	81.1	1279	87.2	1426	95.6	1421	102.2
	≥80	640	78.7	751	84.5	880	119.1	874	103.6
	Total	7755	14.9	9948	18	8977	16.2	9076	15.5

The rates of YLL per 1000 persons due to the respiratory system difficulties in 2011 and 2016 were respectively 6.5 and 7.2 for women and 7.1 and 7.9 for men in Yazd province. The highest rates of YLL per 1000 persons in 2011 and 2016 were observed for the 80+ year old men and then for 79-80-year-old men as the first and second rank age groups (Table 2).

Table 2.

Years of Lost Life Due to Respiratory System Difficulties by Age Groups and Gender in Yazd Province (2011 and 2016).

Age group	Female				Male
	2011		2016		2011		2016
	YLL	YLL (per 1000 persons)	YLL	YLL (per 1000 persons)	YLL	YLL (per 1000 persons)	YLL	YLL (per 1000 persons)
0–4	687	13.9	436	7.5	716	14	890	14.7
5–14	0	0	0	0	0	0	76	0.8
15–29	66	0.4	188	1.4	171	1	317	2.2
30–44	296	2.6	311	2.2	473	3.8	183	1.2
45–59	243	3.7	344	4.6	473	6.4	771	9.4
60–69	378	16.8	509	19.1	558	26.6	531	19.4
70–79	680	43.3	631	43	702	47.1	725	52.1
≥80	1009	124	1582	177.9	833	112.8	1119	132.7
Total	3358	6.5	4000	7.2	3924	7.1	4612	7.9

The rates of YLL per 1000 ue to traffic incidents in 2011 and 2016 were respectively 3.2 and 3.9 for women and 12.5 and 17.3 for men in Yazd province. The highest rates of YLL per 1000 persons in 2011 and 2016 were observed for women at the 70–80 age group and for men at the 15–29 age group. While it is expected that the highest rates of YLL per 1000 persons due to traffic incidents to occur for younger age groups, the results show the highest YLL per 1000 persons for the 0–4-year-old age group. Also, the next higher rank of the YLL per 1000 persons after this age group is for the 15–29-year-old age group. The highest rates of YLL per 1000 persons in 2011 and 2016 for men were observed for age groups of 15–29 and 30–44 respectively (Table 3).

Table 3.

The Years of Lost Life Due to Traffic Accidents by Age Group and Gender in Yazd Province (2011 and 2016).

Age group	Female				Male
	2011		2016		2011		2016
	YLL	YLL (per 1000 persons)	YLL	YLL (per 1000 persons)	YLL	YLL (per 1000 persons)	YLL	YLL (per 1000 persons)
0–4	257	5.2	604	10.4	553	10.8	564	9.3
5–14	315	3.9	325	3.5	215	2.5	1043	10.9
15–29	450	2.8	482	3.6	4027	23.1	3796	26.6
30–44	217	1.9	196	1.4	1366	10.9	2903	18.8
45–59	294	4.4	311	4.2	401	5.5	1265	15.4
60–69	28	1.2	140	5.2	185	8.8	335	12.2
70–79	88	5.6	87	5.9	109	7.3	124	8.9
≥80	20	2.4	34	3.8	25	3.4	109	12.9
Total	1669	3.2	2178	3.9	6880	12.5	10139	17.3

The rates of YLL per 1000 persons due to endocrine and metabolic disorders in 2011 and 2016 were 8.4 and 9.6 for women and 5.4 and 7.8 for men. The highest rates of YLL per 1000 persons in 2011 and 2016 for women and men were observed in 80+ and then the 79-80 years old age groups respectively (Table 4).

Table 4.

The Years of Lost Life Due to Endocrine and Metabolic Disorders by the Age Groups and Gender in Yazd Province (2011 and 2016).

Age group	Female				Male
	2011		2016		2011		2016
	YLL	YLL (per 1000 persons)	YLL	YLL (per 1000 persons)	YLL	YLL (per 1000 persons)	YLL	YLL (per 1000 persons)
0–4	515	10.4	348	6	238	4.7	647	10.7
5–14	81	1	160	1.7	75	0.9	0	0
15–29	62	0.4	72	0.5	110	0.6	133	0.9
30–44	141	1.2	264	1.9	132	1.1	262	1.7
45–59	514	7.8	660	8.9	599	8.2	977	11.9
60–69	1061	47.2	1248	46.7	679	32.4	1150	41.9
70–79	1101	70.2	1352	92.1	774	51.9	778	55.9
≥80	909	111.7	1217	136.9	390	52.8	610	72.3
Total	4384	8.4	5319	9.6	2997	5.4	4555	7.8

Table 5 shows all the years of lost life due to main causes of death, namely the cardiovascular diseases, cancers, respiratory system difficulties, traffic incidents, endocrine and metabolic disorders by gender in 2011 and 2016 within the Yazd province.

Table 5.

All the YLL Due to Main Causes of Death by Gender (Yazd Province, 2011 and 2016).

The main causes of death	Female				Male
	2011		2016		2011		2016
	YLL	YLL (per 1000 persons)	YLL	YLL (per 1000 persons)	YLL	YLL (per 1000 persons)	YLL	YLL (per 1000 persons)
Cardiovascular	16430	31.6	12456	22.5	14980	27.1	14329	25.5
Cancers	7755	14.9	9948	18	8977	16.2	9076	15.5
Respiratory	3358	6.5	4000	7.2	3924	7.1	4612	7.9
Traffic accidents	1669	3.2	2178	3.9	6880	12.5	10139	17.3
Endocrine and metabolic	4384	8.4	5319	9.6	2997	5.4	4555	7.8

Discussion

Iran, like many other countries has witnessed some changes in the patterns of mortality during the past century. Based on the results of the present study which examined the five main causes of deaths in Yazd province, cardiovascular diseases have been the most significant cause of deaths in 2011 and 2016 in that province. Various types of cancers, respiratory system difficulties, traffic incidents and endocrine/metabolic disorders are at the lower ranks of particular causes of deaths, respectively.

As our study shows, the YLL rates have reduced from 2011 to 2016 for women and men. Nevertheless, the cardiovascular diseases are still the main cause of the YLL (Khazaei et al., 2014; Koohi, 2015). However, Faghihi et al. (2015) and Hajivand et al. (2011) have reported that transportation incidents, non-intentional incidents, and traffic accidents are the main causes of death which is not in concordance with the findings of the present study. The results obtained from the studies which have addressed the national trends of mortality causes in recent years suggest that deaths due to contagious diseases have seen a decreasing trend; meanwhile the deaths due to non-contagious diseases such as cardiovascular diseases, non-intentional incidents and cancers followed an increasing trend (Islam, 2014). Recent studies show that more than two third of the mortality cases in Iran are caused by three major factors: cardiovascular disease, non-intentional incidents and cancers (Mirzaei, 2012).

The findings of the present study show an increasing trend on the YLL due to various types of cancers in women of Yazd province; which are in concordance with a number of other studies (Faghihi et al., 2015; Hajivandi et al., 2011). However, the findings of Khazaei et al. (2014) and Ghashlaghi et al. (2005) are not in alignment with ours.

The YLL due to traffic incidents has been following an increasing pattern within the Yazd province for women and men. A number of other studies have reported comparable results to our results here (Faghihi et al., 2015; Mirzaei, 2012; Naghavi, 2008). Increasing the number of motor vehicles through the transition into industrialization during the recent years and subsequently increasing the traffic accidents along with lack of efforts for improving the standards of the life within the new context, including lack of suitable roads and streets in comparison to very high rates of traffic and number of motor vehicles, and also cultural weakness of the people as well as socio-psychological factors can be named as the main determining factors of social health.

The increasing trend of YLL due to the respiratory system difficulties which was shown by the present study for women and men is in alignment with those reported by Khazaei et al. (2014) and Ghashlaghi et al. (2005) as well. Air pollution is one of the problems in all large cities of the world and the increase of air pollution is related with the increase of mortality cases caused by cardiovascular and respiratory disorders.

Our findings show that the YLL caused by endocrine and metabolic diseases also has followed an increasing trend. Diabetes is the most common metabolic disorder and the most common metabolic disease (Faraji, 2015; Mohammadi, 2017). In the Yazd province, the adjusted prevalence for age group of 40–69 was reported as 15.9% for men and 20.6% for women. Those figures show the high rate of prevalence in Iran and particularly in Yazd province [28]. Therefore, considering the high rates of diabetes in the region, results of the present study also confirm that endocrine and metabolic disorders are amongst the major causes of deaths in the Yazd province (Ghashlaghi et al., 2005),

Strengths and Limitations

One of the strength points of the present study is that the whole Yazd province is covered for the first time, so the findings can be useful for various policymaking efforts both in demography and healthcare areas. The YLL rate has been calculated for two years of 2011 and 2016 with five years of distance; so comparisons can be made by the policymakers. Moreover, quality of the data was examined through suitable statistical methods. A limitation was that no data except those for major causes of deaths were exposed to the researcher.

Conclusion

As a general conclusion, mortality rates due to non-contagious diseases are at the rise. Two main causes of YLL within the Yazd province are cardiovascular diseases and cancers. Since creating the change in lifestyle of people is definitely the basic element of prevention against non-contagious causes of death such as heart disease, accidents and mishaps which are rooted in cultural and social behavior conditions, our suggestion is to facilitate this important task through educating and empowering people, policymaking and considering the required laws and regulations in order to create environments which promote healthy behaviors and lifestyle. Therefore, the effects of many factors of danger could be eliminated or reduced through proper interventions within the society. Even minor changes in dangerous factors can lead to great benefits. Prevention through social interventions against factors of cardiovascular danger, including smoking, inappropriate (fatty and lacking fruits and vegetables) diets, lack of physical activities and also other environmental, social and behavioral variables would be possible.

Footnotes

Authors’Contributions

AAN and MS contributed to the design, MS and MM statistical analysis, participated in most of the study steps. MM and MA prepared the manuscript. AAN and MS and MM assisted in designing the study, and helped in the, interpretation of the study. All authors have read and approved the content of the manuscript

Acknowledgements

The authors thank the faculty members of Social Sciences, Yazd University.

Data Accessibility Statement

Datasets are available through the corresponding author upon reasonable request.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Funding for this research was provided by the deputy of research and technology of the Yazd University, number 38542.

ORCID iD

Masoud Mohammadi

Author Biographies

Abbas Askari-Nodoushan, Associate Professor, currently works at the social sciences department in faculty of social Sciences in Yazd University.

Maryam Sabbaghchi, PhD student, currently works at the Social Sciences department in faculty of social sciences in Yazd University.

Masoud Mohammadi, currently works at the nursing and midwifery, in Kermanshah University of Medical Sciences. Masoud does research in Public Health, Epidemiology.

Maryam Askari, currently works at the diabetes research center in Shahid Sadoughi University of Medical Sciences of Yazd.

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