Risk factors for heart failure in a cohort of patients with newly diagnosed myocardial infarction: a matched, case-control study in Iran

Ali Ahmadi,Koorosh Etemad,Arsalan Khaledifar 한국역학회 2016 Epidemiology and Health Vol.38 No.-

OBJECTIVES: Risk factors for heart failure (HF) have not yet been studied in myocardial infarction (MI) patients in Iran. This study was conducted to determine these risk factors. METHODS: In this nationwide, hospital-based, case-control study, the participants were all new MI patients hospitalized from April 2012 to March 2013 in Iran. The data on 1,691 new cases with HF (enrolled by census sampling) were compared with the data of 6,764 patients without HF as controls. We randomly selected four controls per one case, matched on the date at MI and HF diagnosis, according to incidence density sampling. Using conditional logistic regression models, odds ratios (ORs) with a 95% confidence interval (CI) were calculated to identify potential risk factors. RESULTS: The one-year in-hospital mortality rate was 18.2% in the cases and higher than in the controls (12.1%) (p<0.05). Significant risk factors for HF were: right bundle branch block (RBBB) (OR, 2.86; 95% CI, 1.95 to 4.19), stroke (OR, 2.00; 95% CI, 1.39 to 2.89), and coronary artery bypass grafting (CABG) (OR, 2.03; 95% CI, 1.34 to 3.09). Diabetes, hypertension, percutaneous coronary intervention (PCI), atrial fibrillation, ventricular tachycardia, and age were determined to be the factors significantly associated with HF incidence (p<0.05). The most important factor in women was diabetes (OR, 1.41; 95% CI, 1.05 to 1.88). Age, hypertension, PCI, CABG, and RBBB were the most important factors in men. CONCLUSIONS: Our findings may help to better identify and monitor the predictive risk factors for HF in MI patients. The pattern of risk factors was different in men and women.

Domestic elder abuse and associated factors in elderly women in Tehran, Iran

Negar Piri,Koorosh Etemad 한국역학회 2018 Epidemiology and Health Vol.40 No.-

OBJECTIVES: Elderly people are often abused in many ways, with serious and lasting consequences. Elder abuse remains one of the most hidden forms of family conflict, and its frequency is anticipated to be rising in many countries that are rapidly experiencing population aging. The purpose of this study was to investigate the status of domestic elder abuse in elderly women in Tehran, Iran and to identify associated factors. METHODS: This cross-sectional study was conducted in 2017 among 260 women aged 60 and over, selected through multistage random sampling. Information on abuse and its risk factors was collected through interviews with the elderly in their homes. In order to measure domestic elder abuse, the validated Domestic Elderly Abuse Questionnaire was used. The ordinal logistic test was used in Stata version 12 to identify factors related to elder abuse. RESULTS: Overall, 90.4% of the subjects had experienced at least 1 type of abuse, among which, authority deprivation (68.5%) was the most common, and rejection (11.2%) the least common. The ordinal logistic analysis showed that the likelihood of experiencing more sever abuse was significantly higher in elderly people over 72 than in those aged 60-62 years (odds ratio, 2.07; 95% confidence interval, 1.03 to 4.17). CONCLUSIONS: Domestic elder abuse was found to be common in older women. Old age was an important risk factor for domestic elder abuse in elderly women in Tehran. Managing and preventing elder abuse is an important issue that needs to be addressed.

Decomposing gender disparity in total physical activity among Iranian adults

Ebrahim Rahimi,Seyed Saeed Hashemi-Nazari,Koorosh Etemad,Hamid Soori 한국역학회 2017 Epidemiology and Health Vol.39 No.-

OBJECTIVES: While gender differences in physical activity (PA) have been reported, their origin is not well understood. The present study aimed to identify factors contributing to this disparity. METHODS: This was a population-based cross-sectional study based on the 2011 surveillance of risk factors of non-communicable diseases that was conducted among Iranian adults. Multi-staged sampling was performed to obtain the required study sample. The primary outcome was gender differences in the prevalence of sufficient physical activity (SPA). Total physical activity (TPA) was calculated as metabolic equivalents (MET) per minute during a typical week, as recommended by the World Health Organization. On this basis, achieving 600 MET-min/wk or more was defined as SPA. The nonlinear Blinder-Oaxaca decomposition technique was used to explain the disparity. RESULTS: The predicted gap was 19.50%. About one-third of the gap was due to differences in the level of observable covariates. Among them, work status contributed the most (29.61%). A substantial portion of the gap remained unexplained by such differences, of which about 40.41% was related to unobservable variables. The differential effects of standard of living, ethnicity, and smoking status made the largest contribution, accounting for 37.36, 35.47, and 28.50%, respectively. CONCLUSIONS: Interventions to reduce the gender gap in PA should focus on increasing TPA among housewives and women with chronic diseases, as well as those with a higher standard of living. In addition, it is essential to explore the impact of ethnicity and smoking status on women’s TPA in order to promote health.

Temporal trend and spatial distribution of acute lymphoblastic leukemia in Iranian children during 2006-2014: a mixed ecological study

Sajjad Rahimi Pordanjani,Amir Kavousi,Babak Mirbagheri,Abbas Shahsavani,Koorosh Etemad 한국역학회 2020 Epidemiology and Health Vol.42 No.-

OBJECTIVES: The present study investigated the spatiotemporal epidemiological status of acute lymphoblastic leukemia (ALL), the most common childhood cancer, in Iran. METHODS: Using an exploratory mixed design, this ecological study examined 3,769 under-15 children with ALL recorded in the National Cancer Registry of Iran during 2006-2014. Data were analyzed using the Mann-Whitney U test, the Getis-Ord general G (GOGG) index, optimized hot spot analysis, and Pearson correlation coefficients (PCC) at a significance level of 0.05. RESULTS: The average annual incidence of the disease was 2.25 per 100,000 under-15 children, and the cumulative incidence rate (CIR) was 21.31 per 100,000 under-15 children. Patients’ mean age was 5.90 years (standard deviation, 3.68), and the peak incidence was observed among 2-year to 5-year-olds. No significant difference was found in mean age between boys and girls (p=0.261). The incidence of ALL was more common during spring and summer than in other seasons. The GOGG index was 0.039 and significant (p<0.001). Hot spots were identified in south, central, and eastern Iran and cold spots in the north and west of Iran. The PCC between the CIR and latitude was negative (r=-0.507; p=0.003) but that between the CIR and longitude was positive (r=0.347; p=0.055). CONCLUSIONS: The incidence of ALL in Iranian children was lower than that observed in developed countries, but showed an increasing trend. It can be argued that the incidence of ALL is due to synergistic interactions between environmental, infectious, geographical, and genetic risk factors.

Modification of the effect of ambient air temperature on cardiovascular and respiratory mortality by air pollution in Ahvaz, Iran

Sohrab Iranpour,Soheila Khodakarim,Abbas Shahsavani,Ardeshir Khosravi,Koorosh Etemad 한국역학회 2020 Epidemiology and Health Vol.42 No.-

OBJECTIVES: This study investigated the modification of temperature effects on cardiovascular and respiratory mortality by air pollutants (particulate matter less than 2.5 and 10 μm in diameter [respectively], ozone, nitrogen dioxide, carbon monoxide, and sulfur dioxide). METHODS: Poisson additive models with a penalized distributed lag non-linear model were used to assess the association of air temperature with the daily number of deaths from cardiovascular and respiratory diseases in Ahvaz, Iran from March 21, 2014 to March 20, 2018, controlling for day of the week, holidays, relative humidity, wind speed, air pollutants, and seasonal and long-term trends. Subgroup analyses were conducted to evaluate the effect modification for sex and age group. To assess the modification of air pollutants on temperature effects, the level of each pollutant was categorized as either greater than the median value or less than/equal to the median value. RESULTS: We found no significant associations between temperature and cardiovascular and respiratory mortality. In the subgroup analyses, however, high temperatures were significantly associated with an increased risk of cardiovascular mortality among those 75 years old and older, with the strongest effect observed on day 0 relative to exposure. The results revealed a lack of interactive effects between temperature and air pollutants on cardiovascular and respiratory mortality. CONCLUSIONS: A weak but significant association was found between high temperature and cardiovascular mortality, but only in elderly people. Air pollution did not significantly modify the effect of ambient temperature on cardiovascular and respiratory mortality.