Leading Causes of Adult Mortality Vary by Country Income Levels
WEDNESDAY, Sept. 4, 2019 -- Mortality rates and leading causes of death among adults vary across country income levels, and cardiovascular disease mortality is mainly due to modifiable risks, according to two studies published online Sept. 3 in The Lancet. The research was published to coincide with the European Society of Cardiology Congress 2019, held from Aug. 31 to Sept. 4 in Paris.
Gilles R. Dagenais, M.D., from the Université Laval in Quebec City, and colleagues examined differences in the incidence of diseases and related mortality among 162,534 participants enrolled in the first two phases of the Prospective Urban Rural Epidemiology (PURE) study. The researchers found that 7.0 percent of participants died during follow-up. Cardiovascular disease occurred more often in low-income (LICs) and middle-income countries (MICs) than in high-income countries (HICs; 7.1 and 6.8, respectively, versus 4.3 cases per 1,000 person-years). Overall mortality rates were much higher in LICs than MICs and HICs (13.3 versus 6.9 and 3.4, respectively, per 1,000 person-years); this pattern was seen for all causes of death, with the exception of cancer, which had similar mortality across country income levels.
Salim Yusuf, D.Phil., from McMaster University in Hamilton, Ontario, Canada, and colleagues examined the correlations for 14 potentially modifiable risk factors with mortality and cardiovascular disease in 155,722 PURE participants. The researchers found that modifiable risk factors accounted for about 70 percent of cardiovascular disease cases and deaths. The predominant risk factors for cardiovascular disease were metabolic risk factors (41.2 percent of the population-attributable fraction [PAF]). Behavioral risk factors contributed most to deaths (26.3 percent of the PAF), and low education level was the single largest risk factor (12.5 percent of the PAF). Household air pollution, poor diet, low education, and low grip strength had stronger effects on cardiovascular disease or mortality in MICs and LICs than HICs.
"PURE indicates that a large proportion of cardiovascular disease and premature deaths could be averted by targeting a few modifiable risk factors," Yusuf and colleagues write.
The PURE study was funded by grants from several pharmaceutical companies.
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Posted: September 2019