Descriptive Epidemiology of Lymphoma in Northern Iran: Results from the Golestan Registry 2004-2013.

BACKGROUND: There is currently little known about the epidemiology of lymphomas in Iran. The aim of this paper is to describe the geographic and time variations in incidence rates of lymphomas in the Golestan province between 2004 and 2013. METHODS: The Golestan Population-based Cancer Registry (GPCR) routinely registers primary cancer patients from all sources (e.g. pathology centers, hospitals, etc.) throughout the Golestan province. We obtained data on newly-diagnosed lymphomas in Golestan during 2004-2013 from the GPCR dataset. Crude rates and age standardized incidence (ASR) rates (per 100000) of lymphomas were estimated, joinpoint regression was used to quantify incidence trends and average annual percent changes (AAPCs) were calculated. RESULTS: In total, 898 new cases of lymphoma were registered in the GPCR during 2004-2013. The ASR of Hodgkin lymphoma (HL) was 1.5 and 1.1 in males and females, respectively, while corresponding non-Hodgkin lymphoma (NHL) rates were greater, at 6.5 and 3.4 in males and females, respectively. Our results indicated a significant difference in the trends of HL between males (AAPC = -3.2) and females (AAPC = 3.6, P value = 0.001). The incidence rates of lymphoma were considerably higher in the urban population (ASR = 7.3) compared to those residing in rural areas (ASR = 5.3, P value = 0.054). We also found higher incidence rates for both HL and NHL in the western parts of the Golestan province. CONCLUSION: The incidence rates of lymphoma in the Golestan province are relatively high and vary geographically, with a higher incidence observed in the western area. Such differences may reflect unknown lifestyle and environmental determinants linked to ethnic susceptibility differing between the two areas.

Increasing trends of lung cancer in Golestan province, Northern Iran (2004-2016).

INTRODUCTION: We aimed to present the time trends and geographical distribution of lung cancer in Golestan province, a high-risk area for pulmonary tuberculosis (TB) in Northern Iran (2004-2016). METHODS: Data on incident primary lung cancers were obtained from the Golestan population-based cancer registry. The data were analyzed by CanReg-5 software to calculate the age-standardized incidence rates (ASRs). We used Joinpoint software for time trend analysis. Average annual percent changes were calculated. The contribution of population aging, population growth and risk to the overall changes in incidence of lung cancer were determined using partitioning analysis. RESULTS: Overall, 1829 cases of lung cancer were registered by the GPCR during 2004-2016, of which 1274 (69.7%, ASR in 2016 = 21.3) were men and 555 (30.3%, ASR in 2016 = 11.4) were women. The results of Joinpoint regression suggested a significant increasing trend in incidence of lung cancer in Golestan province during 2004 and 2016 (AAPC = 3.74; p-value = 0.01) with more prominent increasing in rural population (AAPC = 4.93; p-value<0.01). The number of new cases of lung cancer increased by 131.6% (from 98 in 2004 to 227 in 2016), of which 34.1%, 22.3% and 75.3% were due to population size, population aging and risk, respectively. Hot points of lung cancer were found in western parts of the Golestan. CONCLUSION: With high incidence rates and increasing trends of lung cancer, further studies are warranted to clarify the role of TB and other risk factors on its burden in this population.

Completeness and Accuracy of Death Registry Data in Golestan, Iran.

BACKGROUND: We aimed to evaluate completeness and accuracy of the Golestan Death Registry (GDR) to identify cancer-related causes of death (CCoD). METHODS: The GDR data (2004-2015) were compared with cancer data collected from clinical/pathological sources (the considered gold standard) by the Golestan Population-Based Cancer Registry (GPCR). Using a linkage method, matched cases, including subjects with CCoD and those with ill-defined cause of death (ICoD) (garbage codes), were identified and entered into the final analysis as study subjects. The completeness (percentage of study subjects with CCoD) and accuracy (number of subjects with correct CoD from the total number of study subjects) of the GDR were calculated. RESULTS: In total, 3,766 matched cases were enrolled. Overall, the completeness and accuracy of the GDR for identifying CCoD were 92.7% and 53.2%, respectively. There were variations by cancer site and age group, with completeness and accuracy highest for brain cancer (96.3%) and leukaemia (79.8%) while the lowest accuracy was observed for colorectal cancer (29.9%). The completeness and accuracy of GDR was higher in patients aged under 60 years (95.7% and 53.6%, respectively). We also found higher completeness (93.7%) and accuracy (55.8%) in residents of rural areas. CONCLUSION: Linkage of death registry data with cancer registry data can be a significant resource for evaluating quality of the death registry data. Our findings suggested that completeness of the GDR for identifying CCoD is reasonable, but accuracy is relatively low. Access to clinical and pathological data from other sources and enhanced training of death certifiers can improve the present situation.

Building cancer registries in a lower resource setting: The 10-year experience of Golestan, Northern Iran.

INTRODUCTION: The Golestan population-based cancer registry (GPCR) was established in Golestan province, Northern Iran, within the Asian belt with predominance of upper-gastrointestinal cancers. We aimed to present the experiences of the registry in a resource-limited setting over the 10 years since its inception (2004-2013). METHODS: The GPCR was established as a research project to enable sustainable funding. A clear plan was developed for use of the GPCR data. New primary cancers were registered based on international standards, indices of data quality were routinely assessed and age-standardized incidence rates (ASR) per 100,000 person-years calculated using IARC's CanReg-5 software. RESULTS: Overall, 19807 new cancer cases were registered during the study period, an average of 1981 cases per annum, with overall ASR of 175.0 and 142.4 in males and females, respectively. The GPCR data suggested gastrointestinal and breast cancers as the most common malignancies in Golestan province. We observed increasing incidence rates of breast and colorectal cancers but declining trends of esophageal cancer. Overall, indices of data quality were within acceptable ranges. CONCLUSIONS: The GPCR data have been included in IARC's Cancer Incidence in Five Continents series, were used in 21 research projects, and published as 30 research papers. The key ingredients for the successful establishment and maintenance of the GPCR included sustainable sources of funding, a clear action plan for the use of data as well as stakeholder cooperation across all areas of the registration. The GPCR may be considered as a model for planning population-based cancer registries in lesser-resourced settings.

The association between abdominal obesity and serum cholesterol level.

BACKGROUND: The main aim of this study is to evaluate the association between serum cholesterol level and abdominal obesity in adult men and women in the north of Iran. MATERIALS AND METHODS: This cross-sectional and analytical study was conducted on the 1956 subjects (990 men and 966 women) between 25 and 65 years old chosen by cluster sampling. Plasma cholesterol was measured in the morning after a 12 h fast and determined by auto-analyzer. Hypercholesterolemia (HC) was defined by a total plasma cholesterol level over 200 mg/dl. Waist circumference ≥102 cm and ≥88 cm in men and women were defined as abdominal obesity. SPSS 16.0 software was used for statistical analysis and P < 0.05 considered as statistical significance. RESULTS: Averagely, the mean of age was 44.2 years and mean ± standard deviation of plasma total cholesterol level was 203 ± 11.3 mg/dl. The HC was seen in 50.8% of subjects with a more common in women than in men. Compared with normal subjects, in abdominal obese people, the odds ratio (OR) of HC was (OR = 4.208 [95% confidence interval [CI]: 1.939-9.130]) and (OR = 3.956 [95% CI: 1.821-8.592]) in men aged 25-35 and 35-45 years, respectively. In women aged 25-35 years, it was (OR = 3.444 [95% CI: 1.959-6.056]) in abdominal obese compared with normal subjects. CONCLUSION: Hypercholesterolemia was revealed as a major health problem among adults, and it was associated with abdominal obesity especially in the early middle-age in the north of Iran. This association was not significant in men and women after the age of 45 and 35, respectively.

Epidemiology of female reproductive cancers in Iran: results of the Gholestan Population-based Cancer Registry.

BACKGROUND: Malignancies of the female reproductive tract are estimated to be the third most common group of cancers in women. OBJECTIVES: We here aimed to present their epidemiological features in Golestan province located in Northeast of Iran. MATERIALS AND METHODS: Data on primary female reproductive cancers diagnosed between 2004-2010 were obtained from Golestan Population-based Cancer Registry (GPCR). CanReg-4 and SPSS software were used for data entry and analysis. Age standardized incidence rates (ASR) (per 100,000 person-years) were calculated using the world standard population. Poisson regression analysis was used to compare incidence rates. P-values of less than 0.05 were considered as significant. RESULTS: A total of 6,064 cancer cases were registered in Golestan females in the GPCR during 2004-2010, of which 652 cases (11%) were female reproductive cancers. Cancers of the ovary (ASR=6.03) and cervix (ASR=4.97) were the most common. We found significant higher rates in females living in cities than in villages. Our results showed a rapid increase in age specific incidence rates of female reproductive cancers at the age of 30 years. CONCLUSIONS: We found significant higher rates of female reproductive cancers among residents of cities than villages. Differences in the prevalence of risk factors including reproductive behavior between the two populations may partly explain such diversity. Our results also showed a rapid increase in incidence rates of these cancers in young age females. Further studies are warranted to determine risk factors of female reproductive cancers in our population.

The association of fasting blood glucose (FBG) and waist circumference in northern adults in Iran: a population based study.

OBJECTIVES: The aim of this study was to evaluate the association between Fasting Blood Glucose (FBG) level and Waist Circumference (WC) in men and women among 25-65 years old people in the north of Iran. MATERIAL AND METHODS: This was a cross-sectional and analytical research gender that carried out on the 1797 subjects (941 males and 856 females) between 25-65 years old using multistage cluster sampling technique. FBG was measured in the morning after a 12-hour fast and was determined by using laboratory kits (enzymatic methods) and spectrophotometry technique. Central obesity was defined based on World Health Organization criteria: waist circumference ≥102 cm and ≥88 cm in men and women, respectively. The SPSS.16 software was used for statistical analysis. RESULTS: As whole, the mean of FBG in women (98.3 ± 40.1 mg/dl) was higher than in men (94.6 ± 32.2 mg/dl). Also, the mean of WC in men 4.5 cm was lower than in women. In men, the mean of FBG statistically differs between normal and central obese subjects both in 35-45 year-age group (P = 0.001) and in 45-55 year-age group (P = 0.042). As whole, in men, the FBG level increased up 2.82 mg/dl in each 10 cm of WC with the highest rate in 35-45 year-age group. In totally, in women, the FBG level increased up 3.48 mg/dl in each 10 cm of WC and in 25-35 year-age group and it was higher than in other age groups. In men, the regression coefficients were constant with age increasing while in women it was decreased. Constant trend in men and decreasing trend in women with age was shown between FBG and WC. The cut-off point of WC for detecting of diabetes obtained 89 cm and 107 cm in men and women, respectively. CONCLUSION: The positive correlation was seen between WC and FBG level and it was declined with age in women. Cut-off point for detecting of diabetes in men was less than in women. WC is useable as a predictor of type 2 diabetes mellitus risk among adults in the north of Iran.

Five-year trend in hydrogenated vegetable oil consumption among northern Iranian families.

BACKGROUND: The main aim of this study was to assess the trends in hydrogenated vegetable oil (HVO) consumption and some related factors among northern Iranian families from 2006 to 2010. METHODS: A cross-sectional, population-based study was conducted with 6497 subjects, 15 to 65 years old, who were chosen by multistage cluster random sampling. The subjects were randomly chosen by 325 clusters with an equal size (n = 20 subjects). A multidimensional questionnaire including sociodemographic questions and type of cooking oil used were administered by interviewers. RESULTS: The percentages of the sample reporting HVO consumption across the 5 years are as follows: 2006, 85.2%; 2007, 79.7%; 2008, 75.9%; 2009, 59.3%; and 2010, 55.7%. Consumption decreased 29.5% during the 5 years of study and an average of 5.9% per year (P < .05). The estimated odds ratio of HVO consumption in rural areas verus urban areas was 2.59 (95% confidence interval [CI], 2.31-2.90); for poor compared with good economic level the odds ratio was 3.99 (95% CI, 3.13-5.10 for; for the uneducated versus college-educated sample it was 5.75 (95% CI, 4.10-8.17); and the odds ratio was 3.34(95% CI, 2.51-4.45) for Sisstani compared with Fars-native ethnic group. CONCLUSION: HVO consumption decreased during the 5-year study (2006 to 2010), but HVO is still used extensively in northern Iran. Preventive early intervention strategies are needed to target uneducated and poor families, with an emphasis on the Sisstanish ethnic group, to increase awareness about the negative consequences of HVO consumption.

Impact of literacy on the prevalence, awareness, treatment and control of hypertension in adults in Golestan Province (northern Iran).

UNLABELLED: Background : Hypertension is considered as a major health problem in our society. The association between educational level with hypertension and its control in the Golestan Province (northern Iran) were the main objectives of this study. METHODS: This was a population-based cross-sectional study that enrolled 3497 subjects aged 15-65 years using stratified and cluster sampling. The interviewers recorded the data using a multidimensional questionnaire, including blood pressure level. Blood pressure was measured three times with 5 minutes interval and defined based on Join National Committee (JNC-7). RESULTS: Totally, 741 (21.2 %) cases suffered from hypertension and illiterate people were significantly more aware of their disease (p=0.011). In the aware group, 435 (89.6%) cases used one method to control their disease and it was not statistically significant as far as educational levels was concerned. The control of hypertension was significantly greater in college educated group than the illiterate one (32.4% vs 68.8%) (p=0.001). Logistic regression analysis revealed that illiteracy is a risk factor for hypertension (p<0.001). CONCLUSION: In spite of awareness in the illiterate people was high, the rate of hypertension control was low in this group. Prevention, detection, treatment, and control of hypertension especially the illiterate people should be given high priority.

Influence of education in the prevalence of obesity in Iranian northern adults.

BACKGROUND: The main aim of this study was to evaluate whether prevalence of obesity in educational levels is different and some related factors in Iranian northern adults. MATERIALS AND METHODS: This was a cross-sectional descriptive study based on population and 2452 cases (1224 men and 1228 women) aged 15-65 years were chosen by cluster and stratify sampling. Subjects were randomly chosen from 125 clusters and each cluster included 20 cases. Interviewers recorded the data using a multidimensional questionnaire including socio-demographic indexes. RESULTS: As a whole, the prevalence of obesity was seen in 24% of subjects (15.5% in male and 32.5% in female) and significantly was seen in 3.1% and 14.1% of uneducated people more than in 1-9 year schooling and in high school or college-educated people, respectively (P = 0.001). The risk of obesity was 2.294 (P = 0.001) in uneducated compared to high school or college-educated people, 1.668 (P = 0.001) in urban area compared to rural area, 2.619 (P = 0.001) in 40-65 year people compared to 15-40 year people, and 1.534 (P = 0.003) in good economic compared to poor economic groups. After adjusted for location area, gender, age, and economic stats, the risk of obesity was 2.044 (P = 0.001) in uneducated people compared to high school or college-educated subjects. CONCLUSION: The obesity as a health problem in Iranian northern adults supported in this study and it was negatively associated with educational levels. Public health programs that aim to reduce obesity should primarily focus on the illiterate and low-educated people.

The correlation between educational levels and central obesity in the north of Iran: An epidemiologic study.

BACKGROUND: The main aim of this study was to evaluate the association between educational levels and central obesity in northern Iran in 2010. METHODS: This was a cross-sectional study carried out on 2428 subjects (1227 men and 1201 women) of 15-65 years of age who were chosen by cluster and stratified sampling methods. Subjects were randomly selected from 125 clusters and each cluster included 20 cases. Interviewers recorded the data using a multidimensional questionnaire comprising socio-demographic indexes. RESULTS: Central obesity was seen in 34.8% of all subjects (15.9% male and 56.7% female) and in 15% of uneducated people. In the uneducated group, it was 20.0% and 31.1% higher than in the 1-9 years of schooling and high school or college educated groups, respectively (P = 0.001). The risk of central obesity increased in uneducated people (OR = 4.214, P = 0.001) and in people with 1-9 years of schooling (OR = 2.283, P = 0.001) compared with high school or college educated people. The risk of central obesity was higher in urban areas than in rural area (OR = 1.481, P = 0.001), in women than men (OR = 7.039, P = 0.001), in 40-65 year olds than 15-40 year olds (OR = 3.090, P = 0.001), and in the wealthy economic group than poor economic group (OR = 1.360, P = 0.013). The risk of central obesity increased in urban areas (OR = 2.266, P = 0.001) and the wealthy economic group (OR = 1.732, P = 0.001) after it was adjusted for education. CONCLUSION: Central obesity as a health problem in northern Iran has been supported in this study, and it had an inverse correlation with educational levels. Public health programs that aim to reduce central obesity should mainly focus on the illiterate and low educated people.

Obesity and risk of hypercholesterolemia in Iranian northern adults.

BACKGROUND: The main aim of this study was to evaluate the association between serum cholesterol level and body mass index (BMI) in northern Iran. METHODS: This was a cross-sectional study carried out on the 1995 subjects (997 males and 998 females) aged 25-65 years that were selected using multistage cluster sampling method. Plasma cholesterol was measured in the morning after a 12-hour fasting and was determined by auto-analyzer. Hypercholesterolemia (HC) was defined by a total plasma cholesterol level over 200 mg/dl. Weight and height were measured and BMI 25-29.9 kg/m2 and ≥ 30 kg/m2 was classified overweight and obesity, respectively. RESULTS: Mean of age was 44.2 ± 11.5 years (44.3 ± 11.5 in men and 44.1 ± 11.2 in women) and plasma total cholesterol level was 203.1 ± 41.8 mg/dl. The HC was detected in 49.1% with higher rate in women (57.0%) than men (44.7%). In men at age 25-35 years, the odds ratio was 3.42 (1.60-7.29) in obese group and 1.90 (1.03-3.50) in overweight group compared to normal weight. In women, at age 35-45 years, the risk of HC in obese group was 3.01 (1.58-5.73) and in overweight group it was 2.06 (1.58-5.73), while in men aged 35-45 years the relative risk was 4.03 (2.22-7.34) in overweight and 3.58 (1.77-7.25) in obese group. In women after age 45 years, higher BMI was not a risk factor for HC. CONCLUSION: There was a positive association between BMI and serum cholesterol level. In early middle age, obese individuals were at risk of HC more than overweight subjects. In men, after age 35 years, the risk of HC increased in overweight group while in women there was no statistically significant association between BMI and HC.

Differences in the Prevalence of Obesity among Fars-Native, Turkman, and Sisstanish Ethnic Groups in Iranian Northern Adults in 2010.

OBJECTIVES: The aim of this study was to evaluate the differences of obesity rate among three ethnic groups in northern adults in IR Iran in 2010. METHODS: The present cross-sectional, analytical study was conducted on 2994 cases of the same age and sex in three ethnic proportions (Fars-native=1625, Turkman=977, and Sisstani=392). The subjects aged between 15 and 65 years old and were selected by multistage cluster sampling techniques including 150 clusters each containing 20 subjects in urban and rural areas in 11 districts in Golestan province (northern IR Iran). Obesity was defined after WHO classification by BMI (Body Mass Index) equal or over 30 kg/m(2). SPSS 16.0 software was used for statistical analysis and P value<0.05 was considered as statistically significant. RESULTS: Mean±SD of BMI in Fars-native, Turkman, and Sisstanish ethnic groups was 26.72±5.56, 26.18±5.34, and 24.59±6.72 kg/m(2), respectively. Averagely, obesity was common in 22.8% of the subjects and was significantly higher among the females compared to males (32.3% vs13.3%) (P=0.001). Also, its prevalence was estimated as 25%, 22.6%, and 14% in Fars-native, Turkman, and Sisstanish ethnic groups, respectively. Statistical differences were significant among the three ethnic groups (P=0.001). The risk of obesity was 2.041 [95% CI, 1.502-2.722] in Fars-native and 1.781 [95% CI, 1.298-2.472] in Turkman groups compared to Sisstanish ethnic group. CONCLUSIONS: Over one out of five adults in northern IR Iran suffer from obesity and an alarming rate was shown among the women. Among the three ethnic groups, the highest and the lowest rates were seen in Fars-native and Sisstanish ethnic groups, respectively.

Trends in waist circumference and central obesity in adults, northern iran.

OBJECTIVES: The main aim of this study is to determine the central obesity trends during the period from 2006 to 2010 among 15-65 years old people in Northern Iran. METHODS: This was a population-based cross-sectional study conducted on 6466 subjects who had been chosen by a multi stage cluster random sampling within five steps. The subjects were randomly chosen from 325 clusters and each cluster included 20 cases. Central obesity was defined as waist circumference ³102 cm and ³88 cm in men and women, respectively. RESULTS: Compared to 2010, the mean waist circumference in 2006 changed from 87.2 cm to 88.1 cm in men (p=0.237), and from 90.3 cm to 88.6 cm in women (p=0.045). The comparison between 2006 and 2010 revealed that the prevalence of central obesity slightly decreased, 6.8% and 2.4% in urban women and men, respectively. Generally, the mean of waist circumference significantly decreased in urban women (by 0.069 cm in each year; p=0.020); however, the decrease of waist circumference in urban men was not significant (0.006 cm decrease each year; p=0.915). CONCLUSION: The prevalence of central obesity declined among both males and females in the urban area; however, there was an attenuated increasing trend in the rural area. The disparity of trends between the two regions should be considered for further study.

Impact of Literacy on the Prevalence, Awareness, Treatment andControl of Hypertension in Iran.

INTRODUCTION: Hypertension is an important global health concern claiming 7.1 million lives annually. Literacy, as an essential element of the health education, and its relationship with health has previously been studied. However, few studies have been conducted on the association between literacy and health outcomes. To assess the association between educational level and hypertension, awareness and hypertension control in the north of Iran were the main objectives of this study. METHODS: The present study was a population-based cross-sectional study carried out on 3497 subjects aged 15-65 years using stratified and cluster sampling. Interviewers recorded the data using a multidimensional questionnaire, including blood pressure level. Blood pressure was measured three times with 5-minute intervals and defined based on JNC-7. RESULTS: Totally, 21.2 %(741 cases) of our patients suffered from hypertension and illiterate people were significantly more aware of their disease (P=0.011). Among the aware group, at least 89.6% (435 cases) used one method to control their disease; this however was not statistically significant among the educational levels. Control of hypertension was significantly greater in college educated group than in illiterate group (32.4% vs. 68.8%; P=0.001). Logistic regression analysis revealed that illiteracy is a risk factor for hypertension (P<0.001). CONCLUSION: In spite of the fact that awareness in illiterate people was high, the rate of hypertension control was low in this group. Prevention, detection, treatment, and control of hypertension especially in illiterate people should receive high priority.

Incidence of childhood cancers in golestan province of iran.

OBJECTIVE: This paper presents the incidence rates of childhood cancers using the data obtained from Golestan population based cancer registry (GPCR) between 2004 and 2006. METHODS: GPCR registers only primary cancers based on standard protocols of the international association of cancer registries (IACR). We collect data on newly diagnosed (incident) cancer cases from all public and private diagnostic and therapeutic centers of the whole province. CanReg-4 software was used for data entry and analysis. FINDINGS: Totally 5076 cancer cases (all ages) were diagnosed in GPCR between 2004 and 2006. Of these, 139 (2.74 %) were children (aged 0-14 years) with mean (±SD) age of 8.06 (±4.48) years. The age standardized incidence rates for childhood cancer were 119.8 and 78.3 per 1000000 person-years in male and female children, respectively. Leukemia was the most common childhood cancer in Golestan province of Iran. Lymphomas and central nervous system tumors were the second and third ones, respectively. CONCLUSION: The incidence rates of childhood cancers were relatively high in Golestan province of Iran. So, controlling of childhood cancers should be mentioned as an important issue in health policy making in this area.