Zoning and Identification of Factors Affecting Premature Death Registration

Extended Abstract
Background
Different causes of death among individuals indicate the extent to which people use different types of health care, and the growth and development of a society. Premature mortality also imposes a heavy burden on society in terms of health, economy, and mental issues. Given the preventability of premature mortality and the serious efforts to reduce premature mortality rate by 25 percent by 2025, we decided to conduct a study in this field under the title of ''Assessment of causes and geographical distribution of early death in 30-69-year-old population covered by the Semnan University of Medical Science (SUMS) and its relation with demographic characteristics: a 10-year cross-sectional study from 2009 to 2018''.
Methods
The population of this study included all cases of premature death in the population aged 30 to 69 years for whom a death certificate had been issued and registered in the death registration system under the supervision of the SUMS in Semnan. Semnan is one of Iran's most populous provinces consisting of eight major cities. The population of the study included all early death cases between 2013 and 2018 in six cities including 1-Garmsar, 2-Aradan, 3-Sorkhe, 4-Semnan, 5-Mahdishahr and 6-Damghan. Demographic information of the deceased was extracted and analyzed from the death registration system without using their personal information. This was a census study and the studied variables included causes of premature death (cardiovascular diseases, malignant neoplasms, respiratory diseases, neurological diseases, accidents, traffic accidents, poisoning, kidney diseases, gastrointestinal diseases, infections, surgical complications, and other causes), age, gender (male, female), place of residence (urban or rural), and education. Descriptive statistics were used for data analysis, and independent chi-square and t-tests were used to analyze the relationship between variables according to the type of variable at a significance level of 5 percent with SPSS software v. 18.
Results
A total of 3,619 premature deaths occurred among individuals aged 30 to 69 from 2009 to 2018. The mean and standard deviation of premature mortality was 55.7 ± 10.6 years. The highest number of premature deaths occurred in 2011 and was 18 percent while the lowest was related to 2010 with 15.3 percent. Premature mortality was more common in men, employed people, medical center staffs, illiterate and urban residents, and most of the deaths occurred in the seventh decade of their life. 39.3 percent of premature deaths was recorded in Semnan district. The major causes of premature mortality included cardiovascular diseases, cancers, and accidents. The prime cause of premature death was found to be cardiovascular diseases, accounting for 31.1 percent of all deaths, often caused by heart attacks and atherosclerosis of various arteries and high blood pressure. The rate of annual premature mortality between 2009 and 2018 was not related to the year of data collection (P = 0.086). Only the number of premature deaths due to car accidents and surgical complications is the same in different age groups (p> 0.05). Cardiovascular diseases increase significantly with age (p<0.001).
Conclusion
The results show that accidents are the major cause of premature mortality at a young age , whereas middle-aged mortality tend to be caused by chronic and non-communicable diseases.This study recommends the cooperation of organizations involved in the control of premature mortality, such as the Ministry of Roads and Transportation, Ministry of Urban Development, and the Ministry of Health.
Practical Implications of Research
To minimize premature deaths and extend life expectancy, we must try to prevent accidents and the underlying causes of internal diseases, in addition to creating a culture of changing the lifestyle of citizens to reduce risk factors as much as possible.
Ethical Consideration

This research has been supported by Semnan University of Medical Sciences and health services grant IR.SEMUMS.REC.1398.114 and its information has been extracted from the health deputy system with the permission of the university.
Conflict of Interests
The Authors declare that there is no conflict of interest.
Acknowledgement
We would like to thank the Deputy Minister of Health at Semnan University of Medical Sciences for providing the necessary facilities for doing this research.