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Background  The incidence and associated risk factors for premature death were investigated in a population-based cohort study in Iran.    Methods  A total of 7245 participants (3216 men), aged 30–70 years, were included. We conducted Cox proportional hazards models to identify the risk factors for premature death. For each risk factor, hazard ratio (HR), 95% confidence intervals (95% CI) and population attributable fraction (PAF) were calculated.    Results  After a median follow-up of 13.8 years, 262 premature deaths (153 in men) occurred. Underlying causes of premature deaths were cardiovascular disease (CVD) ( n  = 126), cancer ( n  = 51), road injuries ( n  = 15), sepsis and pneumonia ( n  = 9) and miscellaneous reasons ( n  = 61). The age-standardized incident rate of premature death was 2.35 per 1000 person years based on WHO standard population. Hypertension [HR 1.40, 95% CI (1.07–1.83)], diabetes (2.53, 1.94–3.29) and current smoking (1.58, 1.16–2.17) were significant risk factors for premature mortality; corresponding PAFs were 12.3, 22.4 and 9.2%, respectively. Overweight (body mass index (BMI): 25–29.9 kg/m 2 ) (0.65, 0.49–0.87) and obesity (BMI ≥30 kg/m 2 ) (0.67, 0.48–0.94) were associated with decreased premature mortality. After replacing general adiposity with central adiposity, we found no significant risk for the latter (0.92, 0.71–1.18). Moreover, when we excluded current smokers, those with prevalent cancer/cardiovascular disease and those with survival of less than 3 years, the inverse association between overweight (0.59, 0.39–0.88) and obesity (0.67, 0.43–1.04), generally remained unchanged; although, diabetes still showed a significant risk (2.62, 1.84–3.72).    Conclusions  Controlling three modifiable risk factors including diabetes, hypertension and smoking might potentially reduce mortality events by over 40%, and among these, prevention of diabetes should be prioritized to decrease burden of events. We didn’t confirm a negative impact of overweight and obesity status on premature mortality events.

Incidence and associated risk factors for premature death in the Tehran Lipid and Glucose Study cohort, Iran