National and sub-national patterns of mortality from stroke in the Iranian population (1990-2015): Complementary results from the NASBOD study.

Background Iran lacks a population level comprehensive assessment of stroke epidemiology. Using data from the NASBOD Study, we estimated the mortality of stroke among the Iranian population from 1990 to 2015. Methods Data were collected from all the available sources including the national death registration system and two major cemeteries. After addressing incompleteness of child and adult death data and by using mixed effect model, spatio-temporal model and Gaussian Process Regression, levels and trends of child and adult mortality were estimated. By considering cause fraction to these estimates; cause specific mortality was estimated. In these process wealth index, urbanization, and years of schooling were used as covariates. Results In 2015, the age-standardized stroke mortality rate due was 47.76 (95% UI: 34.68-65.03) for males and 40.16 (30.38-5 2.72) for females, per 100,000 population. Stroke occurrence for both ischemic and non-ischemic strokes showed decreasing trends in both sexes after 2001-2002, at national and sub-national levels. The highest and lowest mortality rates between provinces ranged from 52.11 (40.3-66.66) to 24.47 (18.71-31.79) in men and from 65.51 (47.13-89.41) to 30.43 (21.95-41.82) in women per 100,000 population. Conclusion Although age-standardized rates of stroke mortality are falling, in the past three decades, the absolute number of people who have had a stroke has increased. Stroke mortality remains high in Iran.