Mortality patterns of the ten leading causes of cardiovascular diseases in Northern Iran: a joinpoint regression analysis (2011–2023)

Abstract Background Cardiovascular diseases remain the leading cause of death worldwide and in Iran, particularly in northern regions. Understanding long-term mortality trends is essential for planning effective prevention and health policy strategies in the context of an aging population. Methods A population-based retrospective study was conducted using mortality data from the Health Deputy of Mazandaran University of Medical Sciences and the Civil Registration Organization (2011–2023). All deaths attributed to cardiovascular diseases (ICD-10 codes I00–I99) in Mazandaran province, northern Iran, were included. Age-standardized mortality rates per 100,000 population were calculated using direct standardization to the 2013 European standard population. Trends in mortality were analyzed using Joinpoint regression to estimate annual percent change (APC) and average annual percent change (AAPC) with 95% confidence intervals. Results Between 2011 and 2023, 73,434 cardiovascular deaths were recorded. The overall age-standardized mortality rate decreased from 173.7 to 167.3 per 100,000 (average annual percent change –0.85%;)95% CI –1.96 to –0.65). A significant declining trend was observed from 2011 to 2018 (annual percent change –2.04%; 95% CI –3.59 to –0.45), followed by a temporary non-significant increase between 2018 and 2021 (annual percent change 3.04%; 95% CI –8.57 to 16.13), and a significant sharp decline from 2021 to 2023. Mortality rates were consistently higher in men than women. Ischemic heart disease was the leading specific cause of cardiovascular death throughout the period, followed by hypertensive diseases. Conclusions Cardiovascular mortality in northern Iran showed an overall statistically significant modest decline over the 13-year period, interrupted by a notable increase coinciding with the COVID-19 pandemic years. Targeted prevention efforts should focus on ischemic heart disease, hypertensive diseases, older adults, and men to further reduce the burden of cardiovascular mortality in the region.