Geographical variations and predictors of coronary artery disease mortality in Turkiye: an environmental and behavioral analysis

OBJECTIVE: This study aims to analyze the geographical variations and identify key environmental and behavioral predictors of coronary artery disease (CAD) mortality in Turkiye. METHODS: A 10-year longitudinal province-level data was used to identify change trajectories of CAD mortality. Environmental determinants (such as air quality and climatic conditions) and behavioral factors of alcohol consumption and smoking were examined for their association with CAD mortality change trajectories using Ordinal Logistic Regression models. RESULTS: The study revealed significantly different trajectoriesof CAD mortality across Turkiye. Environmental factors, particularly air quality (Particulate Matter-10 variation) and climatic conditions (humidity and temperature variations), were heavily associated with the level of CAD mortality. Behavioral factors, notably alcohol consumption and smoking, also exhibited a significantly positive association. Humidity, sunlight, and temperature remained as key predictors of CAD after controlling for smoking and alcohol consumption. CONCLUSION: The study underscores the importance of addressing environmental and lifestyle factors in CAD management and prevention strategies. The findings suggest the necessity for region-specific interventions and public health policies tailored to the unique characteristics of each province in Turkiye. This research contributes to a deeper understanding of the multifactorial nature of CAD mortality, providing valuable insights for future research to investigate causal associations, healthcare planning, and policy-making. TRIAL REGISTRATION: Our study has been registered in ClinicalTrials.GOV system with a procotol ID of CAD001.