Browsing by Author "Onat, Altan"

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Age at Death in the Turkish Adult Risk Factor Study: Temporal Trend and Regional Distribution at 56.700 Person-years' Follow-Up
(Turkish Soc Cardiology, 2009) Onat, Altan; Ugur, Murat; Tuncer, Mustafa; Ayhan, Erkan; Kaya, Zekeriya; Kucukdurmaz, Zekeriya; Kaya, Hasan
Objectives: We analyzed the temporal trend and regional distribution of age at death due to all-causes and the sex-specific and age range defined by coronary mortality in the 18-year follow-up of the Turkish Adult Risk Factor Study. Study Design: The participants of the Turkish Adult Risk Factor Study who have been examined in even years were last surveyed in August 2008. A total of 1,582 individuals were surveyed, which constituted half of the surviving participants of the overall cohort. Information on death was obtained from first-degree relatives and/or health personnel of local health offices. Survivors were evaluated by history, physical examination, and 12-lead electrocardiography. The cumulative follow-up was 56,700 person-years. Results: Of 1582 participants, 868 (431 men, 437 women) were examined, in 604 subjects information was gathered, and 47 participants (26 men, 21 women) were ascertained to have died. Twenty-two deaths were classified as being of coronary origin. Cumulative assessment of the entire cohort in the age range of 45-74 years disclosed coronary mortality to be 7.64 per 1000 person-years in men and 3.84 in women and persisted to be the highest among 30 European countries, whereas overall mortality declined at a greater proportion. Overall mean ages at death were deferred within a 12-year period by 7.4 years in men and 6 years in women, to 71.9 and 74.8 years, respectively. The extension of this mean survival was similar among urban-rural areas and geographic regions. Conclusion: Coronary mortality declined modestly, but life expectancy of Turkish adults rose by a mean of nearly seven years in the 12 years to 2003-08 without showing major differences in sex, urban-rural dwelling or geographic regions.
Diverging Sex-Specific Long-Term Effects of Cigarette Smoking on Fasting Insulin and Glucose Levels in Non-Diabetic People
(Pergamon-elsevier Science Ltd, 2012) Onat, Altan; Can, Gunay; Cicek, Gokhan; Dogan, Yuksel; Kaya, Hasan; Gumrukcuoglu, Hasan Ali; Yuksel, Husniye
Objectives: We determined in non-diabetic persons the associations of current smoking with future glucose and insulin concentrations. Design and methods: Middle-aged non-diabetic adults (n = 1071) were studied in whom these values were measured at baseline and 5.2-years later. Results: Age-adjusted fasting insulin concentrations in 137 smoking men remained lower than never smokers at both surveys. While age-adjusted fasting glucose values in male never smokers declined at follow-up (p = 0.037), they rose in male smokers. In 94 female smokers, age-adjusted fasting insulin values marginally declined, and fasting glucose was reduced (by 0.09 mmol/L., p = 0.055) during follow-up. In contrast in never-smoking women, insulin and glucose concentrations rose (p < 0.001 in both). Age-adjusted insulin levels in former smokers exhibited similar trends as never smokers. Trends were essentially unchanged when adjustment included body mass index. Current male smokers demonstrated evidence of reduced insulin sensitivity, female smokers of improved one, as assessed by QUICKI. Conclusion: Smoking among Turks induces at long-term lower fasting insulin levels which represent improved insulin sensitivity in women, yet a reduced one in men. (C) 2011 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.
Female and Urban Participants Demonstrate an Adverse Trend in Overall Mortality in Turkey - and a Report on the Tarf Survey 2016
(Turkish Soc Cardiology, 2017) Onat, Altan; Ozbek, Mehmet; Karakoyun, Suleyman; Uzun, Okan; Keskin, Muhammed; Karadeniz, Yusuf; Can, Gunay
Objective: This study is an examination of 1) overall mortality trend in the Turkish Adult Risk Factor (TARF) study stratified by sex and place of residence, and 2) brief report on main aspects of the 2016 survey. Methods: The period of last 18 years was divided into 2 for trend analysis of data. Required information on deaths was obtained. Baseline age >= 40 years at the beginning of each period was the inclusion criterion. Cox regression analyses were performed. Results: Among over 2500 participants in each, deaths were recorded in 281 and 334 individuals in Periods 1 and 2, respectively, and baseline mean age was 54.6 years and 56.4 years, respectively, in each period. Age-adjusted hazard ratio for mortality in Period 2 remained virtually the same for rural males, rose to borderline significance for urban males and rural females (p=0.06, p=0.09), and increased 1.72-fold for urban females (p=0.006), as compared to Period 1. Whereas males gained an average of 3.8 years of survival in the later period compared with the earlier period, females gained only 1.8 years. This narrowed the difference in mean age at death in favor of women from 2.5 years to 0.5 year. Of 1144 participants to be surveyed in the TARF 2016, 48 were lost to follow-up, 695 were examined, and 39 participants were ascertained to be deceased. In 362 cases, verbal information was obtained regarding health status. Conclusion: Gain in survival in Turkish women has distinctly stagnated compared with men, and hazard of death has risen significantly for women and urban residents in the past decade, suggesting interaction between female sex and urban residence. Both phenomena require recognition and adoption of appropriate measures.
Mortality and Coronary Events in the Turkish Adult Risk Factor Survey 2006: Mortality Is Declining in Women Whereas Overall Prevalence of Coronary Heart Disease Is on the Incline
(Turkish Soc Cardiology, 2007) Onat, Altan; Albayrak, Sinan; Karabulut, Ahmet; Ayhan, Erkan; Kaya, Zekeriya; Kucukdurmaz, Zekeriya; Tuncer, Mustafa
Objectives: We analyzed all-cause and coronary mortality, incidence and prevalence of coronary heart disease (CHD) in a cohort of the Turkish Adult Risk Factor Study which was surveyed in the summer of 2006 essentially in geographic regions other than Marmara and Middle Anatolia. Study design: The survey consisted of 1585 participants (776 men, 809 women; mean age 55.3 +/- 11.8 years), accounting for 49% of all living participants of the overall cohort. Information on death was obtained from first-degree relatives and/or health personnel of local health offices. Survivors were evaluated by history, physical examination, and 12-lead electrocardiography. New coronary event was defined as fatal or nonfatal myocardial infarction, new stable angina, and/or myocardial ischemia that had occurred after the former survey. Results: Of the participants, 946 were examined, 599 subjects were evaluated on the basis of information gathered, and 40 deaths ( 27 men, 13 women) were documented. Cumulative follow-up of the survey starting from 1990 increased to 45,490 person-years with the addition of 2,842 person-years. Fifteen deaths were attributed to CHD. Annual overall mortality and coronary mortality rates were 14.1 and 5.1 per 1000 adults, respectively. In the 45 to 74 years age bracket, overall mortality declined to 10.9 (p=0.09) and coronary mortality to 5.6 per thousand. A decreasing trend in mortality was pronounced in women. The mean age at death increased to 67.1 years in men, and to 75.9 years in women. The prevalences of CHD were found to be 3%, 11%, and 27% in age groups of 39-49, 50-59, and >= 60 years, respectively, which corresponded to an estimated population of 2.75 million. Conclusion: In the 45 to 74 years age bracket, overall and coronary deaths show a decreasing trend, particularly in women, which extends the mean age at death. However, the prevalence of CHD specific to age groups continues to rise, as well.
Obstructive Sleep Apnea Syndrome Is Associated With Metabolic Syndrome Rather Than Insulin Resistance
(Springer Heidelberg, 2007) Onat, Altan; Hergenc, Gulay; Uyarel, Huseyin; Yazici, Mehmet; Tuncer, Mustafa; Dogan, Yuksel; Rasche, Kurt
The aim of this study was to investigate crosssectionally the prevalence and covariates of obstructive sleep apnea syndrome (OSAS) and its relationship to metabolic syndrome (MS), insulin resistance (IR), and coronary heart disease (CHD) in a population sample of 1,946 men and women representative of Turkish adults. OSAS was identified when habitual snoring and episodes of apnea were combined with another relevant symptom. MS was diagnosed based on modified criteria of the Adult Treatment Panel III and IR by homeostatic model assessment (HOMA). OSAS was identified in 61 men (6.4%) and 58 women (5.8%), at a similar prevalence, after adjusting for covariates. Among individuals with OSAS, significantly higher odds ratios (ORs), adjusted for age, body mass index (BMI), and waist girth, were observed for MS, hypertension, and prevalent CHD, but not for HOMA or menopause. Significantly higher C-reactive protein existed only in women with OSAS who were also more frequent smokers. In logistic regression models, waist circumference, but not BMI nor hypertension, was significantly associated with OSAS among men. In women, by contrast, current cigarette smoking and hypertension were the significant independent covariates. Regression models controlling for sex, age, and smoking revealed that MS (and not IR per se) was associated significantly with OSAS (OR 1.94) in nondiabetic individuals. To conclude, abdominal rather than overall obesity in men and smoking among women are significant independent determinants of OSAS in Turkish adults. OSAS is associated with MS rather than IR per se. Relatively high prevalence of OSAS is observed in Turkish women in whom it is significantly associated with CHD.
Regional Distribution of All-Cause Mortality and Coronary Disease Incidence in Turkey: Findings of Turkish Adult Risk Factor Survey 2010
(Turkish Soc Cardiology, 2011) Onat, Altan; Murat, Sani Namik; Cicek, Gokhan; Ayhan, Erkan; Ornek, Ender; Kaya, Hasan; Can, Gunay
Objectives: We analyzed the distribution of cumulative allcause and cardiovascular mortality and incident coronary heart disease (CHD) across the seven geographic regions of Turkey and presented overall and coronary mortality findings of the 2010 survey of the Turkish Adult Risk Factor Study. Study design: A total of 1406 participants were surveyed. Information on the mode of death was obtained from firstdegree relatives and/or health personnel of local heath offices. Information on survivors was obtained from history, physical examination, and 12-lead electrocardiography. Results: Of the surveyed participants, 686 were examined; information on health status was obtained in 577 subjects, and 32 participants (14 women, 18 men; mean age 72.3 +/- 15.6 years) were ascertained to have died. The total duration of follow-up was 2,520 person-years. Nineteen deaths were of coronary (n=16) or cerebrovascular (n=3) origin. Cumulative 20-year assessment of the entire cohort for the age bracket of 45-74 years disclosed a high coronary mortality rate, being 7.4 and 4.1 per 1000 person-years in men and women, respectively, and representing a limited decline after year 2000. Ageadjusted Cox regression analysis comprising 433 deaths and 506 incident CHD cases over a 7.3-year follow-up showed similar mortality rates across the regions, and a significantly high CHD incidence in males of the Black Sea and Marmara regions and in females of the Southeast Anatolia. Currently, 480,000 incident CHD cases are estimated yearly in Turkey. Conclusion: The high age-adjusted overall mortality in Turkey shows nonsignificant differences across geographic regions, whereas the age-adjusted CHD incidence is high in the Black Sea and Marmara regions.
Serum Total and High-Density Lipoprotein Phospholipid Levels in a Population-Based Study and Relationship To Risk of Metabolic Syndrome and Coronary Disease
(Sage Publications inc, 2008) Hergenc, Gulay; Onat, Altan; Sari, Ibrahim; Yazici, Mehmet; Eryonucu, Beyhan; Can, Gunay
The aim of study was to investigate the role of serum total (TPL) and high-density lipoprotein phospholipids (HDL-pl) as a risk factor in coronary heart disease (CHD) and metabolic syndrome (MS). In a random sample, total and HDL-pI were measured in 1088 and 642 adults from Turkey, respectively, who have a high prevalence of MS; this was done with an enzymatic method that measures total phosphatidylcholine, sphingomyelin, and lysophosphatidylcholine. Serum TPL and HDL-pl levels were significantly higher in women (TPL, 2.8 mmol/L; HDL-pl, 1.21 mmol/L) than in men. Strong correlations existed between serum TPL levels and non-HDL cholesterol (HDL-C), triglycerides, apolipoprotein (apo) B, complement C3, and gamma-glutamyltransferase. Non-HDL-C, HDL triglyceride, and apo A-I were strongly correlated with HDL-pl. Linear regression analyses revealed HDL-C, apo B, triglycerides, diabetes, and female gender as independent significant determinants of TPL levels in adults. HDL-C and impaired glucose regulation were sole significant variables, together contributing one-quarter of serum HDL-pl. Individuals with MS or diabetes had significantly higher TPL concentrations. The gender- and age-adjusted odds ratio (OR) of TPL for MS was 1.73 (95% confidence interval, 1.35-2.21), whereas the multiadjusted OR of HDL-pl per 1 SD increment corresponded to a significantly reduced independent MS likelihood by 26% in women (and 18% in the entire group). The multiadjusted OR of HDL-pl for CHD in men and women combined was 0.32 (P =.057) corresponding to a reduced CHD likelihood by 32% per I SD increment of HDL-pl. Plasma TPL levels point to an adverse relationship to MS, whereas their role in CHD risk needs further investigation. HDL-pls, in contrast, mark substantial protection from MS as well as from CHD.
Tekharf 2009 Taraması: Kırsal Kesim ve Kentlerde Benzer Kardiyovasküler Ölüm Riski
(2010) Kaya, Hasan; Uğur, Murat; Ayhan, Erkan; Doğan, Yüksel; Çiçek, Gökhan; Onat, Altan; Can, Günay
Amaç: TEKHARF Çalışması’nın 2009 sonbaharında gerçekleştirilen tarama verileri incelenerek koroner/kardiyovasküler ve tüm-nedenli ölümlerde kırsal kesim-kent farklılıkları ve 45-74 yaş kesiminde mortalitenin cinsiyete göre dağılımı değerlendirildi.Çalışma planı: TEKHARF Çalışması kapsamında Marmara ile İç Anadolu bölgeleri tekli yıllarda taranmaktadır. 2009 yılında 1655 kişi bu amaçla tarandı. Ölüm nedeni ve şekli konusunda birinci derece akraba ve/veya sağlık ocağı personelinden bilgi alındı. Örneklemden 960 kişi fizik muayene ve 12-derivasyonlu EKG ile incelendi; 572 kişinin sağlık durumu hakkında bilgi edinildi.Bulgular: Taramada 23 erkek ile 20 kadının öldüğü belirlendi. Ölümlerin 21’i koroner hastalığa, dördü serebrovasküler olaya bağlandı. Tüm kohortun 19 yıllık takibinde, 45-74 yaş kesiminde koroner kalp hastalığı kökenli ölümler erkeklerde 1000 kişi-yılında 7.5, kadınlarda 3.9 düzeyinde bulundu. Toplam 405 ölümü (235 kardiyovasküler ölüm) ve 24 bin kişi-yılını aşan izlemi kapsayan Cox regresyon analizinde, kırsal alanda ve kentlerde oturanlar benzer yaş-ayarlı ölüm oranları sergiledi. Kentli kadınlarda, kırsalda yaşayan hemcinslerine göre genel mortalite daha yüksek bulundu (HR 1.41; %95 GA 1.02-1.96).Sonuç: Kardiyovasküler mortalitenin hem mutlak, hem de genel ölümdeki payı yüksek olmayı sürdürmektedir; bu konuda kır-kent farkı gözlenmedi. Kentte yaşayan kadınlarda yaş-ayarlı tüm nedenli ölüm oranı, kırsal alan hemcinslerine göre daha yüksektir.
Tekharf Çalışması Takibinde Gözlemlenen Toplam ve Koroner Mortalitenin Analizi
(2004) Yazıcı, Mehmet; Sarı, İbrahim; Turkmen, Serdar; Karabulut, Ahmet; Onat, Altan; Tuncer, Mustafa; Doğan, Yüksel
TEKHARF Çalışmasının temelde Karadeniz, Doğu ve Güneydoğu Anadolu, Akdeniz ve Ege bölgelerinde oturan kohortu 2004 yazında tarandı. Ölüm konusunda 1. derece akraba ve/veya sağlık ocağı personelinden bilgi alındı; yaşayanlarda bilgi edinmekten başka, fizik muayene ve 12-derivasyonlu EKG kaydı yapıldı. Yeni koroner olay tanımına, son taramadan beri gelişen fatal ve fatal olmayan miyokard infarktüsü, yeni stabil angina ve/veya miyokard iskemisi girdi. 1636 kişilik örneklemden 1036'sı muayene edildi, 514 kişi hakkında bilgi edinildi ve 26 erkek ile 18 kadının öldüğü belirlendi. Yaklaşık 3020 kişi-yılı süreli yeni takip eklenince, toplam izlemede 39,540 kişi-yılına ulaşıldı. Ölenlerden 21'i KKH kökenli sayıldı. Katılımcılardan 31'inde yeni koroner olay gelişti. Tarama başından beri yıllık tüm ölüm oranı bin yetişkinde 10.4, koroner mortalite binde 4.0 düzeyinde bulundu. Tüm nedenli ölümler, 207 ölümün kaydedildiği kırsal kesimde bin kişi-yılı başına 11.6'ya karşılık gelirken, kent¬lerde bu 9.6 olarak hesaplandı (p=0.046). Yetişkinlerdeki üç büyük ölüm nedeninin tüm ölümler deki payı şu şekilde çıktı: koroner %39, serebrovasküler %11, kanser %24. Bu sınıflama gelişmiş ülkelerde 20 yıl önce rastlanan ölüm nedeni kalıbına uyuyordu. Kırkbeş ila 74 yaş kesiminde toplam yıllık mortalite binde 15.2, KKH ölüm prevalansı binde 6 olarak gözlemlendi. Son ülke çapında taramada bu yaş kesiminde tüm ölümler ile koroner kökenli ölümler anlamlılığa ulaşmayan bir azalma eğilimi sergiledi: koroner mortalite bin kişi-yılında 5.1 'e, toplam ölümler bin kişi-yılında 13.5'e geriledi. Son iki yıllık tarama sonuçlarına göre, ölümcül olanlar dahil, yılda bin yetişkinde 11.7 sıklığına karşılık gelen 330 bin yeni koroner olay geliştiği tahminine varabiliriz. Kardiyovasküler kökenli ölümlerin yüksek bir oranda seyrettiği doğrulanmış, kadınlarda koroner mortalitenin düşme eğiliminde olduğuna, buna karşılık tüm erişkinlerde - muhtemelen nüfusun yaşlanmağa başlaması nedeniyle de - yeni koroner olaylarda artışın sürdüğüne ilişkin sonuca varılmıştır.
Tekharf Taramasında Ölüm Yaşı: 56700 Kişi-yıllık İzlemede Dönemsel Eğilim ve Bölgesel Dağılım
(2009) Bulur, Serkan; Küçükdurmaz, Zekeriya; Onat, Altan; Kaya, Hasan; Kaya, Zekeriya; Uğur, Murat; Ayhan, Erkan
Amaç: TEKHARF Çalışması’nın 18 yıllık takibinde tüm-nedenli ölümdeki yaş verilerinin zaman dilimine ve bölgelere bağlı değişimi ve cinsiyete özgü ve belirli yaş kesimindeki koroner mortalite değerlendirildi. Çalışma planı: TEKHARF Çalışması’nın çift yıllarda taranan kohortu 2008 Ağustos ayında yeniden izlendi. Taramaya giren kohortun toplam sayısı 1582 kişi idi ve ülke genelinde hayatta bulunan izlenecek TEKHARF kohortunun yarısını oluşturuyordu. Ölüm konusunda birinci derece akraba ve/veya sağlık ocağı personelinden bilgi alındı; yaşayanlarda bilgi edinmekten başka, fizik muayene ve 12-derivasyonlu EKG kaydı yapıldı. Toplam takip süresi 56700 kişi-yılıydı. Bulgular: Örneklemin 868’i (431 erkek, 437 kadın) muayene edildi, 604 kişi hakkında bilgi edinildi ve 47 kişinin (26 erkek, 21 kadın) öldüğü belirlendi. Ölümlerin 22’si koroner kalp hastalığı (KKH) kökenli sayıldı. Tüm kohortun 18 yıllık takibinde 45-74 yaş kesiminde KKH kökenli ölümler erkeklerde 1000 kişi-yılında 7.64, kadınlarda 3.84 düzeyinde bulundu ve böylece 30 Avrupa ülkesi içinde en yüksek seviyede süregeldiği gözlemlendi; oysa, genel mortalitedeki gerileme daha yüksek orandaydı. Ortalama ölüm yaşı Türkiye genelinde 12 yıl içerisinde erkeklerde 7.4 yıl, kadınlarda altı yıl ertelenerek, 2003-08 döneminde sırasıyla ortalama 71.9 ve 74.8’e ulaştı. Ortalama ömürdeki bu uzama kentsel ve kırsal kesimler ile coğrafi bölgelerde benzerdi. Sonuç: Yetişkinlerimizde koroner mortalite az gerilemiş, ama ömür süresi son 12 yılda yedi yıla varan belirgin uzama göstermiştir; bu uzamanın erkek-kadın, kent-kır sakinleri ve coğrafi bölgelerde önemli farklar sergilemediği gözlenmiştir.
Turkish Adult Risk Factor Study Survey 2012: Overall and Coronary Mortality and Trends in the Prevalence of Metabolic Syndrome
(Turkish Soc Cardiology, 2013) Onat, Altan; Yuksel, Murat; Koroglu, Bayram; Gumrukcuoglu, H. Ali; Aydin, Mesut; Cakmak, H. Altug; Can, Gunay
Objectives: We aimed to analyze 1) overall and coronary mortality findings in the Turkish Adult Risk Factor (TARF) study survey 2012 and 2) the temporal trends in the prevalence of metabolic syndrome (MetS) and its distribution across seven geographic regions. Study design: Information on the mode of death was obtained from first-degree relatives and/ or health personnel of a local health office. Information collected in survivors was based on history, physical examination of the cardiovascular system and Minnesota coding of resting electrocardiograms. Results: Of 1527 participants to be surveyed, 796 were examined. Information was obtained on the health status in 502 subjects, and death was ascertained in 56 participants. Thirty deaths were attributed to coronary and cerebrovascular disease. Cumulative 22-year evaluation of participants in the age bracket 45-74 years revealed coronary mortality to be high, with 7.6 per 1000 person-years in men and 3.8 in women. Data used from 1754 identical subjects (median age 46 years initially), and examined in two periods 12 years apart, indicated an increase in the prevalence of MetS by 1.3% per aging of 1 year. Analysis across geographic regions showed a rise in the prevalence in the Mediterranean region, already having highest prevalence along with thr Southeast Anatolia, while the prevalence declined in the Marmara region and persisted to be thr lowest in the Aegean region. Conclusion: The prevalence of MetS in Turkish adults aged 40 years or over, currently standing at 53%, shows significant differences across geographic regions, being highest in the two southern regions and lowest in the Aegean region.
The Turkish Adult Risk Factor Survey 2009: Similar Cardiovascular Mortality in Rural and Urban Areas
(Turkish Soc Cardiology, 2010) Onat, Altan; Ugur, Murat; Cicek, Gokhan; Ayhan, Erkan; Dogan, Yuksel; Kaya, Hasan; Can, Gunay
Objectives: We analyzed the 2009 survey of the Turkish Adult Risk Factor (TARF) Study to assess the distribution of all-cause and cardiovascular mortality in urban and rural areas and gender-specific coronary mortality in the age-range of 45 to 74 years. Study Design: The Marmara and Central Anatolian regions have been surveyed every odd year in the TARF Study. In 2009, 1,655 participants were surveyed. Information on the mode of death was obtained from first-degree relatives and/or health personnel of local heath office; 960 participants underwent physical examination and ECG recording, and 572 subjects were evaluated on the basis of information obtained regarding health status. Results: In the survey, 23 men and 20 women were ascertained to have died. Twenty-one deaths were attributed to coronary disease and four deaths to cerebrovascular events. Assessment of the entire cohort in the age range of 45-74 years after a 19-year follow-up disclosed a high coronary mortality with 7.5 per 1000 person-years in men and 3.9 in women. In a Cox regression analysis comprising 405 deaths (235 cardiovascular) and over 24,000 person-year follow-up, age- adjusted cardiovascular mortality was similar in rural and urban participants. All- cause mortality was higher in females living in urban areas than those living in rural areas (HR 1.41; 95% CI 1.02-1.96). Conclusion: Cardiovascular mortality both in absolute terms and as a share of overall mortality persists to be high among Turkish adults, with similar rates in urban and rural areas. Age-adjusted all-cause mortality rate is higher among urban versus rural women.
Türkiye'de Kadın ve Kentli Katılımcıların Ölüm Oranında Olumsuz Eğilim ve Tekharf 2016 Taraması Bildirisi
(2017) Can, Günay; Onat, Altan; Özbek, Mehmet; Hayıroğlu, Mert İ; Kaya, Adnan; Uzun, Okan; Çamkıran, Volkan
Amaç: 1) TEKHARF Çalışması'nda kaydedilen genel mortalite eğiliminin cinsiyet ve kır-kent yerleşimine katmanlanarak açıklanması, 2) 2016 takip taramasının ana unsurları hakkında kısa bilgi paylaşılması.Yöntemler: Son 18 yıllık dönem eğilim analizleri için ikiye bölündü. Ölüm konusunda gerekli bilgi alındı. Yaşın her iki dönem başında 40 ve üzerinde olması, örneklemin dahil edilme ölçütüydü. Cox regresyon analizi uygulandı.Bulgular: İlk ve son dönemde, başlangıçtaki ortalama yaş 54.6 ve 56.4 yıl iken, her bir dönemde 2500'ü aşkın katılımcıda 281 ve 334 ölüm kaydedildi. Ölüm için yaş-ayarlı mortalite ikinci dönemde, ilk döneme göre, kırsal kesim erkeklerinde aynen süregiderken, kentli erkekler ile kırsal bölge kadınlarında (p=0.06-0.09) yükseldi. Kentli kadınlarda ise, HR ilk döneme kıyasla son dönemde 1.72-kat arttı (p=0.006). İlk döneme kıyasla son dönemde erkeklerin 3.8 yıllık sağ kalım kazanmasına karşılık, kadınlarda kazanç 1.8 yıldı. Bu da, kadın lehine 2.5 yıl olan ortalama ölüm yaş farkını 0.5 yıla daralttı. TEKHARF 2016 takibinde izlenecek 1144 kişilik örneklemden 48'i takipten kayıp sayıldı; 695'i muayene edildi ve 39 katılımcının öldüğü belirlendi; 362 kişi hakkında da sözel bilgi edinildi.Sonuç: Türk erkeklerine kıyasla, kadınlarda sağ kalım kazancı son on yılda net biçimde duraklamış olduğu gibi, ölüm riski -kadın ve kentlilik arasında etkileşimi düşündürür biçimde- kadınlarda ve kent sakinlerinde anlamlı olarak yükselmiştir. Her iki gözlem açıkça kabul görüp kapsamlı önlem alınması gereğini ortaya koymaktadır.