Cancer mortality in Common Mental Disorders: A 10-year retrospective cohort study.

PURPOSE: Individuals with Common Mental Disorders (CMDs) may have a higher cancer mortality. The purpose of this study was to examine cancer-related mortality among patients with CMDs and verify which cancer types are predominantly involved. METHODS: We used the Regional Mental Health Registry of the Emilia-Romagna region, in Northern Italy to identify patients aged ≥ 18 years who received an ICD 9-CM diagnosis of CMDs (i.e., depressive and neurotic disorders) over a 10 year period (2008-2017). Information on cause of death was retrieved from the Regional Cause of Death Registry. Comparisons were made with data from the regional population without CMDs. RESULTS: Among 101,487 patients suffering from CMDs (55.7% depression; 44.3% neurotic disorders), 3,087 (37.8%) died from neoplasms. The total standardized mortality ratio (SMR) was 1.82 (95% CI 1.78-1.86) while the SMR for all neoplasms was 2.08 (95% CI 2.01-2.16). Individuals of both genders, with both depressive and neurotic disorders had a higher risk of death from almost all cancers compared with the regional population. CONCLUSION: Patients with CMDs have considerably higher cancer mortality risk than the general population. Higher mortality was observed for a broad range of cancers associated with different aetiologies. It is imperative to promote cancer awareness, prevention and treatment for people with CMDs.

An ecological study on health inequalities in the city of Bologna (Emilia-Romagna Region, Northern Italy): bridging knowledge and action.

BACKGROUND: since January 2017, a multidisciplinary research group, involving the Local Health Authority, the Municipality, and the University of Bologna, carried out a city-wide action-research project on health inequalities consisting of an ecological study over the years 2011-2015 based on indicators that are routinely available within health and social services. OBJECTIVES: to document existing geographical inequalities in health outcomes and use of healthcare services in the city of Bologna (Emilia-Romagna Region, Northern Italy), with the aim to suggest policy action to tackle them. DESIGN: the results of the first phase of the above-mentioned project were reported: five related to the social determinants of health (exposure) and five related to the social determinants of ill-health (outcomes). For each municipal statistical area, the distribution of the exposures as well as rates and Bayesian Relative Risks of the outcomes were plotted on the city map. To evaluate the association between social determinants and health outcomes, Spearman correlation coefficients were estimated. SETTING AND PARTICIPANTS: residents in the city of Bologna aged >=18 years in the period 2011-2015, grouped into 90 statistical areas. RESULTS: a North-South divide was apparent for most of the socioeconomic and ill-health indicators, with a high concentration of adverse outcomes in the North-Western part of the city. Adherence to cancer screening represented an exception, being greater in the areas with higher proportion of unfavourable health outcomes. An inverse association between education level and health outcomes was found. Low family income was weakly to moderately correlated with health outcomes. Proportion of residents in council houses and of the teenage foreign population showed a moderate to strong association with all outcomes, but mortality and screening adherence. CONCLUSIONS: an ecological analysis based on data that are routinely collected by local health and social institutions can be effective in revealing the geographical patterns of health inequalities. When accompanied by strategic choices aimed at bridging knowledge and action, this approach may facilitate the direct engagement of local actors towards health equity.

[Development of a predictive model of death or urgent hospitalization to identify frail elderly]. / Sviluppo di un modello predittivo di decesso o ricovero d'urgenza per l'individuazione degli anziani fragili.

OBJECTIVES: to develop and validate a predictive model of mortality or emergency hospitalization in all subjects aged 65 years and over. DESIGN: cohort study based on 9 different databases linked with each other. SETTING AND PARTICIPANTS: the model was developed on the population aged 65 years and over resident at 01.01.2011 for at least two years in the city of Bologna (Emilia-Romagna Region, Northern Italy); 96,000 persons were included. MAIN OUTCOME MEASURES: the outcome was defined in case of emergency hospitalization or death during the one-year follow-up and studied with a logistic regression model. The predictive ability of the model was evaluated by using the area under the Roc curve, the Hosmer-Lemeshow test, and the Brier score in the derivation sample (2/3 of the population). These tests were repeated in the validation sample (1/3 of the population) and in the population of Bologna aged 65 years and over on 01.01.2012, after applying the coefficients of the variables obtained in the derivation model. By using the regression coefficients, a frailty index (risk score) was calculated for each subject later categorized in risk classes. RESULTS: the model is composed of 28 variables and has good predictive abilities. The area under the Roc curve of the derivation sample is 0.77, the Hosmer-Lemeshow test is not significant, and the Brier score is 0.11. Similar performances are obtained in the other two samples. With increasing risk class, the mean age, number of hospitalizations, emergency room service consultations, and multiple drug prescriptions increase, while the average income decreases. CONCLUSION: the model has good predictive ability. The frailty index can be used to support a proactive medicine and stratify the population, plan clinical and preventive activities or identify the potential beneficiaries of specific health promotion projects.

Air pollution from incinerators and reproductive outcomes: a multisite study.

BACKGROUND: The few studies that have investigated the relationship between emissions from municipal solid-waste incinerators and adverse pregnancy outcomes have had conflicting results. We conducted a study to assess the effects of air emissions from the eight incinerators currently in operation in the Emilia-Romagna Region of Italy on reproductive outcomes (sex ratio, multiple births, preterm births, and small for gestational age [SGA] births). METHODS: We considered all births (n = 21,517) to women residing within a 4-km radius of an incinerator at the time of delivery during the period 2003-2010 who were successfully linked to the Delivery Certificate database. This source also provided information on maternal characteristics and deliveries. Each newborn was georeferenced and characterized by a specific level of exposure to incinerator emissions, categorized in quintiles of PM10, and other sources of pollution (NOx quartiles), evaluated by means of ADMS-Urban system dispersion models. We ran logistic regression models for each outcome, adjusting for exposure to other pollution sources and maternal covariates. RESULTS: Incinerator pollution was not associated with sex ratio, multiple births, or frequency of SGA. Preterm delivery increased with increasing exposure (test for trend, P < 0.001); for the highest versus the lowest quintile exposure, the odds ratio was 1.30 (95% confidence interval = 1.08-1.57). A similar trend was observed for very preterm babies. Several sensitivity analyses did not alter these results. CONCLUSIONS: Maternal exposure to incinerator emissions, even at very low levels, was associated with preterm delivery.

Short-term mortality following COVID-19 vaccination in Bologna, Italy: a one-year study.

The main objective of the study is to assess whether there is an increased risk of mortality in the days following the administration of COVID-19 vaccines in Bologna Health Authority in the first year of COVID-19 vaccination campaign. A secondary objective was to describe causes of deaths occurred in the days after vaccination. We conducted a retrospective observational study on all residents of Bologna Health Authority who received at least one COVID-19 vaccination dose from December 27, 2020 to December 31, 2021 and compared mortality in the 3, 7, 14 30 days after vaccination (risk interval) with the mortality in the period of the same length (3, 7, 14 and 30 days) beyond the 30th day after the last dose of vaccination (control interval). The cohort included 717,538 people. The mortality rate was 2.24 per 100 person-years during the 30 days risk interval vs 2.72 in the control interval with an adjusted incidence rate ratio equal to 0.76 (95% CI: 0.70-0.83, p < 0.001). The risk of mortality is significantly lower (p < 0.001) also in the 3, 7, 14 days risk intervals than in the control intervals. This study shows that there is no increase in mortality in the short-term period after COVID-19 vaccines.

Emergency Department Visits and Summer Temperatures in Bologna, Northern Italy, 2010-2019: A Case-Crossover Study and Geographically Weighted Regression Methods.

The aim of the study is to evaluate the association between summer temperatures and emergency department visits (EDVs) in Bologna (Italy) and assess whether this association varies across areas with different socioeconomic and microclimatic characteristics. We included all EDVs within Bologna residences during the summers of 2010-2019. Each subject is attributed a deprivation and a microclimatic discomfort index according to the residence. A time-stratified case-crossover design was conducted to estimate the risk of EDV associated with temperature and the effect modification of deprivation and microclimatic characteristics. In addition, a spatial analysis of data aggregated at the census block level was conducted by applying a Poisson and a geographically weighted Poisson regression model. For each unit increase in temperature above 26 °C, the risk of EDV increases by 0.4% (95%CI: 0.05-0.8). The temperature-EDV relationship is not modified by the microclimatic discomfort index but rather by the deprivation index. The spatial analysis shows that the EDV rate increases with deprivation homogeneously, while it diminishes with increases in median income and microclimatic discomfort, with differences across areas. In conclusion, in Bologna, the EDV risk associated with high temperatures is not very relevant overall, but it tends to increase in areas with a low socioeconomic level.

COVID-19 vaccine effectiveness among the staff of the Bologna Health Trust, Italy, December 2020-April 2021.

BACKGROUND AND AIM: Randomized controlled trials have shown that mRNA vaccines are highly effective in preventing SARS-CoV2 infection. We conducted a study to assess the real-world effectiveness of mRNA vaccines (Pfizer-BioNTech or Moderna) in preventing all and symptomatic SARS-CoV2 infections and COVID-19 related hospitalizations in the staff of the Bologna Health Trust (HT), Italy Methods: We followed up retrospectively 9839 staff of the Bologna HT from December 27, 2020 to April 3, 2020 and calculated the effectiveness in partially and fully vaccinated subjects by applying a multivariable Cox proportional hazard model. RESULTS: Vaccine effectiveness in preventing SARS-CoV2 infections is 85.5% (95%CI: 75.9-91.3) in the partially vaccinated and 84.8% (95%CI: 73.2-91.4) in the fully vaccinated. In preventing symptomatic infection effectiveness is 81.7% (95%CI: 62.7-91.0) in the partially and 87.1% (95%CI: 69.3-94.6) in the fully vaccinated. There were no COVID-19-related hospitalizations in the partially or fully vaccinated vs 15 hospitalization in the unvaccinated cohort. CONCLUSIONS: Our results confirm the effectiveness of mRNA vaccines in a real-world setting in Northern Italy.

Comparison of 2-year clinical outcomes with sirolimus and paclitaxel-eluting stents for patients with diabetes: results of the Registro Regionale AngiopLastiche Emilia-Romagna Registry.

BACKGROUND: Long-term outcomes of percutaneous coronary interventions (PCI) with sirolimus-eluting stents (SES) compared to paclitaxel-eluting-stents (PES) in unselected diabetics in routine practice is still debated. OBJECTIVE: This study compared the 2-year incidence of MACE (all-cause mortality, nonfatal myocardial infarction and target vessel revascularization) of SES and PES in a real-world setting of patients with diabetes. DESIGN: Observational, multicenter, nonrandomized study. SETTING: Prospective web-based registry (REAL Registry; study period, 2002-2005) comprising all 13 hospitals performing PCI. PATIENTS: Among the 945 eligible patients treated with either SES alone (n = 606) or PES alone (n = 339), 29% were insulin-requiring, 72% had multivessel coronary disease, 26% had prior myocardial infarction and 10% had poor left ventricular function. MEASUREMENTS: Unadjusted and propensity score-adjusted 2-year clinical outcome. RESULTS: After propensity score adjustment, 2-year MACE incidence in the SES and PES groups was equivalent (23.3% vs. 23.7%, HR 1.01, 95%CI 0.72-1.42, P = 0.96). Adjusted 2-year angiographic stent thrombosis occurred in 1.1% of the SES patients versus 2.6% of the PES patients (P = 0.15). In this large, real-world, diabetic population treated with DES, there was no difference in outcome between SES and PES. Further studies are needed to demonstrate the long-term safety of different types of DES in patients with diabetes.

COVID-19 cases before and after the "I Stay at home" decree, Bologna Local Health Authority, Italy.

BACKGROUND AND AIM OF THE WORK: Various measures have been taken by the Italian Government to contain and mitigate the COVID-19 outbreak and on March 11th a decree called "I stay at home" put the whole nation under lockdown. Our aim is to describe sociodemographic and transmission profile of COVID-19 cases that were transmitted before and after the introduction of the decree in the Bologna Local Health Authority. METHODS: Cases were classified as transmitted before or after the decree according to the date of last contact with a COVID-19 case or, if this date was unavailable, we used the date of onset of symptoms considering the incubation period. Sociodemographic, clinical and epidemiological information was collected by using the infectious disease monitoring database, hospital discharge, deprivation index and long term care facility databases. RESULTS: In the period after the publication of the decree, there were more elderly, females, strangers, retired, residents in nursing homes and deprived people than in the first period. There were also more health care personnel and less professionals/managers, sales or office workers. In both phases, family is mentioned as the first community attended although less frequently in the second group. CONCLUSIONS: The profile of the new COVID-19 cases changed during the outbreak suggesting a differential effect of lockdown measures on the population. An equity lens should be used when analyzing the impact of pandemia and the measures taken to curb it.

Mental Health Disorders and Summer Temperature-Related Mortality: A Case Crossover Study.

Identifying the most vulnerable subjects is crucial for the effectiveness of health interventions aimed at limiting the adverse consequences of high temperatures. We conducted a case crossover study aimed at assessing whether suffering from mental health disorders modifies the effect of high temperatures on mortality. We included all deaths occurred in the area of Bologna Local Health Trust during the summers 2004-2017. Subjects with mental disorders were identified by using the local Mental Health Registry. A conditional logistic model was applied, and a z-test was used to study the effect modification. Several models were estimated stratifying by subjects' characteristics. For every 1 °C above 24 °C, mortality among people without mental disorders increased by 1.9% (95% CI 1.0-2.6, p < 0.0001), while among mental health service users, mortality increased by 5.5% (95% CI 2.4-8.6, p < 0.0001) (z-test equal to p = 0.0259). The effect modification varied according to gender, residency and cause of death. The highest probability of dying due to an increase in temperature was registered in patients with depression and cognitive decline. In order to reduce the effects of high temperatures on mortality, health intervention strategies should include mental health patients among the most vulnerable subjects taking account of their demographic and clinical characteristics.

Two-year clinical outcomes with drug-eluting stents for diabetic patients with de novo coronary lesions: results from a real-world multicenter registry.

BACKGROUND: The long-term effectiveness of drug-eluting stents (DES) in unselected diabetics in routine practice is currently unclear. METHODS AND RESULTS: To evaluate the long-term effectiveness of bare metal stents and DES in a real-world setting of diabetic patients, we analyzed 2-year follow-up data from all diabetic patients with de novo lesions enrolled in a prospective Web-based multicenter registry (Registro Regionale Angioplastiche dell'Emilia-Romagna; study period, 2002 to 2004) comprising all 13 hospitals performing percutaneous coronary interventions in the Emilia-Romagna region of Italy. Among the 1648 eligible patients treated with either bare metal stents alone (n=1089) or DES alone (n=559), 27% were insulin dependent and 83% had multivessel coronary disease. At 2 years, use of DES was associated with lower crude incidence of major adverse cardiac advents (all-cause mortality, nonfatal myocardial infarction, and target vessel revascularization) compared with bare metal stents (22.5% versus 28.1%; P=0.01). After propensity score adjustment, only target vessel revascularization appeared significantly lower in the DES group (11.6% versus 15.0%; hazard ratio, 0.66; 95% confidence interval, 0.46 to 0.96; P=0.041). Two-year angiographic stent thrombosis occurred in 1.5% DES patients and 0.7% of the bare-metal-stents patients (P=0.18). At Cox regression analysis, predictors of 2-year major adverse cardiac advents were left ventricular ejection fraction <35%, Charlson comorbidity index, insulin-dependent diabetes, and total lesion length. CONCLUSIONS: In this large, real-world, diabetic population, the use of DES was associated with a moderate reduction in the 2-year risk of target vessel revascularization, a benefit that was limited to non-insulin-dependent diabetic patients. Larger long-term studies are needed to clarify the long-term effectiveness and safety of such devices in diabetic patients.

Long-term outcomes with drug-eluting stents versus bare metal stents in the treatment of saphenous vein graft disease (results from the REgistro Regionale AngiopLastiche Emilia-Romagna registry).

Percutaneous revascularization of saphenous vein grafts (SVGs) remains a challenging task. Drug-eluting stents (DESs) have been shown to decrease the incidence of restenosis in de novo native coronary artery lesions. However, their clinical value in SVGs remains to be established. We compared long-term clinical outcomes of percutaneous coronary intervention with DESs and bare metal stents (BMSs) for de novo lesions in SVGs. In a large prospective, multicenter registry, 360 patients underwent stenting of a de novo lesion in SVGs using BMSs (288 patients) or DESs (72 patients). Incidence of major adverse cardiac events (MACEs), including all-cause mortality, reinfarction, and target vessel revascularization, was recorded at a 12-month follow-up. Compared with the DES group, patients receiving BMSs were more likely to be men, to have chronic renal insufficiency or higher Charlson scores, but less likely to have undergone previous percutaneous coronary intervention. Incidence of MACEs at 12-month follow-up was similar in the 2 groups (17.8% in DES group vs 20.3% in BMS group, respectively, p = 0.460). Cox regression analysis identified age, chronic renal failure, cardiogenic shock at presentation, and ostial location of stenosis as independent predictors of long-term MACEs. In conclusion, our data suggest that rates of 12-month MACEs associated with the use of DESs and BMSs are similar in patients undergoing treatment of de novo lesions in SVGs.

Long-term outcomes with cobalt-chromium bare-metal vs. drug-eluting stents: the REgistro regionale AngiopLastiche dell'Emilia-Romagna registry.

OBJECTIVE: To compare the long-term efficacy of cobalt-chromium bare-metal stents (CCSs) with that of first-generation drug-eluting stents (DESs) in patients within a large real-world multicentre registry. METHODS: The incidence of major adverse cardiac events [death, acute myocardial infarction, and target-vessel revascularization (TVR)] and angiographic stent thrombosis were assessed in consecutive patients undergoing percutaneous coronary intervention with CCS (n = 1103) or DES (n = 5195) during 2-year follow-up. Propensity score-adjusted outcomes, overall and in patients with low (≤ 10%), intermediate (10-15%), and high (>15%) 1-year restenosis risk, were estimated. RESULTS: DES-treated patients had significantly higher rates of diabetes, longer lesions, and smaller vessel diameters than CCS-treated patients (all P < 0.0001). However, CCS patients were older and presented a higher rate of hypertension, previous myocardial infarction, and heart failure (all P < 0.01). At 2 years, adjusted rates of myocardial infarction, death, and cumulative-stent thrombosis were similar for DES and CCS. DES provided statistically significant (P < 0.01) reductions in TVR and adjusted major adverse cardiac event rates (9.7 and 17.2%, respectively) compared with CCS (13.2 and 21.2%, respectively). In patients at highest and intermediate risk of restenosis, adjusted TVR rates were significantly (P < 0.01) lower with DES (12.2 and 8.9%, respectively) than CCS (19.9 and 17.1%, respectively), but rates were similar in low-risk patients. CONCLUSION: DESs were more effective than CCSs in lowering TVR rates in patients with an intermediate-high baseline restenosis risk.