The Socio-Economic Health Deprivation Index and its association with mortality and attitudes towards influenza vaccination among the elderly in Palermo, Sicily.

INTRODUCTION: Socio-economic status (SES) seems to be a determinant of health and is associated with vaccination coverage among older and at-risk populations. The aim of this study was to evaluate trends in health outcomes and the Socio-Economic and Health Deprivation Index (SEHDI) among elderly people in the city of Palermo. METHODS: In the 2015 CCM project, the Palermo Unit collected mortality data for use in validating the SEHDI. Italian census data from 2009 to 2015 on overall mortality and causes of death were used. The outcome used to validate the SEHDI was vaccination coverage from the 2009-2010 to 2014-2015 influenza seasons among the elderly in Palermo. RESULTS: The SEHDI correlated significantly with all-cause mortality (p < 0.05), though this correlation displayed a decreasing trend. Regarding mortality due to influenza or pneumonia, however, the significant correlation (p < 0.05) showed an increasing trend. A linear trend was observed in the inverse correlation between the SEHDI and vaccination coverage rates (p < 0.05), with an overall 27% vaccination coverage among older people. Elderly subjects living in a census district with more regular immigrants, divorced people and single-parent families were more reluctant to undergo influenza vaccination. CONCLUSIONS: This study allowed us to identify subgroups of elderly people who are less likely to adhere to influenza vaccination, and to whom health promotion interventions could be addressed in order to facilitate "healthy aging".

The relationship between ambient particulate matter and respiratory mortality: a multi-city study in Italy.

The association of air pollutants with natural and respiratory mortality has been consistently reported. However, several aspects of the relationship between particulate matter with a 50% cut-off aerodynamic diameter of 10 µm (PM(10)) and respiratory mortality require further investigation. The aim of the present study was to assess the PM(10)-respiratory mortality association in Italy and examine potentially susceptible groups. All deaths from natural (n=276,205) and respiratory (n=19,629) causes among subjects aged ≥ 35 yrs in 10 northern, central and southern Italian cities in 2001-2005 were included in the study. Pollution data for PM(10), nitrogen dioxide and ozone were also obtained. A time-stratified case-crossover analysis was carried out. Different cumulative lags were selected to analyse immediate, delayed, prolonged and best-time effects of air pollution. The shape of the exposure-response curve was analysed. Age, sex, chronic conditions and death site were investigated as potential effect modifiers. We found a 2.29% (95% CI 1.03-3.58%) increase in respiratory mortality at 0-3 days lag. The increase in respiratory mortality was higher in summer (7.57%). The exposure-response curve had a linear shape without any threshold. Sex and chronic diseases modified the relationship between particular matter (PM) and respiratory mortality. The effect of PM on respiratory mortality was stronger and more persistent than that on natural mortality. Females and chronic disease sufferers were more likely to die of a respiratory disease caused by air pollution than males and healthy people.

Epidemiology and direct medical costs of human leishmaniasis in Italy.

INTRODUCTION: In the last decades, visceral Leishmaniasis infection rate has increased in Western Mediterranean areas. Epidemiological data show that in Italy, especially in some regions, the prevalence of canine form is high. The aim of this study is to evaluate the epidemiological setting of Leishmaniasis in Italy, according to age groups and geographical areas, and to estimate the associated direct medical costs. METHODS: The study examined the ordinary and day-hospital discharges and the respective mean of hospital length of stay for Leishmaniasis and visceral Leishmaniasis in Italy, during the period 1999-2003. Moreover, we collected data about notifications of Leishmaniasis, from 1993 to 2004, and mortality due to this infectious disease, from 1993 to 1998. We evaluated the prevalence rates of discharges, the visceral and cutaneous Leishmaniasis notifications incidence rates and the mortality rates from disease, per 1,000,000 residents. Costs analysis was performed getting DRG number 423 rate, which corresponds to "other diagnosis related to infectious and parasitary diseases". RESULTS: Ordinary discharges decreased in the study period, while day-hospital discharges increased. Sicilia, Campania and Lazio regions showed the highest number of ordinary hospital discharges for Leishmaniasis (prevalence rates were respectively 16.29, 15.02 and 12.83 per 1,000,000 residents, in 2003). Campania and Sicilia showed also the highest prevalence rates of day-hospital discharges (respectively 17.29 and 35.39 per 1,000,000 residents in 2003). The analysis of incidence rates of notifications showed a cyclic trend of the visceral form of the disease, with the highest rates observed in the group aged 0-14 years (incidence rates per 1,000,000: 7.46 in 1996 and 8.59 in 2000). The highest mortality rates were observed in the group aged over 65 years; low but constant mortality rates for Leishmaniasis were seen in the age group 25-64 years. Direct costs for both ordinary and day-hospital admissions were: 1,561,218.46 Euro in 1999; 1,637,256.44 Euro in 2000; 1,459,892.92 Euro in 2001, 1,468,983.58 Euro in 2002 and 1,370,227.80 Euro in 2003. DISCUSSION: Discharges for Leishmaniasis showed non-homogeneous trend in Italy, especially in coastal Regions. Leishmaniasis notifications have slowly increased after 1993 and a high number of notifications was observed in the 0-14 years old group. The highest mortality rates were reported in the extreme age-groups: mortality was relevant for patients over 65 years. Moreover, cost analysis showed that health care of human Leishmaniasis requires long time of hospitalization with consequent high costs. Conclusion. Preventive measures have to be turned to extreme age groups. For future studies issues such as high costs of treating disease, cost-effectiveness evaluation of the 'current therapeutic approach compared to preventive interventions on dogs and vector insects would be of interest.