Assessment of Excess Mortality in Italy in 2020-2021 as a Function of Selected Macro-Factors.

BACKGROUND: Excess mortality (EM) can reliably capture the impact of a pandemic, this study aims at assessing the numerous factors associated with EM during the COVID-19 pandemic in Italy. METHODS: Mortality records (ISTAT 2015-2021) aggregated in the 610 Italian Labour Market Areas (LMAs) were used to obtain the EM P-scores to associate EM with socioeconomic variables. A two-step analysis was implemented: (1) Functional representation of EM and clustering. (2) Distinct functional regression by cluster. RESULTS: The LMAs are divided into four clusters: 1 low EM; 2 moderate EM; 3 high EM; and 4 high EM-first wave. Low-Income showed a negative association with EM clusters 1 and 4. Population density and percentage of over 70 did not seem to affect EM significantly. Bed availability positively associates with EM during the first wave. The employment rate positively associates with EM during the first two waves, becoming negatively associated when the vaccination campaign began. CONCLUSIONS: The clustering shows diverse behaviours by geography and time, the impact of socioeconomic characteristics, and local governments and health services' responses. The LMAs allow to draw a clear picture of local characteristics associated with the spread of the virus. The employment rate trend confirmed that essential workers were at risk, especially during the first wave.

Burden of Mortality from Asbestos-Related Diseases in Italy.

Asbestos is one of the major worldwide occupational carcinogens. The global burden of asbestos-related diseases (ARDs) was estimated around 231,000 cases/year. Italy was one of the main European asbestos producers until the 1992 ban. The WHO recommended national programs, including epidemiological surveillance, to eliminate ARDs. The present paper shows the estimate of the burden of mortality from ARDs in Italy, established for the first time. National standardized rates of mortality from mesothelioma and asbestosis and their temporal trends, based on the National Institute of Statistics database, were computed. Deaths from lung cancer attributable to asbestos exposure were estimated using population-based case-control studies. Asbestos-related lung and ovarian cancer deaths attributable to occupational exposure were estimated, considering the Italian occupational cohort studies. In the 2010-2016 period, 4400 deaths/year attributable to asbestos were estimated: 1515 from mesothelioma, 58 from asbestosis, 2830 from lung and 16 from ovarian cancers. The estimates based on occupational cohorts showed that each year 271 deaths from mesothelioma, 302 from lung cancer and 16 from ovarian cancer were attributable to occupational asbestos exposure in industrial sectors with high asbestos levels. The important health impact of asbestos in Italy, 10-25 years after the ban, was highlighted. These results suggest the need for appropriate interventions in terms of prevention, health care and social security at the local level and could contribute to the global estimate of ARDs.

Exploring methods for the assessment of temporal trends in mortality and hospitalization in Italian industrially contaminated sites.

INTRODUCTION: The Italian contaminated sites of interest for remediation are monitored by SENTIERI, an epidemiological surveillance system describing the health status of populations living nearby these sites. There is an increasing concern on how to assess temporal changes in the health status of these populations. METHODS: A sequence of three statistical techniques was adopted to analyse temporal trends of mortality and hospitalization, by using different indicators and reference populations, in a sample of 36 sites with industrial sources of contamination monitored by SENTIERI. RESULTS: Positive temporal trends in health risks are detected reflecting mainly long term effects of industrial activities. The adopted methodology identifies multiple factors influencing the temporal patterns: type of health outcomes, type of disease, and its link with gender and type of emission sources. CONCLUSIONS: Reliable methods to assess health profile changes in local populations attributable to contaminations are key elements to measure the impact of remediation activities.

Primary Sclerosing Cholangitis: Burden of Disease and Mortality Using Data from the National Rare Diseases Registry in Italy.

Introduction: Studies on the epidemiology of primary sclerosing cholangitis (PSC) are mainly based on tertiary referral centers; and are retrospective case series susceptible to selection bias. The aim of this study was to estimate incidence; survival and cause of mortality of PSC in Italy; using population-based data. Methods: Data collected from the National Rare Diseases Registry (RNMR) and the National Mortality Database (NMD) were integrated and analyzed. Results: We identified 502 PSC incident cases. The crude incidence rate between 2012 and 2014 was 0.10 per 100,000 individuals. Sixty percent were male; mean age at disease onset and at diagnosis were 33 and 37 years; respectively; highlighting a mean diagnostic delay of 4 years. The rate of interregional mobility was 12%. Ten-year survival was 92%. In 32% of cases the cause of death was biliary-related; 12% died of biliary or gallbladder cancer. Conclusions: For rare diseases such as PSC; population-based cohort's studies are of paramount importance. Incidence rates of PSC in Italy are markedly lower and survival much longer than the ones reported from tertiary; single-centre series. Moreover; the diagnostic delay and the patient interregional mobility highlights the need for increasing awareness on the disease and for resource reallocation among Italian regions within the National Health Service.

Economic Deprivation as a Predictor of the Direction of Lethal Violence: An Analysis of Italian Provinces.

Research on suicide and homicide rates has neglected an integrated model seeking to explain social variation in the direction of lethal violence. The present investigation explores the association between measures of social deprivation on the relative incidence of suicide over homicide in Italian provinces. Data refer to official government sources on lethal violence rates and measures of social deprivation. The central dependent variable (SHR) is the tendency towards suicide measured as the suicide rate divided by the sum of the suicide and homicide rates. Data were available for 102 Italian provinces in the Census year 2001. The percentage of the population marked by two indicators of deprivation (low education, household population density) were negatively associated with the SHR. The results are largely consistent with a stream of previous research that connects deprivation with a relatively high probability for disadvantaged populations to direct aggression outwardly in the form of homicide rather than inwardly in the form of suicide. The present study specifies which elements of deprivation best predict the direction of violence and is the first study for the Italian context.

Social determinants effects from the Italian risk factor surveillance system PASSI.

OBJECTIVES: To offer examples on how risk factor surveillance systems can help in providing useful information on social determinants effects and health inequalities. METHODS: The Italian risk factor surveillance system (PASSI) collects monthly information from most of the Italian Local Health Units (over 85% of the Italian population is covered) on major health-related behaviours together with information on health practices, attitudes and opinions. Multivariate analysis of associations with possible indicators of social determinants collected by the system, offers important indications on the value that the system has in providing useful information on the effects of social determinants. RESULTS: Social determinants, although measured through very simple indicators, have major influence on health outcomes (in the example here, depression), geographical disparities in health (efficacy of smoking ban), and access to preventive services (pap test in our analysis). CONCLUSIONS: Risk factor surveillance can offer valuable information for monitoring social determinants effects and inequalities, and, when considering data over time, for evaluating the gross impact of future interventions and policies aimed at reducing them.

Features and initial assessment of the Italian Behavioral Risk Factor Surveillance System (PASSI), 2007-2008.

INTRODUCTION: Surveillance systems for health status and behaviors of populations are fundamental for planning, implementing, and monitoring preventive interventions. In 2006, the Italian Ministry of Health provided funding to the National Institute of Public Health to develop an ongoing surveillance system for adult behavioral risk factors. We describe the main features of the system (known as PASSI) and provide a preliminary assessment of its activity. METHODS: PASSI is conducted by participating local health units, which use a common questionnaire and methods. Each month, local health unit staff conduct telephone interviews of a random sample of resident adults aged 18 to 69 years. Data are transmitted to the national coordinating center, where they are cleaned, managed, and made available for local, regional, and national analysis. Training, data analysis, and communications are centrally supervised, and data quality is routinely monitored. RESULTS: In 2007 and 2008, nearly 60,000 interviews were completed. The demographic characteristics of survey participants closely corresponded to census data in the surveyed areas. The response rate was 82%; the refusal rate was 10% or less. Communications activities have been conducted to disseminate the results and encourage their use. CONCLUSION: PASSI is administered by the public health system with limited human and financial resources. In the first 2 years of activity, the data quality was good, and information collected was useful. The organizational model of PASSI may be of interest to countries that are developing surveillance systems as well as those with systems already in place.

[Objectives, tools and methods for an epidemiological use of electronic health archives in various areas of Italy]. / Obiettivi, strumenti e metodi per un utilizzo epidemiologico di archivi sanitari elettronici correnti in diverse aree italiane.

The availability of Electronic Health Archives (EHA) has increased remarkably over the last twenty years. As part of a joint project of the Italian Association of Epidemiology (AIE) and the Italian Association of Medical Statistics and Clinical Epidemiology (SISMEC), a workgroup of experts was set up in 2005 with the aim of comparing various experiences and of standardizing the procedures by which electronic sources can be integrated. In particular, the workgroup's aim was to estimate the frequency of certain major diseases using standard algorithms applied to EHA. This volume is published with the purpose of making available in a common publication the methods and the results obtained. The results from a multicentre study using a standard approach to probabilistic record-linkage procedures are also included in a specific chapter. Eleven Italian centres from five Italian regions with an overall population of 11,932,026 collected and treated more than 21,374,426 records (year 2003) from five electronic information sources: death certificates, hospital discharge records (including outpatient discharges), drug prescriptions, tax- exemptions, and pathology records in order to estimate the frequency of the following diseases: diabetes, ischemic heart diseases, acute myocardial infarction, stroke, asthma, chronic obstructive pulmonary disease, obstructive lung diseases. For each pathology a specific algorithm was developed and used by all centres for the identification of the prevalent/incident cases of the selected diseases. Standardized methods were used to estimate the rates. The results confirm the need for a common standard approach to produce estimates based on EHA, considering the variability of the quality and of the completeness of the archives, and the difficulties of standardizing record-linkage operations in the various centres. The main achievement of this work was the elimination of the variability due to the use of different algorithms to identify cases using EHA.