Sociodemographic profile, health-related behaviours and experiences of healthcare access in Italian transgender and gender diverse adult population.

PURPOSE: Information on the general health of transgender and gender diverse (TGD) individuals continues to be lacking. To bridge this gap, the National Institute of Health in Italy together with the National Office against Racial Discriminations, clinical centres, and TGD organizations carried out a cross-sectional study to define the sociodemographic profile, health-related behaviours, and experiences of healthcare access in Italian TGD adult population. METHODS: A national survey was conducted by Computer-Assisted Web Interviewing (CAWI) technique. Collected data were compared within the TGD subgroups and between TGD people and the Italian general population (IGP). RESULTS: TGD respondents were 959: 65% assigned female at birth (AFAB) and 35% assigned male at birth (AMAB). 91.8% and 8.2% were binary and non-binary TGD respondents, respectively. More than 20% of the TGD population reported to be unemployed with the highest rate detectable in AMAB and non-binary people. Cigarette smoking and binge drinking were higher in the TGD population compared with IGP (p < 0.05), affecting TGD subgroups differently. A significant lower percentage of AFAB TGD people reported having had screening for cervical and breast cancer in comparison with AFAB IGP (p < 0.0001, in both cases). Over 40% was the percentage of AFAB and non-binary TGD people accessing healthcare who felt discriminated against because of their gender identity. CONCLUSIONS: Our results are a first step towards a better understanding of the health needs of TGD people in Italy in order to plan the best policy choices for a more inclusive public health.

Body mass index stratification in hospitalized Italian adults with congenital heart disease in relation to complexity, diagnosis, sex and age.

BACKGROUND AND AIMS: Adults with congenital heart disease (ACHD) are at risk of overweight and obesity, two major health problems, though underweight can be a negative prognostic factor too. Awareness of the body mass index (BMI) in ACHD is very limited. The present study describes the use and prevalence of BMI in Italian symptomatic hospitalized ACHD patients in relation to complexity by Bethesda system classification, diagnosis, sex and age. METHODS AND RESULTS: We classified 1388 ACHD patients, aged 18-69 years, on the basis of their BMI, and compared them to the Italian reference population. In our total ACHD population we found a significantly higher prevalence of underweight compared to the Italian reference population (6.34% vs 3.20%). ACHD women were more underweight than men. Underweight decreased with age. Overweight was significantly less frequent in the total ACHD population (26.73% compared to 31.70%) in the Italian reference population. Men were more likely to be overweight than women. In statistical terms obesity was similar in the Italian reference population (10.50%) and our ACHD population (9.58%). Both overweight and obesity increased with age. Results were comparable using a diagnostic anatomical-functional classification and the Bethesda system classification. CONCLUSIONS: In our cohort of ACHD the prevalence of underweight was double that of the Italian reference population. The prevalence of overweight was lower, while obesity was similar. Since BMI does not account for differences in body fat distribution, a future aim will be to quantify the visceral component of the adipose tissue in ACHD patients and examine their body composition in order to reflect their risk of acquired cardiovascular disease better, and either to maintain or achieve an adequate visceral component.

Premature mortality in Italy during the first decade of the AIDS epidemic: 1984-1993.

BACKGROUND: AIDS has become a leading cause of premature mortality in many countries, owing to the decline in other major causes of premature death and the increase in AIDS itself. This study was carried out to determine the trends in premature mortality due to selected causes in Italy. METHODS: Data from the Italian Mortality Data Base, for the ten years from 1984 to 1993 (the first decade of the AIDS epidemic) were analysed. Premature mortality was measured in terms of years of potential life lost before the age of 70 years (YPLL), excluding infant mortality. Trends in premature mortality due to AIDS were compared with those of the principal causes of premature death: lung cancer, colon-rectum cancer, stomach cancer, leukaemia, female breast cancer, uterine cancer, myocardial infarction, stroke, liver diseases, suicide, road accidents and overdose. RESULTS: In this period there has been a marked increase in premature mortality from AIDS both among males aged 1-69 years (from a rate of YPLL of 0.01 per 1000 in 1984 to 3.71 in 1993) and females of the same age group (from 0 deaths in 1984 to a rate of YPLL of 1.02). Throughout the same period all the other causes of premature death have been declining, with the exception of suicide and overdose among males, and overdose and lung cancer among females. For people aged 25-44 years, AIDS has become the greatest cause of premature death. The increasing trend in premature mortality due to AIDS is most pronounced in the northern and central areas of Italy. CONCLUSIONS: AIDS is the leading cause of death among males aged 25-44 years in Italy and is having an important impact on premature mortality among females in the same age group.

The impact of the major causes of death on life expectancy in Italy.

BACKGROUND: This study aims to evaluate the contribution of the reduction in major cardiovascular diseases (CVD), malignant neoplasms (MN), accidents and AIDS mortality to the gains in life expectancy observed during the decade 1985-1994, as well as to calculate and compare the potential gains due to the partial or total elimination of these causes. METHODS: Mortality data from the Italian Mortality Data Base were analysed by the method of decomposition of changes in life expectancy and the partial multiple decrement life table technique. RESULTS: In Italy, considering the decade 1985-1994, the gain in life expectancy at birth was 2.27 years for men and 2.16 for women. The major contribution to this increase was the reduction in CVD mortality followed by fewer deaths from accidents and MN. Conversely, AIDS caused a loss in the length of life of adults. Major potential gains in life expectancy at birth could be obtained by the elimination or even partial reduction of CVD and MN mortality. When working life (15-64 years) is considered, the relative importance of the causes changes. The elimination of accidents and AIDS would result in increased life expectancy longer than that associated with a 50% reduction in CVD. CONCLUSIONS: The findings of this study provide useful information which could contribute to a more effective allocation of resources for research activity and public health programmes.

Suicide prevention among youths. Systematic review of available evidence-based interventions and implications for Italy.

Suicide completion is a leading cause of death for children, adolescents, and young adults. There is evidence that the suicide rate for those aged 15 to 24 years has tripled since 1950, and suicide is now the second or third leading cause of death in this age group. Recent studies indicate that the incidence of suicide attempts among adolescents may exceed 10% annually. The role of caregivers and schools (as well as colleges and universities) is important in the assessment, management, and prevention of suicidal behaviour in children and youth. Recognition of risk factors for suicide is of paramount importance for prevention. Furthermore, a number of educational programs have demonstrated possible key roles in implementing suicide prevention strategies. As suicide is a problem of concern among Italian youths, this paper overviews current official statistical evidence of the phenomenon and suggests a national suicide prevention strategy based on a number of tools already involved in this field, especially in the USA.

Gender differentials in life expectancy in Italy.

OBJECTIVE: To analyze the gender differential in life expectancy in Italy from 1970 to 1997, to determine which ages and causes of death mostly influenced its trend. METHODS: Pollard method was used to explain which ages and which pathologies give the highest contribution to the gender differential. RESULTS: A slight reduction of the gender differential has been observed since 1980. The olds and very olds became the most relevant contributors to the differential. Cardiovascular diseases were the principal contributing causes of death until 1980 and Cancer replaced them afterwards. CONCLUSION: Relatively recent adoption of unhealthy life styles by women together with an opposite process run by young men towards healthier behaviour, seem to be at the basis of the slight reduction of the gender differential in life expectancy observed since 1980.

Differential impact of combined antiretroviral therapy on the survival of italian patients with specific AIDS-defining illnesses.

BACKGROUND: A decrease in HIV-related mortality and morbidity has been observed since 1996 in most developed countries as a consequence of the extensive use of combined antiretroviral therapies. The purpose of this study was to investigate whether combined antiretroviral therapies had a differential impact on the survival of patients with different AIDS-defining illnesses (ADIs). METHODS: In total, 35,318 persons representing all the adults with AIDS (PWAs) diagnosed in Italy from January 1, 1990 to August 31, 1998 were studied. Actuarial life tables and the Kaplan-Meier method were used to estimate the cumulative probability of survival; the multivariate Cox proportional hazards model was used to estimate adjusted relative hazard of death (RH). RESULTS: Among PWAs diagnosed after 1995, the proportion of survivors 24 months after diagnosis was more than doubled (66%) compared with that of PWAs diagnosed before the end of 1995 (31%). Significantly decreased RHs for some ADIs were observed as early as 1996 (i.e., esophageal candidiasis, Pneumocystis carinii pneumonia, brain toxoplasmosis, HIV-wasting syndrome, and pulmonary tuberculosis). In the last period (1997-1998), the decrease was marked and significant for almost all the ADIs, ranging from 55% to 80% compared with the RHs of the reference year (1995). Conversely, primary lymphoma of the brain and Burkitt's lymphoma showed a low and not statistically significant decrease; these were the ADIs with the worst outcome. CONCLUSIONS: After 1995, there was a rather uniform increase in the survival of PWAs diagnosed with most specific ADIs but not for patients affected by primary brain lymphoma and Burkitt's lymphoma. The determinants of this differential effect need to be investigated.

Creutzfeldt-Jakob disease mortality in Italy, 1982-1996.

We report an estimate of Creutzfeldt-Jakob disease (CJD) deaths in Italy from 1982 to 1996 by using mortality data based on a retrospective review of deaths taken from the mortality data base of the Italian Census Bureau (ISTAT, years 1982-1993), and on the prospective surveillance performed by the Italian National Register of CJD (years 1993-1996). One hundred and ninety-five and 154 deaths attributed to CJD were recorded by ISTAT and the CJD register, respectively. The average annual age-adjusted mortality rate was 0. 45 and 0.84 deaths per million for the period 1982-1993 and 1993-1996, respectively. The yearly increase in the number of CJD deaths was mostly due to a rise in the reported deaths among people older than 60 years. The result of the linkage between ISTAT and the CJD register shows that the integrated age-adjusted mortality rate for 1993 was about 1 case per million, similar to the rates observed in other studies and obtained by the CJD register alone in 1996. This study indicates that the data of the CJD register is accurate and therefore important for assessing eventual changes in the characteristics of the disease resulting from bovine spongiform encephalopathy or other new risk factors.