Mortality patterns in Southern Adriatic islands of Croatia: a registry-based study.

AIM: To investigate the mortality patterns on the Southern Adriatic islands of Croatia and compare them with those in two, mainly coastal, mainland counties. METHODS: In this registry-based study we used the official mortality register data to analyze the mortality patterns on seven Croatian islands (Brac, Hvar, Korcula, Lastovo, Mljet, Solta, and Vis) and Peljesac peninsula in the 1998-2013 period and calculated the average lifespan, life expectancy, and standardized mortality ratios (SMR). We compared the leading causes of death with those in the mainland population of two southernmost Croatian counties. RESULTS: The average lifespan of the island population was 3-10 years longer for men and 2-7 years longer for women than that on the mainland. All-cause SMRs were significantly lower for both men and women on Korcula, Brac, Mljet, and Peljesac but significantly higher for women on Solta (1.22; 95% confidence intervals 1.07-1.38). The leading causes of death on the islands were cardiovascular diseases, with higher percentages in men and lower in women in comparison with those on the mainland. There were no substantial differences in the life expectancy at birth. CONCLUSIONS: Despite longer lifespan, lack of differences in life expectancy at birth suggests that the recent generations of islanders no longer show beneficial mortality patterns, possibly due to diminishing adherence to the Mediterranean diet and lifestyle. Restoring the traditional lifestyles is a public health priority, with the ultimate aim of reducing inequalities and improving the health of island inhabitants.

Epidemiology and Outcomes of Congenital Diaphragmatic Hernia in Croatia: A Population-Based Study.

BACKGROUND: Outcomes of neonates with congenital diaphragmatic hernia (CDH) are variable; reports are frequently limited to the experience of single tertiary care centres-a possible source of bias. Population-based studies decrease survivor bias and provide additional insight into this high-mortality condition. The objective of this study was to examine the incidence and outcomes of CDH in Croatia. METHODS: All cases of CDH in Croatia from 2001 through 2013 were ascertained from public health records. Overall and sex- and region-specific incidence rates were calculated, and characteristics associated with 1-year survival were assessed. RESULTS: We identified 145 cases of CDH during the study period, for an incidence of 2.67 per 10 000 total births. The incidence did not differ by calendar year (P = 0.38) or geographic region (P = 0.67). There was a slightly higher incidence among males (rate ratio, 1.37, 95% CI 0.99, 1.91). The 1-year survival rate was 33.1% for the entire cohort and 47.9% for liveborns who received any treatment at an intensive care unit. From multivariable analysis, survival was decreased in neonates with left CDH, liver up (odds ratio 0.1, 95% CI, 0.03, 0.4) and increased when treated in a centre with higher case volume (odds ratio 12.8, 95% CI, 2.2, 72.1). CONCLUSIONS: The incidence of CDH in Croatia is within the range of previous reports. Survival was substantially higher in neonates treated in a centre with higher case volume, which suggests that centralisation of medical care for CDH may be warranted in Croatia.

Adherence to the Mediterranean Diet Related to the Health Related and Well-Being Outcomes of European Mature Adults and Elderly, with an Additional Reference to Croatia.

With the increase in life expectancy, expectation of a longer healthy life is also increasing. Importance of consumption of certain foods is confirmed to have a strong effect on quality of life. One of the healthiest dietary patterns consistently associated with a range of beneficial health outcomes is the Mediterranean diet (MD). The aim of this study was to assess MD adherence in the population over 50 years of age, in Europe, with special reference to Croatia, and to assess regional differences and investigate the association with health-related indicators (disease incidence, body mass index (BMI), grip strength measure, control, autonomy, self-realization, and pleasure scale (CASP-12)). This research uses data from the SHARE project for the population over 50 years of age. The frequency of individual responses was analyzed (frequencies, cross tables, and appropriate tests of significance, depending on the data set), and logistic regression was used to connect adherence to the Mediterranean diet with health indicators. The results of the study indicate a positive correlation between adherence to the principles of the Mediterranean diet with CASP and self-perception of health, which the followers of the MD pattern predominantly rate as "very good" or "excellent" (37.05%) what is significantly different (p < 0.05) from individuals which do not follow the patterns of MD (21.55%). The regression models indicate significant changes in the measure of maximum grip strength also among MD followers (ORMEDIUM = 1.449; ORHIGH = 1.293). Data for EU countries are also classified by regions (Central and Eastern; Northern, Southern and Western Europe), additionally allocating Croatia, and the trends in meat, fish and egg consumption showed the greatest differences for Croatian participants (39.6% twice a week) versus participants from four European regions. Data for Croatia deviates from the European average also in terms of the proportion of overweight and obese persons in all observed age groups, of which the largest proportion is in the 50-64 age group (normal BMI: only 30.3%). This study extended the currently available literature covering 27 European countries, placing the findings in a wider geographical context. The Mediterranean diet has once again proven to be an important factor related to health-related behavior. The presented results are extremely important for public health services, indicating possible critical factors in preserving the health of the population over 50 years old.

Genetic scores for predicting longevity in the Croatian oldest-old population.

Longevity is a hallmark of successful ageing and a complex trait with a significant genetic component. In this study, 43 single nucleotide polymorphisms (SNPs) were chosen from the literature and genotyped in a Croatian oldest-old sample (85+ years, sample size (N) = 314), in order to determine whether any of these SNPs have a significant effect on reaching the age thresholds for longevity (90+ years, N = 212) and extreme longevity (95+ years, N = 84). The best models were selected for both survival ages using multivariate logistic regression. In the model for reaching age 90, nine SNPs explained 20% of variance for survival to that age, while the 95-year model included five SNPs accounting for 9.3% of variance. The two SNPs that showed the most significant association (p ≤ 0.01) with longevity were TERC rs16847897 and GHRHR rs2267723. Unweighted and weighted Genetic Longevity Scores (uGLS and wGLS) were calculated and their predictive power was tested. All four scores showed significant correlation with age at death (p ≤ 0.01). They also passed the ROC curve test with at least 50% predictive ability, but wGLS90 stood out as the most accurate score, with a 69% chance of accurately predicting survival to the age of 90.

The Labin Region, an ecologically vulnerable geographical area in Croatia: Mortality characteristics in an area polluted by industrial over a 40-year period.

The history of the Labin region in Croatia includes intensive industrial development with repercussions of pollution on environment and health. Assuming that prolonged exposure to polluted environments causes qualitative changes in mortality, the aim was to analyse the mortality characteristics of the population of the Labin Region for the 1968-2008 period based on data from the Croatian Bureau of Statistics. Public health and social opportunities in this geographical area carry a long-term burden of exposure to an industrial polluted environment with outcomes expressed by mortality or/and morbidity in the population. This study includes data on 11,903 deaths, most of which due to diseases of the circulatory, respiratory and digestive systems as well as neoplasms. In the third and fourth decade of the study period, a group of neoplasms showed significant increases, while the increase in respiratory diseases were more gradual. The female population died mostly from diseases of the circulatory and endocrine system as well as neoplasms, while the male population mainly died from diseases of the digestive system and external causes. This research provides guidelines that could create better public health, raising the quality of life and contribute to a future environmental protection in local communities by targeted policies.

[Incidence and prevalence of asbestos-related diseases in Croatia]. / Pojavnost bolesti uzrokovanih azbestom u Republici Hrvatskoj u razdoblju od 2002. do 2007.

The aim of this study was to identify the incidence and prevalence of asbestos-related diseases in Croatia, based on the Hospital Morbidity Database and General Mortality Database of the Croatian National Institute of Public Health. Both databases cover a period from 2002 to 2007), and include information from the Register of Occupational Diseases. Diagnoses in focus were mesothelioma (C45), asbestosis, and pleural plaque (J61 and J92). Yearly rates of inpatients treated for mesothelioma, asbestosis, or pleural plaque that were higher than the Croatian average (2.1) were recorded in the Counties of Split-Dalmatia (5.0), Dubrovnik-Neretva (3.9), Istria (3.7), and Primorje-Gorski kotar (3.1 per 100,000 people). From 2002 to 2007, 649 occupational diseases were reported, out of which 11.7% were asbestos-related. The most frequent were pleural plaque with asbestosis (38 cases, 50.0%), pleural plaque (23 cases, 30.3%), and mesothelioma (6 cases, 7.9%). Mortality attributable to asbestos was assessed using official Croatian National Statistics Bureau reports for 2002 to 2007 at the county and national level. During that period, Croatia recorded 312 deaths with the average yearly rate of 1.2 per 100.000 people. Four counties had higher rates than the national average: Primorje-Gorski kotar (3.4), Split-Dalmatia (2.8), Istria (2.8), and S1. Brod-Posavina (1.5). The number of inpatients treated for asbestos-related diseases was higher than the national average in the counties of Split-Dalmatia, Dubrovnik-Neretva, and Primorje-Gorski Kotar. Mesothelioma incidence was above the national average in the counties of Split-Dalmatia, Primorje-Gorski Kotar, and Istria. The rates of occupational, asbestos-related diseases were higher than the national average in the counties of Split-Dalmatia and Primorje-Gorski Kotar. We were aware that the interpretation of data is somewhat limited by the relatively small absolute number of treated persons and deaths for the observed period, by the fact that crude rates have not been adjusted for total numbers and for regional differences in population distribution by age and gender. The real extent of asbestos-related burden in Croatian general population remains unknown, because only occupational exposure has been monitored. Therefore, the National Public Health Institute and county public health institutes should implement a specific monitoring programme in collaboration with government environmental bodies to assess asbestos exposure of the population living in the vicinity of asbestos plants. It is also necessary to establish the number of exposed persons who have developed an asbestos-related disease. Their health should be monitored and their environment inspected on a regular basis.

Mortality Characteristics of Two Populations in the Northern Mediterranean (Croatia) in the Period 1960⁻2012: An Ecological Study.

In the second half of the 20th century, the town of Bakar (Primorje-Gorski Kotar County, Croatia), where a coking plant was operational 1978⁻1994, experienced intensive industrialisation. The town of Mali Losinj (Primorje-Gorski Kotar County, Croatia) in this period based its economy on non-industrial sectors. The study goal was comparing mortality characteristics of these populations in the northern Mediterranean for 1960⁻2012. An ecological study design was used. Data were analysed for 1960⁻2012 for the deceased with recorded place of residence in the study area. Data on the deceased for 1960⁻1993 were taken from death reports, for 1994⁻2012 from digital archives of the Teaching Institute of Public Health, Primorje-Gorski Kotar County. Data on causes of death for 1960⁻1994 were recoded to the three-digit code of underlying cause of death according to the International Classification of Diseases (ICD⁻10). Among studied populations significant difference was found among the causes of deaths coded within ICD⁻10 chapters: neoplasms (particularly stomach carcinoma), mental and behavioural disorders and diseases of the respiratory system (particularly chronic obstructive pulmonary disease, (COPD)). Increase in mortality from neoplasms, increase in respiratory diseases for the area exposed to industrial pollution, also stomach carcinoma and COPD particularly in the town Bakar require further research.

Physicians' strike and general mortality: Croatia's experience of 2003.

The aim of the study was to establish whether the physicians' strike, which took place in Croatia in 2003, had an impact on the mortality of the population. Mortality data from the National Bureau of Statistics relating to the strike period (15 January - 14 February 2003) were selected and compared with the previous and subsequent periods of the same duration in 2001, 2002 and 2004. Of the 52,575 deaths in 2003, Croatia recorded 4,682 (8.9%, 95% Confidence interval 8.4-9.4) in the strike period from the 15th of January to the 14th of February 2003 or 1.1 deaths per 1000. No deviations of the 15th of January to the 14th of February period's share of the death total in relation to other observation periods were noted. It is impossible to associate the strike based on the figures shown in this paper with either an increase or decrease in population mortality.

Socioeconomic inequalities show remarkably poor association with health and disease in Southern Croatia.

OBJECTIVES: This study aimed at investigating the association of socioeconomic status and health outcomes in populations of the two remote Croatian islands and one coastal city. METHODS: Medical history and survey information were used to create 33 variables that were analysed using logistic regression. The population from the island of Vis was followed up and mortality data were used to calculate hazard ratios using Cox regression. RESULTS: Socioeconomic inequalities were poorly associated with health and disease indices. In the matrix of 33 outcome variables and 13 socioeconomic predictor classes, only 10 associations were significant at the level of P < 0.001. None of the associations was replicated across samples. We did not detect the association of any socioeconomic estimate with mortality data for the island of Vis. CONCLUSIONS: Homogenous island populations were expected to have greater levels of social homogeneity and consequently less expressed inequalities in health. The lack of stronger association in the urban population of Split is likely the result of the mechanisms that persisted from the former communist regime and high level of retained formal and informal social support.