[Mortality amenable to health care services and health inequalities among Italian Regions]. / La mortalità riconducibile ai servizi sanitari e le disuguaglianze di salute nelle regioni italiane.

OBJECTIVES: to investigate differences in amenable mortality among Italian Regions using the lists of causes of death conceived by Nolte and McKee, and Tobias and Yeh, and assess whether these differences are in part attributable to the list used. We also estimated the contribution of amenable mortality to the gaps in all-cause mortality among North, Centre and South of Italy. DESIGN: cross-sectional study. SETTING AND PARTICIPANTS: Italian National Institute of Statistics (ISTAT) mortality data for the period 2006-2009. MAIN OUTCOME MEASURES: age- and gender-standardised amenable mortality rates. RESULTS: for the period 2006-2009, in Italy the Nolte and McKee mortality rate was 62.38 per 100,000 inhabitants, ranging from 54.92 in the Autonomous Province of Bolzano (Northern Italy) to 62.38 in Campania Region (Southern Italy). For the same period, the Tobias and Yeh mortality rate was 69.59 per 100,000, ranging from 60.06 in Marche Region (Central Italy) to 88.12 in Campania Region. Using Nolte and McKee's list, amenable mortality accounted for 40.65% of the differences in all-cause mortality between Northern and Southern Italy, and for 33.66% of the differences between Southern and Central Italy. Using Tobias and Yeh's list, amenable mortality accounted for 53.99% of the differences in all-cause mortality between Northern and Southern Italy, and for 42.62% of the differences between Southern and Central Italy. CONCLUSION: the findings here presented show that amenable mortality rates calculated using Tobias and Yeh's list were higher than rates calculated using Nolte and McKee's list. Geographical pattern of amenable mortality derived by the two lists were almost coincident. Moreover, amenable mortality makes a substantial contribution to inequalities in health among North, Centre and South of Italy.

Amenable mortality as a performance indicator of Italian health-care services.

BACKGROUND: Mortality amenable to health-care services ('amenable mortality') has been defined as "premature deaths that should not occur in the presence of timely and effective health care" and as "conditions for which effective clinical interventions exist." We analyzed the regional variability in health-care services using amenable mortality as a performance indicator. Convergent validity was examined against other indicators, such as health expenditure, GDP per capita, life expectancy at birth, disability-free life expectancy at age 15, number of diagnostic and laboratory tests per 1,000 inhabitants, and the prevalence of cancer and cardiovascular diseases. METHODS: Amenable mortality rate was calculated as the average annual number of deaths in the population aged 0-74 years per 100,000 inhabitants, and it was then stratified by gender and region. Data were drawn from national mortality statistics for the period 2006-08. RESULTS: During the study period (2006-08), the age-standardized death rate (SDR) amenable to health-care services in Italy was 62.6 per 100,000 inhabitants: 66.0 per 100,000 for males and 59.1 per 100,000 for females. Significant regional variations ranged from 54.1 per 100,000 inhabitants in Alto Adige to 76.3 per 100,000 in Campania. Regional variability in SDR was examined separately for male and females. The variability proved to be statistically significant for both males and females (males: Q-test = 638.5, p < 0.001; females: Q-test = 700.1, p < 0.001). However, among men, we found a clear-cut divide in SDR values between Central and Southern Italy; among women, this divide was less pronounced. Amenable mortality was negatively correlated with life expectancy at birth for both genders (male: r = -0.64, p = 0.002; female: r = -0.88, p <0.001) and with disability-free life expectancy at age 15 (male: r = -0.70, p <0.001; female: r = -0.67, p <0.001). Amenable mortality displayed a statistically significant negative relationship with GDP per capita, the quantity of diagnostic and laboratory tests per 1,000 inhabitants, and the prevalence of cancer. CONCLUSIONS: Amenable mortality shows a wide variation across Italian regions and an inverse relationship with life expectancy and GDP per capita, as expected.

[Geographical and temporal trends in infant mortality in Italy and current limits of the routine data]. / Trend geografici e temporali della mortalità infantile in Italia e limiti negli attuali flussi informativi correnti.

OBJECTIVE: to compare trends in infant, neonatal and post-neonatal mortality in Italy from 1991 to 2005 both at the national level and among the three Italian large geographical macro-areas (North, Center, South-Islands). DESIGN: observational study based on routine data. SETTING AND PARTICIPANTS: the analysis was performed on the cohort of newborns (up to the first age of life) in Italy from 1991 to 2005. MAIN OUTCOME MEASURES: infant, neonatal and post-neonatal mortality rate calculated for 3-year and 5-year periods, relative risks, attributable fraction. RESULTS: during the study period infant mortality rates significantly decreased from 7.72 to 3.91 per 1,000 births, neonatal mortality rates from 5.87 to 2.84 per 1,000 births, and postneonatal mortality rates from 1.85 to 1.08. Despite these significant reductions, important disparities persist in different geographical areas within Italy. In particular, rates appears to be much higher in the southern regions of the country: during the period 2001-2005 the excess of mortality in the South comparing with the North was 37%. Since 1998, following a change in legislation, individual matching of Certificates of Delivery Care (CedAP) and Death Certificates during the first year of life, at a national level, is not possible. CONCLUSION: during the period 1991-2005 Italy experienced significant infant mortality reduction, but important geographical disparities still remain. In order to investigate these disparities and the determinants of infant mortality in Italy, the lack of routine data could represent an important limit to conduct update epidemiologic studies.