Obesity as a risk factor for hospitalization in COronaVirus Disease-19 (COVID-19) patients: Analysis of the Tuscany regional database.

BACKGROUND AND AIMS: Aim of the present study is to determine the role of obesity as a risk factor for COronaVirus Disease-19 (COVID-19) hospitalization. METHODS AND RESULTS: This observational study was performed using Istituto Superiore di Sanità (ISS) Tuscany COVID-19 database by the Agenzia Regionale Sanità (ARS), including all COVID-19 cases registered until April 30th, 2020, with reported information on chronic diseases. The principal outcome was hospitalization. An age and gender-adjusted logistic regression model was used to assess the association of clinical and demographic characteristics with hospitalization. Further multivariate models were applied. Of 4481 included subjects (36.9% aged over 70 years), 1907 (42.6%) were admitted to hospital. Obesity was associated with hospitalization after adjusting for age and gender. The association of obesity with hospitalization retained statistical significance in a fully adjusted model, including possible confounders (OR: 2.99 [IC 95% 2.04-4.37]). The effect of obesity was more evident in younger (<70 years) than in older (≥70 years) subjects. CONCLUSIONS: The present data confirm that obesity is associated with an increased risk of hospitalization in patients with COVID-19. Interestingly, the association of obesity with hospitalization was greater in younger (<70 years) patients.

Retrospective Study on the Features and Outcomes of a Tuscany COVID-19 Hospitalized Patients Cohort: Preliminary Results.

Background: A few months after the COVID-19 pandemic onset, knowledge of SARS-CoV-2 infection and outcomes and treatments blew up. This paper aimed to evaluate the features of a Tuscany COVID-19 hospitalized cohort and to identify risk factors for COVID-19 severity. Methods: This retrospective observational COVID-19 cohort study (1 March 2020-1 March 2021) was conducted on patients ≥ 18 years old, admitted to Tuscany Hospital, and subjected to follow-up within 12 months after discharge. Patients were enrolled at Pisana, Senese and Careggi University Hospitals, and South East, North West, and Center Local Hospitals. Results: 2888 patients (M = 58.5%, mean age = 66.2 years) were enrolled, of whom 14.3% (N = 413) were admitted to an intensive care unit. Smokers were 25%, and overweight and obese 65%. The most used drugs were corticosteroids, antacids, antibiotics, and antithrombotics, all antiviral drugs, with slight differences between 2020 and 2021. A strong association was found between outcomes of evolution towards critical COVID-19 (non-invasive mechanical ventilation (NIV) and/or admission to intensive care) and smoking (RR = 4.91), ex-smoking (RR = 3.48), overweight (RR = 1.30), obese subjects (RR = 1.62), comorbidities (aRR = 1.38). The alteration of liver enzymes (aspartate aminotransferase, alanine aminotransferase, or gamma-glutamyl transpeptidase) was associated with NIV (aOR = 2.28). Conclusions: Our cohort, characterized by patients with a mean age of 66.2 years, showed 65% of patients were overweight and obese. Smoking/ex-smoking, overweight/obesity, and other comorbidities were associated with COVID-19 adverse outcomes. The findings also demonstrated that alterations in liver enzymes were associated with worse outcomes.

Foreigners living in Tuscany at the time of coronavirus outbreak.

Background: During the coronavirus outbreak, a worldwide state of emergency and lockdown significantly affected the volunteer services for foreigners. The SARS-CoV-2 surveillance program was strengthened among migrants arriving in Italy. However, few screening measures for SARS-CoV2 infection have been conducted on the foreign population already present in Italy. In Tuscany, a great effort was made to know the epidemiological features of coronavirus outbreaks in the foreigners. Based on these premises, this study describes the prevalence and characteristics of SARS-CoV-2 infection in foreigners present in the Tuscan territory during the months of the highest incidence of this pandemic. Methods: Ministry of Health established the COVID-19 surveillance and predisposed the methods for reporting cases of SARS-CoV-2 infection in agreement with the Department of Infectious Diseases of the Istituto Superiore di Sanità. Data on SARS-CoV-2, updated daily, were collected based on the platform of the Istituto Superiore di Sanità.For each patient were available data on diagnosis, gender, age, nationality, exposure place, hospitalization and symptoms severity. Symptoms severity was classified using a 6-level scale (asymptomatic, paucisymptomatic, mild symptoms, severe symptoms, critic, and died). Results: By July 14, 2020, 10,090 SARS-CoV-2 cases were recorded. Out of 10,090 cases, 8,947 were Italians (88.7%), 608 foreigners (6%); in 535 patients (5.3%) citizenship was missing. The average age of foreigners was 44.1 years (range: 42.9-45.4), compared to 61.1 years (range: 60.7-61.5) of Italians. Chronic pathologies affected 16.8% of foreigners (14.0% -20.0%) and 36.4% of Italians (35.4% -37.4%). Foreigners with asymptomatic or mild symptoms of COVID-19 were 81.7% (78.4% -84.6%), while the Italians were 67% (66.6% -68.5%). Foreigners with severe COVID-19 were 15.2% (12.6% -18.4%) and Italians were 17.6% (16.8% -18.4%). Foreigners in critical conditions were 1.0% (0.5% -2.2%) and Italians were 2.6% (2.3% -3.0%). 38.6% (33.7% -43.7%) of foreigners were infected at the workplace as a health or social-health worker, compared to 24.2% (23.1% -25.4%) of Italians. Conclusion: The time between the onset of symptoms and the execution of the laboratory tests was similar between foreigners and Italians. The foreigners infected by SARS-COV-2 were younger compared to the Italians. Foreigners showed few comorbidities, and asymptomatic or mild symptomatic COVID-19, and consequently, a low lethality index. National and Tuscany policy decisions are needed to create equity in the access to the health care system for immigrants and their families, regardless of their immigration status.

The impact of different rehabilitation strategies after major events in the elderly: the case of stroke and hip fracture in the Tuscany region.

BACKGROUND: On a regional level, our aims were to describe rehabilitation patterns for elderly patients with stroke and hip fracture and to investigate mortality risk during the 6-month post acute period. METHODS: Data sources included administrative data relative to patients aged 65+ resident in Tuscany admitted in hospital for stroke or hip fracture between 2001 and 2003, traced up to 3 years before and 6 months following index admission. The study design involves computerized linkage of administrative data, and an exploratory analysis of the association between rehabilitation patterns and 6-month mortality, adjusting for clinical, demographic, and acute-related care characteristics using multivariate Cox regression. RESULTS: Rehabilitation patterns vary greatly across Tuscany with considerable cost implications. Six month mortality risk for stroke patients is significantly lower among residents of Local Health Authorities where patients are more frequently rehabilitated, specifically in extra-hospital settings. CONCLUSION: Our study, targeting two crucial conditions for elderly patients, found a high variability of rehabilitation patterns across a region, albeit coherent between the two pathologies, associated with remarkable differences in average expenditure. Differences in hazard rates for 6-month mortality after stroke at population level were also found. These results need to be confirmed and further investigated through a more robust information framework.

[Mortality in the area around Massa-Carrara 10 years after ANIC-Agricoltura and Farmoplant chemical plants were shut down]. / Mortalità nell'area di Massa-Carrara nel decennio successivo alla chiusura degli impianti ANIC-Agricoltura e Farmoplant.

OBJECTIVE: To describe mortality of residents in the area of Massa-Carrara for the period 1995-2000 and to compare it with mortality for the years 1990-1994. DESIGN: Geographical descriptive study. SETTING: In the area of Massa-Carrara cause and gender specific standardized mortality ratios (SMR), adjusted for age and municipal deprivation index (reference: Tuscany Region), have been computed for the years 1995-2000 and compared with mortality in the period 1990-1994 calculating ratios between standardized rates by age classes with a direct method (CMF). For those causes showing a statistically significant increase a spatial analysis on a group of municipalities around Massa and Carrara has been carried out. MAIN OUTCOME: Mortality for all causes, and for 30 specific causes. RESULTS: The study results confirm, for the years 1995-2000, the previous observation (1990-1994) of statistically significant excesses for mortality from all causes (SMR 109), all cancers (SMR 112), respiratory diseases (SMR 126), cirrhosis (SMR 226), liver (SMR 161) and lung cancer (SMR 115) in males. A statistically significant excess for larynx (SMR 158) and pleural cancer (SMR 178) is observed in the years 1995-2000, which was not present in 1990-1994. A mortality excess for cirrhosis is confirmed in females (SMR 158) and a new one emerges for liver cancer (SMR 144). The comparison between mortality data for the periods 1995-2000 and 1990-1994 has shown a statistically significant decrease in mortality for all causes and for several specific causes, a significant increase in liver (CMF males 1.35; CMF females 1.78) and blood cancer mortality is also detected (CMF females 1.44). CONCLUSIONS: This study confirms the negative health impact of environmental, occupational exposures in populations living in areas where high-risk factories are located. Adverse health effects are stronger in socially and economically deprived areas, and persist over many years after closing polluting industrial plants. The results of this study point out to the need of health promoting actions aiming at modifying lifestyle risk factors, ameliorating socio-economic conditions, and maintaining a constant control on environment, also through a specific environmental epidemiological surveillance to monitor the impact of reclamation procedures completed or in progress.

Attempt to calculate the prevalence and features of chronic hepatitis C infection in Tuscany using administrative data.

AIM: To evaluate this prevalence in Tuscan populations that was known and unknown to the Tuscan Regional Health Service in 2015. METHODS: Tuscan Health administrative data were used to evaluate hepatitis C virus (HCV) infected people known to the Regional Health Service. Residents in Tuscany with a HCV exemption code (070.54) were identified. Using the universal code attributed to each resident, these patients were matched with hospital admission codes identified by the International Classification of Diseases, Ninth Revision (ICD-9), Clinical Modification, and with codes for dispensing drugs to patients by local and hospital pharmacies. Individuals were considered only once. Capture-recapture analysis was used to evaluate the HCV-infected population unknown to the Regional Health Service. RESULTS: In total, 14526 individuals were living on 31/12/2015 with an exemption code for HCV. In total, 9524 patients were treated with pegylated interferon + ribavirin and/or direct-acting antiviral drugs during the last 10 years, and 13879 total hospital admissions were noted in the last 15 years. After data linkage, the total number was 25918. After applying the Capture-Recapture analysis, the number of unknown HCV-infected people was 23497. Therefore, the total number of chronic HCV-infected people was 38643, excluding those achieved sustained virological response to previous treatment. CONCLUSION: Our results show a prevalence of HCV infected people of 1%. Tuscan administrative data could be useful for calculating health care costs and health planning in the coming years.

[A study on mortality around six municipal solid waste landfills in Tuscany Region]. / Studio di mortalità intorno a sei discariche di rifiuti in Toscana.

OBJECTIVE: Describing mortality of populations residing in the neighbourhoods of selected waste landfill sites and contributing to the definition of their health status. DESIGN: Descriptive study of mortality at municipality and aggregated municipalities level. SETTING AND METHODS: Mortality from 1995 to 2000 in six areas of five provinces of Tuscany Region where municipal and/or hazardous waste landfills are located. Areas considered at higher exposure were those including municipalities where inhabitants mainly reside within 5 km from selected landfills. Comparison was made with rates observed in the five provinces in the same period. Statistical comparisons were perfomed using standardised mortality ratios (SMR) and bayesian mortality ratios (BMR) adjusted for age. MAIN OUTCOMES: Mortality for all causes, groups and specific causes of cancer and non-cancer diseases. RESULTS: Statistically significant mortality excesses were found for circulatory system and cerebrovascular diseases, for lymphohematopoietic system, liver and bladder cancer and non-Hodgkins lymphoma. CONCLUSION: Methods utilized have produced preliminary indications on associations between residence in areas with landfills and mortality. These excesses, also due to the limitations of macrogeographic studies, indicate that further insights at microgeographic level are needed.

The Tuscany experimental registry for Alzheimer's disease and other dementias: how many demented people does it capture?

BACKGROUND AND AIMS: A Regional Registry for Alzheimer's Disease and Other Dementias is being tested in Tuscany (Italy) to provide a basis for epidemiological studies. Current results are presented and critically evaluated. METHODS: The Registry extracts data on cases of dementia from Hospital Discharge Records, Outpatient Service Records, Regional Mortality Registry and Disease-Specific Co-payment Exemption Records, based on ICD-9 codes of dementias, and from Prescription Records based on registered anti-dementia drug codes. A list of cases of dementia prevalent at the end of 2005 was produced by cross-checking captured cases with the Regional Mortality Registry. RESULTS: The Registry captured 47,889 cases, of which 27,796 were still alive at the end of 2005. Captured cases represent slightly less than half of all the cases of dementia estimated to be present in Tuscany among older residents (65+) according to recent prevalence studies. Conversely, of 87 subjects 65 years of age or older selected from the Registry and directly evaluated, 80 (92%) were truly cognitively impaired subjects. CONCLUSIONS: The Registry has low sensitivity, probably because not all demented individuals are diagnosed as such in current practice and/or use health services. Conversely, the Registry has high specificity, and the produced lists of prevalent dementia cases are the key to estimating health and quality-of-care indicators for the demented population, and may constitute a basis for epidemiological studies.

Stage-specific incidence of breast cancer before the beginning of organized screening programs in Italy.

OBJECTIVE: To measure stage-specific geographic and time variability of breast cancer in seven Italian areas before the onset of organized screening programs. METHODS: All invasive cancers (8689 cases) arising in women aged 40-79 years during the pre-screening period 1985-1997, were considered. Multiple Poisson regression analysis was performed. RESULTS: About 39% of the cases were classified as "early," 52% as "advanced," and 9% as "unspecified" stage. Age-adjusted incidence rates showed a significant geographic variation for early but not for advanced cancers (range: 58-103 cases/100,000 and 104-125 cases/100,000, respectively). The result was confirmed in the multiple regression analysis after adjustment for year of diagnosis and age. Early breast cancer risk adjusted for age and registry showed a significant increase over time (+3.9% per year for all ages, and +6.2% per year for age category 50-79). In contrast, a decreasing time trend was observed for advanced cancer of 3 cm or over in women aged less than 60. CONCLUSIONS: In our study, early breast cancer incidence varied both by geographic area and time before the commencement of screening. The differences in early-stage incidence may well be related to differences in availability of "spontaneous" mammography. Late-stage incidence decreased over time in younger women and for very advanced cases, but not in the older ones, nor for cancers less than 3 cm. Early detection outside organized screening was only partially efficient in reducing advanced breast cancer incidence. The trend of incidence of advanced disease, as previously proposed, is confirmed to be a valid early indicator of effectiveness of screening.