Impatto delle grandi crisi economiche su salute e mortalità: il caso italiano

Secondo alcuni studi, le crisi economiche avrebbero un impatto positivo sulla salute degli individui e delle popolazioni. I dati italiani raccontano una storia ben diversa. Se la Grande Depressione non ha prodotto significative modificazioni dell’andamento positivo della mortalità di quegli anni, la Grande Recessione è stata accompagnata da un sensibile riduzione dei ritmi di diminuzione che si sperimentavano fino a quel momento. Responsabili di questo andamento sono state le malattie del sistema circolatorio (la prima causa di morte in Italia) e, tra queste, soprattutto le malattie cosiddette “minori” (malattie ipertensive, malattie delle arterie e delle vene, cardiopatie diverse dalle ischemiche, ecc.). Per le classi di età adulte, tuttavia, anche le grandi patologie del sistema circolatorio, cardiopatie ischemiche e malattie cerebrovascolari, hanno sperimentato un forte rallentamento in coincidenza con l’avvio della crisi, fino ad arrestare la riduzione del rischio di morte. I suicidi e gli incidenti del traffico hanno reagito alla crisi nella direzione attesa: aumentando i primi e riducendosi i secondi, sebbene per questi ultimi l’andamento favorevole fosse iniziato ancor prima che la crisi facesse sentire i suoi effetti. Anche la salute mostra negli anni recenti un andamento meno favorevole di quanto ci si poteva attendere considerata l’evoluzione degli ultimi decenni. In più, la tendenza a ridurre il ricorso alla prevenzione e alle cure è un ulteriore elemento di preoccupazione per la pesante ipoteca che pone sulla evoluzione futura, soprattutto per i gruppi di popolazione più fragili e meno protetti

Adjusting old-age thresholds by health status: empirical findings and implications. A case study of Italy

While traditional measures of population ageing are bound to the concept of chronological age, new indicators have been proposed that take into account the dramatic changes that have occurred in later life due to increasing longevity. In this paper, we re-evaluate demographic ageing in Italy using prospective oldage thresholds based on both total remaining life expectancy and remaining life expectancy in good health. We show that the proportion of individuals above the prospective thresholds has been increasing much more slowly than the proportion of people aged 65 years and older, and that the increase in the proportion of individuals above the prospective thresholds adjusted for health status has been more or less large depending on trends in health status at older ages. Given these results and the ongoing improvements in health conditions among older people, we think the consequences of population ageing for Italian society could be less severe than expected

On ne meurt qu'une fois... mais de combien de causes ?

L'analyse des causes de décès permet de mieux comprendre les évolutions de la mortalité. En France, les certificats de décès remplis par les médecins mentionnent en général plusieurs causes de décès : 2,4 en moyenne en 2011. Habituellement, une seule d'entre elles, la cause dite initiale, est prise en compte. Ceci conduit à sous-estimer fortement la contribution de certaines maladies à la mortalité, par exemple les maladies endocriniennes. Il est utile de prendre en compte également ces causes dites associées, sachant qu'avec l'augmentation de l'espérance de vie, on meurt de plus en plus souvent d'une combinaison de causes et non d'une seul

We only die once...but from how many causes ?

Analysing causes of death provides a better understanding of long-term mortality trends. In France, the death certificates completed by physicians generally mention several causes of death (2.4 on average in 2011). As a general rule, just one of them, the so-called underlying cause, is taken into account. As a result, the contribution of certain diseases - endocrine diseases for example - to mortality is severely underestimated. In a context of rising life expectancy where people increasingly die not from a single cause of death but from several, it is important to also take these contributing causes into accoun

After the epidemiologic transition: a reassessment of mortality from infectious diseases among over-65s in France and Italy

Objectives To assess more accurately the contribution of infectious diseases (IDs) to mortality at age 65?. Methods We use cause-of-death data for France and Italy in 2009. In addition to chapter I of the 10th International Classification of Diseases (ICD-10), our list of IDs includes numerous diseases classified in other chapters. We compute mortality rates considering all death certificate entries (underlying and contributing causes). Results Mortality rates at age 65? based on our extended list are more than three times higher than rates based solely on ICD-10 chapter I. IDs are frequently contributing causes of death. In France, the share of deaths at age 65? nvolving an ID as underlying cause increases from 2.1 to 7.3 % with the extended list, and to 20.8 % when contributing causes are also considered. For Italy, these percentages are 1.4, 4.2 and 18.7 %, respectively. Conclusions Publicly available statistics underestimate the contribution of IDs to the over-65s’ mortality. Old age is a risk factor for IDs, and these diseases are more difficult to treat at advanced ages. Health policies should develop targeted actions for that populatio

Cause-specific mortality analysis: Is the underlying cause of death sufficient?

Cause-specific mortality analysis is based predominantly on examination of the underlying cause of death. Our view is that this single-cause approach is not sufficient. With increasing data availability and technical developments in favor of better data quality, the time has come to consider all items of information reported by certifying physicians on death certificates (i. e. the multiple causes). These data can be used in two main ways: either to reassess the role played by a given cause in mortality, or to examine how causes combine with one another. In this paper, we rely on our experience of multiple cause-of-death (MCOD) analysis in the framework of a French-Italian comparative project to provide information on data quality, and to show that, especially in the context of population aging, MCOD analysis is a very relevant tool for public health policy