A population-based study of the years of life lost in the Friuli Venezia Giulia region, Italy

Background. The number of years of life lost (YLL) in a population depends not only on the number of deaths but also on the age at which the deaths have occurred, and, as a measure of the burden of premature mortality, is an important piece of information for public health professionals. Methods. We calculated YLL in the population of Friuli Venezia Giulia, a 1 200 000 inhabitant Italian region, in 2013 and the trend in the past 14 years, through a populationbased study using the regional mortality database as the source of information. The same projected life expectancy estimates for 2050 were used for calculating YLL both in males and females, for each calendar year. Results. In 2013, we counted 14 080 deaths and estimated 220 961 YLL. Malignant neoplasms and cardiovascular diseases accounted for the greatest number of YLL. Injuries had the highest number of YLL per death. Overall, YLL decreased from 2000 to 2013, but differences were observed for different causes of death. Cancers, cardiovascular diseases, and unintentional injuries showed a decreasing trend, whereas infectious diseases resulted increasing over time. Conclusion. This study, estimating the relative impact of different conditions on the society though the YLL, is a relevant input for the regional public health agenda

Risks of hospitalization and drug consumption in children and young adults with diagnosed celiac disease and the role of maternal education: A population-based matched birth cohort study

Background: Celiac disease (CD) may affect healthcare use in children and young adults. Socio-economic factors may act as a confounder or effect modifier. We assessed such hypotheses in a population-based birth cohort of young celiac subjects and references matched by maternal education. Methods: The cohort included all newborns recorded in the Medical Birth Register of Friuli-Venezia Giulia Region (Italy) between 1989 and 2011. CD incident cases were identified through pathology reports, hospital discharges and copayment exemptions and matched with up to five references by sex, year of birth and maternal education. Cox regression models were used to estimate Hazard Ratios (HRs) for major causes of inpatient diagnosis and drug prescription occurring after diagnosis in CD patients compared to references, stratifying by time of first event and maternal education. Results: We identified 1294 CD cases and 5681 references. CD cases had a higher risk of hospital admission for any cause (HR: 2.34; 95 % CI 2.08-2.63) and for all major ICD9-CM categories except obstetric complications, skin and musculoskeletal diseases, and injuries and poisoning. Prescription of all major ATC drug categories, except dermatologicals and genito-urinary medications, was significantly increased in CD subjects. For most outcomes, HRs were highest in the first year after CD diagnosis but remained significant after five or more years. HRs were similar across different categories of maternal education. Conclusions: Diagnosed CD subjects had a higher risk of hospitalization and medication use compared to the general population, even five or more years after diagnosis, with no effect modification of maternal education

ISS mapped from ICD-9-CM by a novel freeware versus traditional coding: a comparative study

<p>Abstract</p> <p>Background</p> <p>Injury severity measures are based either on the Abbreviated Injury Scale (AIS) or the International Classification of diseases (ICD). The latter is more convenient because routinely collected by clinicians for administrative reasons. To exploit this advantage, a proprietary program that maps ICD-9-CM into AIS codes has been used for many years. Recently, a program called ICDPIC trauma and developed in the USA has become available free of charge for registered STATA^®users. We compared the ICDPIC calculated Injury Severity Score (ISS) with the one from direct, prospective AIS coding by expert trauma registrars (dAIS).</p> <p>Methods</p> <p>The administrative records of the 289 major trauma cases admitted to the hospital of Udine-Italy from 1 July 2004 to 30 June 2005 and enrolled in the Italian Trauma Registry were retrieved and ICDPIC-ISS was calculated. The agreement between ICDPIC-ISS and dAIS-ISS was assessed by Cohen's Kappa and Bland-Altman charts. We then plotted the differences between the 2 scores against the ratio between the number of traumatic ICD-9-CM codes and the number of dAIS codes for each patient (DIARATIO). We also compared the absolute differences in ISS among 3 groups identified by DIARATIO. The discriminative power for survival of both scores was finally calculated by ROC curves.</p> <p>Results</p> <p>The scores matched in 33/272 patients (12.1%, k 0.07) and, when categorized, in 80/272 (22.4%, k 0.09). The Bland-Altman average difference was 6.36 (limits: minus 22.0 to plus 34.7). ICDPIC-ISS of 75 was particularly unreliable. The differences increased (p < 0.01) as DIARATIO increased indicating incomplete administrative coding as a cause of the differences. The area under the curve of ICDPIC-ISS was lower (0.63 vs. 0.76, p = 0.02).</p> <p>Conclusions</p> <p>Despite its great potential convenience, ICPIC-ISS agreed poorly with its conventionally calculated counterpart. Its discriminative power for survival was also significantly lower. Incomplete ICD-9-CM coding was a main cause of these findings. Because this quality of coding is standard in Italy and probably in other European countries, its effects on the performances of other trauma scores based on ICD administrative data deserve further research. Mapping ICD-9-CM code 862.8 to AIS of 6 is an overestimation.</p

The influence of patients’ complexity and general practitioners’ characteristics on referrals to outpatient health services in an Italian region

Background. Patient referrals to outpatient health services may affect both health outcomes and health expenditures. General practitioners (GP) have a crucial role in driving the use of outpatient services and recognizing factors which affect referrals is important for health managers and planners. Objectives. We investigated patient- and physician-related determinants of patient referrals in an Italian region. Methods. This was cross-sectional study based on the individual linkage of administrative databases from the health information system of the Friuli Venezia Giulia region. For each GP of the region, the association of the number of patient referrals to different types of outpatient services with the proportion of patients with chronic conditions, with the number of hospital admissions and drug prescriptions in 2012, and with GP’s characteristics was investigated through multilevel multivariable Poisson regression models. Results. Some chronic conditions (e.g., cancer, autoimmune diseases, endocrine diseases, digestive system diseases) were positively associated with the number of referrals, as were hospital admissions and drug prescriptions. Time since GP’s graduation was inversely related with referrals. Conclusion. Patient complexity and GP’s experience affect referral rates. These factors should be considered in case of a reorganization of the general practice structure in Friuli Venezia Giulia

Determinants of Heterogeneity in Management of Patients with AMI Diagnosis: A Retrospective Population Study

Background: In Italy cardiovascular diseases are the leading cause of death. Percutaneous Transluminal Coronary Angioplasty (PTCA) reduces short-term deaths in patients with Acute Myocardial Infarction (AMI). We evaluated inequalities in accessing PTCA among AMI patients. Methods: This is a retrospective cohort study on 9894 Italian patients hospitalized for AMI in 2003-2007. Generalized linear models were estimated for the probability of PTCA and for time between hospital admission and intervention. Result: Gender was the most relevant factor in the probability of intervention. Patients 6575 years and those with higher Charlson index had lower probability. The presence of a coronary unit was associated with greater probability. Surgical intervention within 24 hours from admission was more likely with increasing age and Charlson index and less likely for patients living near a coronary unit. Days between admission and intervention resulted affected by all covariates and deprivation index. Conclusion: Consistently with literature, we pointed out the role of gender and age on the likelihood of PTCA. Additional factors affecting time to intervention (coronary units and deprivation index) were also identified

Residential Proximity to Major Roadways and Lung Cancer Mortality. Italy, 1990–2010: An Observational Study

Background: Air pollution from road traffic has been associated to an increased risk of lung cancer. Herein, we investigated the association between lung cancer mortality and residence near Italian highways or national major roads. Methods: Information on deaths for lung cancer registered from 1990 to 2010 and stratified by age, gender, and urban or rural municipality of residence at death were obtained from the National Institute of Statistics. Distance between the centroid of the municipality of residence and closest major roadways was considered as a proxy of pollution exposure. Relative Risks (RR) and 95% confidence intervals (CI) were computed using Poisson log-linear models adjusted for age, calendar period, deprivation index, North/South gradient, and urban/rural status. Results: A gradient in risk for lung cancer mortality was seen for residents within 50 meters (m) of national major roads. In particular, in rural municipalities a statistically significant increased risk for lung cancer death was observed in both sexes (RR = 1.27 for distance &lt;25 m vs. 500–1999 m, 95% CI 1.17–1.42, in men; RR = 1.97, 95% CI 1.64–2.39, in women). In urban municipalities, weak risks of borderline significance were documented in both sexes (RR = 1.06, 95% CI 0.99–1.15 in men; and RR = 1.09, 95% CI 0.97–1.22 in women). No statistically significant association emerged between residence within 100 to 500 m from highways and RRs of death for lung cancer. Conclusions: In Italy, residing near national major roads, in particular in rural municipalities, was related to elevated risks of death for lung cancer

Use of healthcare services at the end of life in decedents compared to their surviving counterparts: A case-control study among adults born before 1946 in Friuli Venezia Giulia

BACKGROUND:There is a heterogeneous literature on healthcare utilization patterns at the end of life. The objective of this study is to examine the impact of closeness to death on the utilization of acute hospital-based healthcare services and some primary healthcare services and compare differences in gender, age groups and major causes of death disease specific mortality. METHODS:A matched case-control study, nested in a cohort of 411,812 subjects, linked to administrative databases was conducted. All subjects were residents in the Friuli Venezia Giulia Region (Italy), born before 1946, alive in January 2000 and were followed up to December 2014. Overall, 158,571 decedents/cases were matched by gender and year of birth to one control, alive at least one year after their matched case's death (index-date). Hospital admissions, emergency department visits, drug prescriptions, specialist visits and laboratory tests that occurred 365 days before death/index-date, have been evaluated. Odds Ratios (ORs) for healthcare utilization were estimated through conditional regression models, further adjusted for Charlson Comorbidity Index and stratified by gender, age groups and major causes of death. RESULTS:Decedents were significantly more likely of having at least one hospital admission (OR 7.0, 6.9-7.1), emergency department visit (OR 5.2, 5.1-5.3), drug prescription (OR 2.8, 2.7-2.9), specialist visit (OR 1.4, 1.4-1.4) and laboratory test (OR 2.7, 2.6-2.7) than their matched surviving counterparts. The ORs were generally lower in the oldest age group (95+) than in the youngest (55-74). Healthcare utilization did not vary by sex, but was higher in subjects who died of cancer. CONCLUSION:Closeness to death appeared to be strongly associated with healthcare utilization in adult/elderly subjects. The risk seems to be greater among younger age groups than older ones, especially for acute based services. Reducing acute healthcare at the EOL represents an important issue to improve the quality of life in proximity to death