Analisi dell'epidemiologia delle patologie delle vie biliari nella Regione Veneto utilizzando le fonti correnti

Digestive diseases have a relevant impact in the population for their prevalence and for health services use for various causes. In 2005 digestive diseases were the second cause of hospitalization in Italy and colon cancer was the fourth cause of death between the cancer causes of death both for men and women. The aim of the research is the study of epidemiology of gastrointestinal diseases in the Veneto Region through the analysis of current data (hospital discharge records, mortality data, drug prescriptions and "esenzioni ticket"). The study focuses on colon cancer in elderly people, gallstone disease and biliary tree cancer. Colorectal cancer is the third commonest cancer and the second commonest cause of death in the Western World. Its incidence shows a steep gradient with increasing age. All medical-eligible hospital discharge cases of colorectal cancer in elderly subjects (> 65 years old) residents in Veneto Region were recorded between January 1st 2000 and December 31st 2006. Cases were selected according to ICD-9 codes for diagnosis (153.0 and 154.0); surgical DRG-codes for colorectal cancer were further analyzed. Hospitalization rates for colorectal cancer increased from 8,088 in 2000 to 9,291 in 2006, representing the 13.1% of the overall number of hospitalization for neoplastic diseases. The crude rate of hospitalization for colorectal cancer was 102 per 10,000 elderly subjects. The increase in surgical treatments was present in all classes of age, reaching a maximum peak in men 65-74 years old (450 resections/100,000 inhabitants) and in women aged >85 (with a 200 resections/100,000 inhabitants). The colorectal cancer incidence has increased in both sexes over the last six years, but with a higher prevalence in males than in females; an increased number of surgical interventions has been also recorded, suggesting that the age per se. The increase in cancer incidence cannot be related at least in this age range to the colon rectal cancer screening. However itâs important to consider the possibility to extend this secondary prevention action at least until the age of 75. Gallstone disease is a very common gastrointestinal disorder, affecting as more than 14% of adults. Cholecystectomy is considered the treatment of choice for symptomatic patients We used the hospital discharge records of Veneto Region from 2000 through 2009. We identified all resident patients who underwent laparoscopic cholecystectomy (LC), open colecystectomy (OC) and operative ERCP for gallstone disease. We excluded anyone diagnosed as having a bile tract cancer. The crude rate of LC showed an increasing trend over the last 10 years (from 130 in 2000 to 139 in 2009 per 100,000 residents) while the crude rate of OC decreased during the same period (from 28 in 2000 to 14 in 2009 per 100,000 residents). We observed a decline in the rate of OC and an increase in the rate of LC. OC were more frequent in males than in females. We also studied the epidemiology of biliary tree cancer using data of hospital discharge records. We observed a highest age adjusted prevalence of hospitalization in men. Hospitalization for all biliary tract cancer was stable in the last ten years; however we also found a progressive increase in hospitalization for inta-epatic cholangiocarcinomaLe patologie gastrointestinali risultano importanti in termini di morbosità e conseguente carico assistenziale; infatti nel 2005 queste forme morbose sono state la seconda causa di ricovero in Italia e la neoplasia del colon-retto la quarta in ordine di importanza fra le cause di morte tumorale sia per gli uomini (7,3% di tutti i decessi pere tumore) sia per le donne (9,1%). La ricerca si propone di studiare l'epidemiologia delle patologie gastrointestinali nella Regione Veneto attraverso l'utilizzo delle fonti correnti, con particolare riferimento alle Schede di dimissione ospedaliera (SDO) e alle Schede di morte. In particolare lo studio ha riguardato la neoplasia maligna del colon nella popolazione anziana, la calcolosi della colecisti e le neoplasie maligne delle vie biliari. Negli anziani la neoplasia del colon retto rappresenta la quarta forma tumorale più frequente nei maschi e la terza nelle femmine. In base ai dati del Registro Tumori della Regione Veneto l'incidenza del carcinoma colon-rettale aumenta con l'età  sia nei maschi che nelle femmine e raggiunge un valore massimo nei soggetti con più di 80 anni con valori maggiori nel sesso femminile (500 casi per 100.000 vs 300). L'analisi è stata condotta utilizzando come fonte dati l'archivio regionale delle SDO per la fascia di età  anziana degli anni 2000-2006. I ricoveri della popolazione anziana residente in Veneto per neoplasia del colon-retto hanno presentato un andamento in aumento dal 2000 (8088) al 2006 (9291), rappresentando il 60% dei ricoveri totali per la patologia considerata, il 13,1% dei ricoveri per neoplasie nella popolazione anziana ed essendo corrispondenti a un tasso grezzo di 102 per 10.000 residenti con età  maggiore o uguale a 65 anni. I ricoveri per intervento di resezione del colon nei soggetti over 65 sono passati nell'intervallo di tempo 2000-2006 da 1.269 a 1.661, mentre quelli del retto da 469 a 644 con un incremento pari al 31% e al 30% rispettivamente. I tassi di intervento nei maschi aumentano con l'età  fino alla classe 75-79 quando si registra un valore pari a 450 interventi per 100.000 residenti di età  superiore ai 65 anni, mentre nelle femmine l'incremento è costante fino alla classe 80-100 nella quale il parametro risulta pari a 200 interventi per 100.000 residenti. Inoltre nel sesso maschile si è verificato un aumento del tasso di intervento nel periodo considerato in tutte le classi di età  ma più pronunciato in quelle maggiori (80-100). Nelle donne, che rispetto ai maschi presentano valori molto inferiori del parametro, l'incremento maggiore si ha nelle fasce 65-69 e 75-79. La calcolosi della colecisti viene descritta nella letteratura come una patologia molto frequente nella popolazione occidentale con una prevalenza del 14% nella popolazione adulta. Il trattamento di scelta è rappresentato dalla colecistectomia laparoscopica. Nello studio si è cercato di valutare il carico di ospedalizzazioni per calcolosi della colecisti con particolare riferimento al profilo di cura. Utilizzando le schede di dimissione ospedaliera della Regione Veneto dal 2000 al 2009 si sono identificati i soggetti che sono stati sottoposti alla colecistectomia laparoscopica, a quella laparotomica e all'ERCP operativa escludendo i soggetti con neoplasia maligna dell'albero biliare. L'analisi ha evidenziato negli ultimi 10 anni un incremento del tasso di colecistectomia laparoscopica (da 130 in 2000 a 139 in 2009 per 100.000 residenti) e una riduzione del tasso di colecistectomia laparotomia (da 28 in 2000 a14 in 2009 per 100.000 residenti). Il numero di ERCP operative risulta stabile nel tempo con un tasso osservato di 23 per 100.000 residenti. Un altro capitolo della ricerca ha riguardato lo studio dell'epidemiologia delle neoplasie maligne delle vie biliari e la stima della loro andamento nel tempo nella Regione Veneto. Utilizzando le SDO si è analizzata il carico si ospedalizzazione per le patologie in questione; inoltre attraverso procedure di linkage si è sviluppato un algoritmo per l'individuazione dei casi incidenti di neoplasia maligna delle vie biliari per stimare la loro diffusione nella Regione Veneto. Dall'analisi è emerso una maggior concentrazione dell'ospedalizzazione per neoplasie maligne delle vie biliari nelle classi di età  avanzate e nei maschi rispetto alle femmine. Complessivamente l'ospedalizzazione per queste patologie rimane costante nell'ultimo decennio, ma disaggregando per tipo di neoplasia si osserva nel tempo un aumento dei ricoveri per neoplasia maligna delle vie biliari intraepatiche mentre quelle per gli altri tipi di neoplasia rimangono sostanzialmente costanti. Tale trend risulta ravvisabile anche nell'analisi dei casi incidenti di neoplasie delle vie biliari che dovrebbe rappresentare con maggiore precisione il l'andamento temporale della diffusione della patologia nella popolazione del Venet

Epidemiological aspects of biliary tree tumors in a region of northern Italy: emerging trends and sex-based differences

Background Cholangiocarcinoma (CCA) and gallbladder cancer are the second cause of liver malignancy after hepatocellular carcinoma. Epidemiological data point to an increase in the incidence of CCA in both western and eastern countries; however, data on more recent years are lacking. Aims The aim of this study was to elucidate the more recent epidemiology of CCA and gallbladder carcinoma in north-east Italy using automatically collected regional data on hospital admissions over a 10-year period. Materials and methods We performed a retrospective analysis of the Veneto region (north-east Italy) database of patients\u2019 hospital discharge records, identifying cases with the following codes: intrahepatic cholangiocarcinoma (155.1), primary gallbladder cancer (156.0), and primary extrahepatic biliary tract cancer (156.1). Hospitalizations were recorded according to the surgical or medical procedures involved (based on International Classification of Diseases-9 procedure codes), and only the first hospitalization was considered for the 2005\u20132009 period. Results The number of hospitalizations for biliary tumors as a whole has remained stable over the past 10 years. The hospitalization rate of intrahepatic CCA is increasing; this cancer is more frequent in males than in females. The hospitalization rate for gallbladder cancer is increasing with age. However, the figures for extrahepatic CCA have remained stable over the past 10 years. The duration of survival was significantly longer for patients who underwent radical surgery than for those who did not. Conclusion Efforts are needed to prevent CCA, bearing in mind the emerging conditions associated with its onset. Secondary prevention of these tumors will substantially improve the duration of survival

Descriptive epidemiology of chronic liver disease in northeastern Italy: an analysis of multiple causes of death

BACKGROUND: The analysis of multiple causes of death data has been applied in the United States to examine the population burden of chronic liver disease (CLD) and to assess time trends of alcohol-related and hepatitis C virus (HCV)-related CLD mortality. The aim of this study was to assess the mortality for CLD by etiology in the Veneto Region (northeastern Italy). METHODS: Using the 2008–2010 regional archive of mortality, all causes registered on death certificates were extracted and different descriptive epidemiological measures were computed for HCV-related, alcohol-related, and overall CLD-related mortality. RESULTS: The crude mortality rate of all CLD was close to 40 per 100,000 residents. In middle ages (35 to 74 years) CLD was mentioned in about 10% and 6% of all deaths in males and females, respectively. Etiology was unspecified in about half of CLD deaths. In females and males, respectively, HCV was mentioned in 44% and 21% and alcohol in 11% and 26% of overall CLD deaths. A bimodal distribution with age was observed for HCV-related proportional mortality among females, reflecting the available seroprevalence data. CONCLUSIONS: Multiple causes of death analyses can provide useful insights into the burden of CLD mortality according to etiology among different population subgroups

White Paper of Italian Gastroenterology: Delivery of services for digestive diseases in Italy: Weaknesses and strengths

In 2011 the three major Italian gastroenterological scientific societies (AIGO, the Italian Society of Hospital Gastroenterologists and Endoscopists; SIED, the Italian Society of Endoscopy; SIGE, the Italian Society of Gastroenterology) prepared their official document aimed at analysing medical care for digestive diseases in Italy, on the basis of national and regional data (Health Ministry and Lombardia, Veneto, Emilia-Romagna databases) and to make proposals for planning of care. Digestive diseases were the first or second cause of hospitalizations in Italy in 1999-2009, with more than 1,500,000 admissions/year; however only 5-9% of these admissions was in specialized Gastroenterology units. Reported data show a better outcome in Gastroenterology Units than in non-specialized units: shorter average length of stay, in particular for admissions with ICD-9-CM codes proxying for emergency conditions (6.7 days versus 8.4 days); better case mix (higher average diagnosis-related groups weight in Gastroenterology Units: 1 vs 0.97 in Internal Medicine units and 0.76 in Surgery units); lower inappropriateness of admissions (16-25% versus 29-87%); lower in-hospital mortality in urgent admissions (2.2% versus 5.1%); for patients with urgent admissions due to gastrointestinnal haemorrhage, in-hospital mortality was 2.3% in Gastroenterology units versus 4.0% in others. The present document summarizes the scientific societies' official report, which constitutes the "White paper of Italian Gastroenterology"

White Paper of Italian Gastroenterology: Delivery of services for digestive diseases in Italy: Weaknesses and strengths

In 2011 the three major Italian gastroenterological scientific societies (AIGO, the Italian Society of Hospital Gastroenterologists and Endoscopists; SIED, the Italian Society of Endoscopy; SIGE, the Italian Society of Gastroenterology) prepared their official document aimed at analysing medical care for digestive diseases in Italy, on the basis of national and regional data (Health Ministry and Lombardia, Veneto, Emilia-Romagna databases) and to make proposals for planning of care. Digestive diseases were the first or second cause of hospitalizations in Italy in 1999-2009, with more than 1,500,000 admissions/year; however only 5-9% of these admissions was in specialized Gastroenterology units. Reported data show a better outcome in Gastroenterology Units than in non-specialized units: shorter average length of stay, in particular for admissions with ICD-9-CM codes proxying for emergency conditions (6.7 days versus 8.4 days); better case mix (higher average diagnosis-related groups weight in Gastroenterology Units: 1 vs 0.97 in Internal Medicine units and 0.76 in Surgery units); lower inappropriateness of admissions (16-25% versus 29-87%); lower in-hospital mortality in urgent admissions (2.2% versus 5.1%); for patients with urgent admissions due to gastrointestinnal haemorrhage, in-hospital mortality was 2.3% in Gastroenterology units versus 4.0% in others. The present document summarizes the scientific societies' official report, which constitutes the "White paper of Italian Gastroenterology". © 2014 Editrice Gastroenterologica Italiana S.r.l