Silicosis mortality in Italy: temporal trends 1990-2012 and spatial patterns 2000-2012

The present study investigates the occurrence of silicosis in Italy and its temporal trends and spatial patterns using mortality data. The aim is to give a contribution, albeit with a conservative estimate inferred from mortality data, to epidemiological knowledge of silicosis in Italy. Trends in mortality due to silicosis from 1990 to 2012 were evaluated and a municipal cluster analysis was performed. It shows that mortality due to silicosis is declining but still not eradicated and that one of its main features is regional variability: in this respect, the cluster analysis performed allowed to identify 34 different geographic areas. The results obtained may help display a more detailed picture of silicosis epidemiology and contribute to the fight against exposure to silica, an undisputable public health commitment

Health impact of the exposure to fibres with fluoro-edenitic composition on the residents in Biancavilla (Sicily, Italy): mortality and hospitalization from current data

Introduction. The objective of this chapter is to study the health impact of the exposure to fibres with fluoro-edenitic composition on the residents in Biancavilla (Sicily, Italy), in terms of mortality and hospitalization. The diseases which international scientific literature indicates as associated with asbestos exposure were taken into consideration: mesothelioma of pleura, peritoneum, pericardium and tunica vaginalis testis, malignant neoplasm of larynx, malignant neoplasm of trachea, bronchus and lung, malignant neoplasm of ovary, pneumoconiosis; moreover, in order to describe the health profile of the study population, large groups of diseases were taken into consideration.Material and methods. Current data (available in the Data Bases of the Unit of Statistics of ISS) regarding mortality and hospitalization were analyzed. Standardized Mortality Ratios, Standardized Hospitalization Ratios and Age-standardized Death Rates were calculated. The demographic background of the population residing in Biancavilla was also outlined.Conclusions. Our findings support the etiologic role of fibres with fluoro-edenitic composition in the occurrence of the above mentioned diseases, already observed in other studies

Exploring methods for the assessment of temporal trends in mortality and hospitalization in Italian industrially contaminated sites

Introduction. The Italian contaminated sites of interest for remediation are monitored by SENTIERI, an epidemiological surveillance system describing the health status of populations living nearby these sites. There is an increasing concern on how to assess temporal changes in the health status of these populations. Methods. A sequence of three statistical techniques was adopted to analyse temporal trends of mortality and hospitalization, by using different indicators and reference populations, in a sample of 36 sites with industrial sources of contamination monitored by SENTIERI. Results. Positive temporal trends in health risks are detected reflecting mainly long term effects of industrial activities. The adopted methodology identifies multiple factors influencing the temporal patterns: type of health outcomes, type of disease, and its link with gender and type of emission sources. Conclusions. Reliable methods to assess health profile changes in local populations attributable to contaminations are key elements to measure the impact of remediation activities

First national analysis of severe obesity hospitalizations in Italy: insights from discharge card database

BackgroundObesity is associated with numerous severe diseases necessitating intensive healthcare for diagnosis and treatment. Most patients with obesity, especially in its severe form, require at least one hospitalization. However, few studies in Italy have assessed the burden of obesity on the National Health System. This study aims to routinely estimate the ‘disease burden’ by analyzing hospital admissions related to severe obesity.SubjectsWe analyzed the medical records of the Italian national hospital discharge database, including all patients older than 18 years discharged with the diagnosis of ‘severe obesity’.’ We included patients who underwent bariatric surgery, even without an explicit obesity code, such as laparoscopic restrictive gastric procedures, other stomach operations, and high gastric bypass. Special focus was given to those who underwent abdominal reshaping surgery. The cross-sectional survey PASSI in Italy served as an additional data source to estimate. The phenomenon was described using appropriate indicators, including rates and ratios between rates. Linear regression was employed to analyze trends in standardized rates over time.ResultsBetween 2014 and 2021, a total of 243,325 patients were discharged with a severe obesity code in Italy. Among these patients, 36.8% underwent at least one bariatric surgery procedure. We investigated the types of bariatric surgery procedures performed. The most frequent procedure was “other operations on the stomach,” where sleeve gastrectomy is included which also appears to be steadily increasing during the study period together with the gastric bypass, while the gastric bondage is decreasing over time.ConclusionThese findings underscore the significant burden of severe obesity on Italy’s healthcare system, a burden that is progressively increasing. The growing utilization of bariatric surgery suggests an escalating trend toward adopting drastic solutions to combat this health issue

Early mortality from malignant mesothelioma in Italy as a proxy of environmental exposure to asbestos in children

Malignant mesothelioma (MM) is a rare neoplasm caused by asbestos. Mortality fromMM in ≤50 years old people, considering the long latency, is likely related to asbestosexposure in childhood. Mortality from MM (C45, ICD10 code) is described among ≤50years (ys) old people in Italy, in 2003-2016. National and regional Standardized Rates(SRs) were computed by age-class. The North-South trend of regional SRs, increasing in>50ys age-class, showed a flat cline in ≤50ys old people. Municipal Standardized MortalityRatios (SMRs) were computed, with respect to regional figures, for ≤50 ys oldpopulation. In Italy, 487 people ≤50 ys old died from MM, in 2003-2016 (2.5% of allMM deaths), corresponding to 35/year. The highest SMRs were observed in NorthernRegions, the most industrialized areas. Exceeding SMRs were found in 10 municipalitieswhere former asbestos-cement plants, shipyards, and a quarry contaminated by fluoroedenite fibres were present. Early mortality from MM, proxy of childhood environmental asbestos exposure, deserves particular concern

Assessing COVID-19-Related Excess Mortality Using Multiple Approaches—Italy, 2020–2021

Introduction: Excess mortality (EM) is a valid indicator of COVID-19’s impact on public health. Several studies regarding the estimation of EM have been conducted in Italy, and some of them have shown conflicting values. We focused on three estimation models and compared their results with respect to the same target population, which allowed us to highlight their strengths and limitations. Methods: We selected three estimation models: model 1 (Maruotti et al.) is a Negative-Binomial GLMM with seasonal patterns; model 2 (Dorrucci et al.) is a Negative Binomial GLM epidemiological approach; and model 3 (Scortichini et al.) is a quasi-Poisson GLM time-series approach with temperature distributions. We extended the time windows of the original models until December 2021, computing various EM estimates to allow for comparisons. Results: We compared the results with our benchmark, the ISS-ISTAT official estimates. Model 1 was the most consistent, model 2 was almost identical, and model 3 differed from the two. Model 1 was the most stable towards changes in the baseline years, while model 2 had a lower cross-validation RMSE. Discussion: Presently, an unambiguous explanation of EM in Italy is not possible. We provide a range that we consider sound, given the high variability associated with the use of different models. However, all three models accurately represented the spatiotemporal trends of the pandemic waves in Italy

mesothelioma mortality surveillance and asbestos exposure tracking in italy

INTRODUCTION: Spatial distribution of mortality from pleural mesothelioma (which in the ICD-10 Revision has a specific code: C45.0) in Italy for the period 2003-2009 is described. Previous mortality studies at national level employed the topographic code "Malignant neoplasms of pleura", because of unavailability of a specific code in ICD-9 Revision for pleural mesothelioma. METHODS: Standardized mortality ratios were computed for all municipalities, using each regional population as reference; for municipalities in Regions with rate higher than the national rate, the latter has been used as reference. SMRs were computed specifically also for each Italian Polluted Sites "of national concern for environmental remediation" (IPS) with asbestos exposure sources, composed by one or more municipalities, using regional rate as reference. Spatial Scan Statistics procedure, using SatScan software, was applied in cluster analysis: the country was divided into geographic macro-areas and the relative risks (RR) express the ratio of risk within the cluster to the risk of the macro-area outside the cluster. Clusters with p-value < 0.10 were selected. RESULTS: The national standardized annual mortality rate was 1.7 cases per 100 000. Several areas with evident burden of asbestos-related disease were detected. Significant clusters were found in correspondence to asbestos-cement industries (e.g. Casale Monferrato, women: RR = 28.7), shipyards (e.g. Trieste, men: RR = 4.8), petrochemical industries (e.g. Priolo, men: RR = 6.9) and a stone quarry contaminated by fluoro-edenite fibres (Biancavilla, women: RR = 25.9). Some of the increased clusters correspond to IPS. CONCLUSIONS: The results may contribute to detect asbestos exposure and to set priorites for environmental remediation

A population-based cohort approach to assess excess mortality due to the spread of COVID-19 in Italy, January-May 2020

Aims: To assess the impact of the COVID-19 pandemic on all-cause mortality in Italy during the first wave of the epidemic, taking into consideration the geographical heterogeneity of the spread of COVID-19. Methods: This study is a retrospective, population-based cohort study using national statistics throughout Italy. Survival analysis was applied to data aggregated by day of death, age groups, sex, and Italian administrative units (107 provinces). We applied Cox models to estimate the relative hazards (RH) of excess mortality, comparing all-cause deaths in 2020 with the expected deaths from all causes in the same time period. The RH of excess deaths was estimated in areas with a high, moderate, and low spread of COVID-19. We reported the estimate also restricting the analysis to the period of March-April 2020 (first peak of the epidemic). Results: The study population consisted of 57,204,501 individuals living in Italy as of January 1, 2020. The number of excess deaths was 36,445, which accounts for 13.4% of excess mortalities from all causes during January-May 2020 (i.e., RH = 1.134; 95% confidence interval (CI): 1.129-1.140). In the macro-area with a relatively higher spread of COVID-19 (i.e., incidence rate, IR): 450-1,610 cases per 100,000 residents), the RH of excess deaths was 1.375 (95% CI: 1.364-1.386). In the area with a relatively moderate spread of COVID-19 (i.e., IR: 150-449 cases) it was 1.049 (95% CI: 1.038-1.060). In the area with a relatively lower spread of COVID-19 (i.e., IR: 30-149 cases), it was 0.967 (95% CI: 0.959-0.976). Between March and April (peak months of the first wave of the epidemic in Italy), we estimated an excess mortality from all causes of 43.5%. The RH of all-cause mortality for increments of 500 cases per 100,000 residents was 1.352 (95% CI: 1.346-1.359), corresponding to an increase of about 35%. Conclusions: Our analysis, making use of a population-based cohort model, estimated all-cause excess mortality in Italy taking account of both time period and of COVID-19 geographical spread. The study highlights the importance of a temporal/geographic framework in analyzing the risk of COVID-19-epidemy related mortality

Valutazione della qualità delle notifiche di decesso associate a COVID-19 riportate al sistema di sorveglianza integrata COVID-19 ISS: confronto con la rilevazione sulle cause di morte dell’Istat - Italia, 2020

Introduction The rapid spread throughout Italy of SARS-CoV-2 virus infections and associated disease (COVID-19) has resulted in the urgent implementation of a surveillance system coordinated by the Istituto Superiore di Sanità (ISS). The objective of this study is to assess the quality of COVID-19 death notifications reported to the COVID-19 integrated surveillance system of the ISS. Materials and methods Deaths data from the COVID-19 integrated surveillance system of the ISS was compared with those detected by the Istituto Nazionale di Statistica (Istat) Survey on Deaths and Causes of Deaths in the 2020 year. Database of mortality by cause is available from the Statistical Service of the ISS. Analysis was based on information regarding date of death, sex, age (age group, in some cases), Region/Autonomous Province (AP) of death reporting, Region/ AP of residence or domicile. Results The two compared flows show good agreement, with smaller percentage differences in the periods coinciding with the two main epidemic waves (March/April and November/December) and more pronounced in the summer period. In absolute terms, the first wave was characterized by a higher number of deaths reported to ISS COVID-19 integrated surveillance system than those reported among Istat Survey on Deaths and Causes of Deaths (COVID-19 initial cause), while the second wave was characterized by a trend reversal. As regard regional data flows, Piedmont, the AP of Trento, Latium, Basilicata and Sardinia present a lower number of deaths reported to the COVID-19 integrated surveillance than the number of deaths reported to the Istat Survey on Deaths and Causes of Deaths flow (&gt;10% less). Opposite situation regarding Veneto, Friuli Venezia Giulia and Abruzzo where deaths reported to COVID-19 integrated surveillance are &gt;10% more than those classified with initial COVID-19 cause in the Istat causes of death flow. Conclusions Overall, the analysis reported, although at an aggregate level and descriptive only, shows a good correspondence between the two flows. The integrated surveillance system has been found to be an effective tool in capturing such a public health impact-relevant phenomenon as mortality attributable to COVID-19 in Ital