Mortality inequalities in Rome: the role of individual education and neighbourhood real estate market // Differenziali di mortalità a Roma: il ruolo dell’istruzione e dei prezzi immobiliari del quartiere di residenza

OBIETTIVI: studiare l’associazione tra livello di istruzione, prezzi degli immobili nel quartiere in cui si risiede e mortalità per tutte le cause. DISEGNO: studio di coorte. SETTING E PARTECIPANTI: dalla coorte censuaria del 2011 sono stati selezionati i residenti a Roma, viventi (da fonte anagrafica) all’indirizzo del censimento, di età compresa tra i 18 e i 99 anni. I soggetti sono stati seguiti, attraverso record linkage con database amministrativi, fino a dicembre 2016. I dati includono informazioni individuali quali genere, età, istruzione, quartiere di residenza, data di morte. I quartieri sono stati classificati secondo il prezzo degli immobili (euro/m2). PRINCIPALI MISURE DI OUTCOME: mortalità per tutte le cause, analizzata con modelli di Cox. RISULTATI: sono stati inclusi 2.051.376 individui (54% donne, 22,5% con un alto livello di istruzione). Durante il follow-up, sono morte 127.352 persone. L’istruzione è un forte determinante della mortalità. Tenendo conto di età, genere, stato civile e prezzo degli immobili nel quartiere di residenza, rispetto a chi ha un livello di istruzione alto, le persone con un’istruzione media hanno un hazard ratio (HR) di 1,16 (IC95% 1,14-1,19) e quelle con un’istruzione bassa hanno un HR di 1,35 (IC95% 1,32-1,37). Tenendo conto degli stessi fattori e del titolo di studio, a ogni mille euro di aumento del prezzo al m2 degli immobili corrisponde un HR di 0,96 (IC95% 0,96-0,97). CONCLUSIONI: entrambi gli indicatori utilizzati sono associati alla mortalità per tutte le cause. Un semplice indicatore come il prezzo immobiliare può essere utilizzato per mettere in luce disuguaglianze nello stato di salute.OBJECTIVES: to investigate the association between real estate prices, education, and mortality. DESIGN: cohort study. SETTING AND PARTICIPANTS: residents in Rome at the 2011 Italian Census, not living in institutions, and living in the address reported in the Census survey. People aged 18-99 years were followed from 2011 to 2016 using anonymous record linkage procedures with administrative databases. The Census includes several individual information, such as gender, age, education, residential neighbourhood. Data and cause of death were collected from mortality register. Real estate prices (euros/m2) were available for each neighbourhood. MAIN OUTCOME MEASURES: adjusted Cox regression models (hazard ratios - HRs and 95%CIs) were used to estimate the association among individual education, real estate price in the neighbourhood, and mortality. RESULTS: the subjects selected were 2,051,376 (54% women, 22.5% with high education level). During the follow-up, 127,352 subjects died. Taking into account gender, age, marital status, and real estate prices, education level was strongly associated with all-cause mortality; compared to highly educated the higher mortality, risk was 35% (95%CI 32%-37%) for low education level and 16% (95%CI 14%-19%) for medium education level. Taking into account the same factors and education level, each increase of 1,000 euros in price/m2 was inversely associated with mortality (HR 0.96, 95%CI 0.96-0.97). CONCLUSIONS: there is an independent association between the two indicators and mortality in Rome. A simple indicator such as real estate prices can be used to tackle inequalities

Walking four times weekly for at least 15min is associated with longevity in a Cohort of very elderly people

Objectives: This study investigated the role of walking outdoors on longevity, controlling for individual and other life-style factors as possible confounders. Methods:A 10-year cohort study was conducted with 152 self-caring and mobile, mean age 80 years, were enrolled in the study. Information on socio-demographic characteristics, clinical and biochemical data, diet, physical activity, smoking, depression status, cognitive status and anthropometrics measurements, were obtained for all participants. Cox proportional-hazards models were used to determine independent predictors of longevity. Results: During the 10-years of follow-up, 96(63%) died. Old age, chronic diseases, smoking, depression, CD4/CD8 ratio and coffee consumption were significantly predictors of mortality. Over-all survival was highest for subjects walking at open air for 4 times weekly for at least 15 min in comparison to subjects walking less than 4 times weekly (40% versus 22%). After adjusting for sex, age, education, chronic diseases, smoking, Body Mass Index and CD4/CD8 ratio, elderly people walking at open air for four times weekly had 40% decreased risk of mortality that individuals who walked less than four times weekly [relative risk (RR) = 0.53; 95% confidence interval (CI) = 0.32-0.88, p = 0.01]. Conclusions: Findings suggest an independent and protective effect of walking on mortality and supports the encouragement of physical activity in advanced age for increasing longevity. (c) 2012 Elsevier Ireland Ltd. All rights reserved

Covid-19 and clinical-epidemiological research in Italy: proposal of a research agenda on priority topics by the Italian association of epidemiology

BACKGROUND: the Covid-19 pandemic has provoked a huge of clinical and epidemiological research initiatives, especially in the most involved countries. However, this very large effort was characterized by several methodological weaknesses, both in the field of discovering effective treatments (with too many small and uncontrolled trials) and in the field of identifying preventable risks and prognostic factors (with too few large, representative and well-designed cohorts or case-control studies). OBJECTIVES: in response to the fragmented and uncoordinated research production on Covid-19, the italian Association of Epidemiology (AIE) stimulated the formation of a working group (WG) with the aims of identifying the most important gaps in knowledge and to propose a structured research agenda of clinical and epidemiological studies considered at high priority on Covid-19, including recommendations on the preferable methodology. METHODS: the WG was composed by 25 subjects, mainly epidemiologists, statisticians, and other experts in specific fields, who have voluntarily agreed to the proposal. The agreement on a list of main research questions and on the structure of the specific documents to be produced were defined through few meetings and cycles of document exchanges. RESULTS: twelve main research questions on Covid-19 were identified, covering aetiology, prognosis, interventions, follow-up and impact on general and specific populations (children, pregnant women). For each of them, a two-page form was developed, structured in: background, main topics, methods (with recommendations on preferred study design and warnings for bias prevention) and an essential bibliography. CONCLUSIONS: this research agenda represents an initial contribution to direct clinical and epidemiological research efforts on high priority topics with a focus on methodological aspects. Further development and refinements of this agenda by Public Health Authorities are encouraged