Revisiting the mortality of France and Italy with the multiple-cause-of-death approach

In this paper, we use the multiple cause-of-death approach to compare the mortality profiles of France and Italy in 2003. Our analysis leads to a substantial re-evaluation of the role played by certain conditions in the process leading to death. Regarding the associations of causes, we distinguish three patterns that are common to both countries. The numerous similarities that emerge from the comparison of the two countries are a clear indication that, contrary to what is generally thought, misreporting by the certifying physicians generally do not distort the observation.cause of death, France, international comparisons, Italy, mortality, multiple causes of death

Revisiting the mortality of France and Italy with the multiple-cause-of-death approach

International audience; In this paper we revisit the mortality profiles of France and Italy in 2003 using the multiple-cause-of-death approach. The method leads to a substantial upward reassessment of the role played by certain conditions - e.g. diseases of the blood and diseases of the skin - in overall mortality. Regarding the associations of causes, we distinguish three patterns of pairwise joint occurrence of causes that are common to both countries. The numerous similarities that emerge from the comparison of the two countries are a positive signal of the reliability of the multiple-cause-of-death data

Frailty at death : an examination of multiple causes of death in four low mortality countries in 2017

Altres ajuts: University of California Berkeley Center for the Economics and Demography of Aging (NIH grant #P30AG012839).BACKGROUND The increasing prevalence of frailty in ageing populations represents a major social and public health challenge which warrants a better understanding of the contribution of frailty to the morbid process.OBJECTIVE To examine frailty-related mortality as reported on death certificates in France, Italy, Spain, and the United States in 2017. METHODS We identify frailty at death for the population aged 50 years and over in France, Italy, Spain, and the United States. We estimate the proportions of deaths by sex, age group, and country using specific frailty-related ICD-codes on the death certificate, (1) as the underlying cause of death (UC), (2) elsewhere in Part I (sequence of diseases or conditions or events leading directly to death), and (3) anywhere in Part II (conditions that do not belong in Part I but whose presence contributed to death). RESULTS The age-standardized proportion of deaths with frailty at ages 50 and over is highest in Italy (25.0%) followed by France (24.1%) and Spain (17.3%), and lowest in the United States (14.0%). Cross-country differences are smaller when frailty-related codes are either the underlying cause of the death or reported in Part II. Frailty-related mortality increases with age and is higher among females than males. Dementia is the most frequently reported frailty-related code. CONCLUSIONS Notable cross-country differences were found in the prevalence and type of frailty-related symptoms at death, even after adjusting for differential age distributions. CONTRIBUTION Strong similarities between countries were found that warrant monitoring frailty at death in low-mortality countries to complement information on frailty prevalence in the living population

Frailty at death: An examination of multiple causes of death in four low mortality countries in 2017

Background: The increasing prevalence of frailty in ageing populations represents a major social and public health challenge which warrants a better understanding of the contribution of frailty to the morbid process. Objective: To examine frailty-related mortality as reported on death certificates in France, Italy, Spain, and the United States in 2017. Methods: We identify frailty at death for the population aged 50 years and over in France, Italy, Spain, and the United States. We estimate the proportions of deaths by sex, age group, and country using specific frailty-related ICD-codes on the death certificate, (1) as the underlying cause of death (UC), (2) elsewhere in Part I (sequence of diseases or conditions or events leading directly to death), and (3) anywhere in Part II (conditions that do not belong in Part I but whose presence contributed to death). Results: The age-standardized proportion of deaths with frailty at ages 50 and over is highest in Italy (25.0Š) followed by France (24.1Š) and Spain (17.3Š), and lowest in the United States (14.0Š). Cross-country differences are smaller when frailty-related codes are either the underlying cause of the death or reported in Part II. Frailty-related mortality increases with age and is higher among females than males. Dementia is the most frequently reported frailty-related code. Conclusions: Notable cross-country differences were found in the prevalence and type of frailty-related symptoms at death, even after adjusting for differential age distributions. Contribution: Strong similarities between countries were found that warrant monitoring frailty at death in low-mortality countries to complement information on frailty prevalence in the living population

Sudden Unexpected Deaths and Vaccinations during the First Two Years of Life in Italy: A Case Series Study

Background The signal of an association between vaccination in the second year of life with a hexavalent vaccine and sudden unexpected deaths (SUD) in the two days following vaccination was reported in Germany in 2003. A study to establish whether the immunisation with hexavalent vaccines increased the short term risk of SUD in infants was conducted in Italy. Methodology/Principal Findings The reference population comprises around 3 million infants vaccinated in Italy in the study period 1999–2004 (1.5 million received hexavalent vaccines). Events of SUD in infants aged 1–23 months were identified through the death certificates. Vaccination history was retrieved from immunisation registries. Association between immunisation and death was assessed adopting a case series design focusing on the risk periods 0–1, 0–7, and 0–14 days after immunisation. Among the 604 infants who died of SUD, 244 (40%) had received at least one vaccination. Four deaths occurred within two days from vaccination with the hexavalent vaccines (RR = 1.5; 95% CI 0.6 to 4.2). The RRs for the risk periods 0–7 and 0–14 were 2.0 (95% CI 1.2 to 3.5) and 1.5 (95% CI 0.9 to 2.4). The increased risk was limited to the first dose (RR = 2.2; 95% CI 1.1 to 4.4), whereas no increase was observed for the second and third doses combined. Conclusions The RRs of SUD for any vaccines and any risk periods, even when greater than 1, were almost an order of magnitude lower than the estimates in Germany. The limited increase in RRs found in Italy appears confined to the first dose and may be partly explained by a residual uncontrolled confounding effect of age

Drug induced mortality: a multiple cause approach on Italian causes of death Register

Background: Drug-related mortality is a complex phenomenon that has several health, social and economic effects. In this paper trends of drug-induced mortality in Italy are analysed. Two approaches have been followed: the traditional analysis of the underlying cause of death (UC) (data refers to the Istat mortality database from 1980 to 2011), and the multiple cause (MC)analysis, that is the analysis of all conditions reported on the death certificate (data for 2003-2011 period). Methods: Data presented in this paper are based on the Italian mortality register. The selection of Icd codes used for the analysis follows the definition of the European Monitoring Centre for Drugs and Drug Addiction. Using different indicators (crude and standardized rates, ratio multiple to underlying), the results obtained from the two approaches (UC and MC) have been compared. Moreover, as a measure of association between drug-related causes and specific conditions on the death certificate, an estimation of the age-standardized relative risk (RR) has been used. Results: In the years 2009-2011, the total number of certificates whit mention of drug use was 1,293, 60% higher than the number UC based. The groups of conditions more strongly associated with drug-related causes are the mental and behavioral disorders (especially alcohol consumption), viral hepatitis, cirrhosis and fibrosis of liver, AIDS and endocarditis. Conclusions : The analysis based on multiple cause approach shows, for the first time, a more detailed picture of the drug related death; it allows to better describe the mortality profiles and to re-evaluate  the contribution of a specific cause to death

Hospitalization for drug-related disorders in Italy: trends and comorbidity

Background: The drug abuse has several health, social and economic effects. Hospital discharge records(HDR) collected by the Ministry of Health represent a major source of epidemiological data. In this paper we used this source in order to assess drug abuse hospitalization patterns and trends in Italy by means of the study of comorbidity at discharge. Methods: Analysis are based on the National HDR Register and refers to data from 1999 to 2011 for the Ital-ian resident population. Two approaches have been followed: the main diagnosisand the comorbidity approach based on the analysis of all diagnoses reported on the HDR. As a measure of the association between drug-related disorders and specific conditions reported, an estimation of age-standardised relative risk (RR) has been used. Results: The number of hospitalizations for drug-related diagnosis declined from 10,968 cases in 1999 to 6,180 in 2011.Using the comorbidity approach we found that in the period 2009-2011 the number of HDR with a mention of drug use is 2.8 times higher than the number based only on the main diagnosis.The conditions more strongly associated to the group of drug users are mental disorders, alcohol abuseand infectious diseases such as HIV disease and viral hepatitis. Conclusions : These data can provide important information about the epidemiology of drug problems and the impact of drug policies.In addition the strong evidence of association of drug abuse and mental health provides a solid underpinning for planning more coordinated interventions of prevention and public health