Italian Institute Of Statistics Research Articles

THE IMPACT OF COVID-19 CRISIS ON ITALIAN PROXIMITY TOURISM: AN ORIGIN-DESTINATION MATRIX APPROACH

The importance of proximity tourism has increased in the recent years due to COVID-19 crisis. Due to restrictions imposed by Governments to contain contagions, people could not cross national borders. Considering the work carried out by Guardia and Muro (2009) first, Domínguez (2014), and Alvarez-Diaz et al. (2020) later, this work focuses on the assessment of proximity tourism in Italy in the 2019-2020-2021 period. This study is based on the analysis of microdata made available by ISTAT (Italian Institute of Statistics). The work proposes to shed more light on the concept of proximity tourism and, in so doing, authors used an origin-destination matrix approach by calculating the coefficient of tourist attractiveness. The results of the study suggest a significant increase in trips within the Italian territory. Furthermore, these findings are also important in the political and market-decision sphere to orient internal and local policies in terms of domestic tourism.

Leveraging digitalization and people-centeredness: an investigation of the attractiveness of Italian museums and cultural institutions

PurposeThe evolving visitors' expectations and the unfolding digital transformation compel rethinking on the service offering of museums and cultural institutions. Although digitalization and people-centeredness are widely exploited to enhance the visiting experience, there is limited evidence of their implications on organizational attractiveness. The article investigates this issue, examining the service attributes that entice visitors.Design/methodology/approachThe study collected secondary data from the latest census study by the Italian Institute of Statistics on museums and cultural institutions. Two hierarchical regression models have been run on a sample of large publicly owned organizations (n = 312) to identify the service factors that were most effective in attracting Italian and foreign visitors.FindingsMuseums and cultural institutions undergoing a digital transformation were more effective in attracting visitors. The delivery of virtual tours and online events captivated the Italian audience. Foreigners appreciated the opportunity to use applications augmenting the on-site visit.Practical implicationsDigitalization and people-centeredness improve the attractiveness of museums and cultural institutions. Using digital channels to engage visitors fosters their desire to interact with cultural heritage. Furthermore, digitalization enriches the on-site visit, expanding conventional services with virtuality. However, the adverse effects on cultural heritage should be carefully handled.Originality/valueThis study highlights the service attributes that add to the attractiveness of museums and cultural institutions, enabling them to engage visitors and improve the visiting experience.

Gender and regional differences of avoidable mortality in Italy: a 14-year time-trend analysis

Abstract Background Similar to other European countries, Italy's healthcare system is undergoing significant changes. Variations in ‘avoidable’ mortality (AM) may reflect such changes on management and quality of care. The aim of this study was to investigate the regional and gender-related trends of AM, and to provide evidence for addressing policy and reducing health disparities in Italy. Methods We conducted a 14-year time-trend analysis (2006-2019). Mortality and population data were obtained from the Italian Institute of Statistics. Bi-yearly age-standardized AM was calculated by gender and region, using the joint OECD/Eurostat list that includes both preventable and treatable causes of death. Results Overall, AM showed a significant reduction from 2006/7 to 2018/9 (221.0 vs. 166.4 per 100,000 pop, p < 0.05). A heterogeneous decrease in AM was registered between regions, ranging from −39% of Trento to − 17% of Molise. The analysis showed significant gender differences in AM, with females showing lower rates in both 2006/7 (144.5 vs. 306.3, p < 0.05) and 2018/9 (117.1 vs. 219.9, p < 0.05). Gender differences were also registered across regions, both overall and in terms of yearly % reduction. Conclusions While gender disparities in AM have reduced between 2006 and 2019 in Italy, the study shows that inequalities between regions have increased, thus underlying a worsening in the capacity of the Italian healthcare system to equally provide quality care to its population. We advocate the urgent need to reduce health disparities through a balanced regional development strategy. Key messages • Avoidable mortality is a key indicator for assessing quality and equity of healthcare. We have recorded significant gender and regional differences in this indicator between 2006 and 2019 in Italy. • Targeted interventions are needed to reduce gender and geographic disparities and to achieve the global goals of universalism and accessibility of health services, also in Italy.

Cultural persistence or change? Gender differences in educational expectations of first and second-generation immigrants in Italy

This paper analyzes whether cultural heritage determines gender differences in educational expectations to go to university of first- and second-generation immigrants in Italy. The analysis relies on the “Integration of Second-Generation Survey” (INTEG2GEN) carried out by the Italian Institute of Statistics (ISTAT) in 2015. INTEG2GEN is a national representative survey of students living in Italy and attending lower and upper secondary school. Our findings suggest that parents’ cultural background plays a non-negligible role for their daughters’ and sons’ expectations. Nevertheless, there is a gender difference in the way they react to it. Males are more sensitive to cultural orientations towards education. Females are more responsive to gender inequality issues and tend to conform to gender roles deemed appropriate according to their cultural tradition. Nevertheless, females seem more open to changes and opportunities they face in the new country.

Immigrant Labour Market Outcomes: New Insights from a Lack of Language Proficiency in Italy

In this paper, we examine how immigrants’ proficiency in the Italian language affects their labour market performance using hitherto unexploited immigration survey published by the Italian Institute of Statistics. With respect to immigrants with good proficiency in the Italian language, our empirical findings suggest that weak language proficiency reduces the probability to be employed by about 25–30 percentage points. Language proficiency in Italian also significantly affects the hourly wages of immigrants. The point estimates suggest an hourly wage gap of more than 30% between immigrants with good proficiency in the Italian language compared to those with weak proficiency, irrespective of gender. Robustness checks confirmed our estimates.

Estimated excess mortality figures in the year 2020-2021 in casentino municipalities (Italy)

Abstract Background In 2020, the total deaths from all causes were the highest ever recorded in Italy since World War II (15.6% excess), with peaks during Sars-Cov2 waves and reductions in periods of national lockdown. On the contrary, in 2021, the total number of deaths from all causes reduced compared to the previous year. Analysing local mortality data, our study aims to assess whether, in the Casentino Valley (Arezzo, Tuscany), an excess of deaths from all causes occurred between January 2020 and December 2021 compared to the five years 2015-2019. Methods We used the official mortality data from the Italian Institute of Statistics (ISTAT), and that are published in the Table of deaths by the municipality on March 2, 2022. From this database, we extrapolated all deaths from all causes between January 1, 2020, and December 31, 2021, in the 10 municipalities of Casentino. The data collected were processed using Microsoft Excel 2016 software. We then distinguished by total per month, gender, and age group and then compared these data with the previous five years’ average by calculating the percentage change. Results Overall, both the years 2020 and 2021, it is shown an increase in the deaths percentages compared to the previous five-year period, respectively 5.66% and 8.07%. In particular, there is an excess of mortality in November and December 2020. The increase in mortality is more remarkable for males (13% in 2020 and 20% in 2021). The highest percentage increase was recorded in 2021 for the 75-84 age group (+15%) and in 2020 for males over 85 (+29%). Conclusions The data analysed confirms the excess mortality in 2020-2021 compared to the average of the previous 5 years in Casentino. There are peaks in November and December 2020, corresponding with the second wave of Sars Cov2 infection. The results obtained establish the basis for subsequent analyses that will verify the correlation of mortality peaks with the incidence of Sars-Cov2 cases in the territory studied. Key messages • Between January 1, 2020, and December 31, 2021 there was an excess of all-cause mortality in our area. • This excess mortality appears to be related to peaks in Sars-Cov2 infection.

Thriving in the post-Covid-19 era: a new normality for libraries' service offering

PurposeSocial distancing and physical closure triggered by the Covid-19 pandemic put the libraries' viability under stress. Although the spread of the pandemic enacted a new normality for library management, little is known about the ingredients that are needed in the recipe for increased libraries' attractiveness. The article addresses the current gap in the scientific knowledge, unveiling what libraries can do to thrive in the post-Covid-19 era.Design/methodology/approachSecondary data were collected from the census study accomplished in 2020 by the Italian Institute of Statistics on a large sample (n = 3,531) of libraries operating across Italy. Three regression models were run to obtain evidence of the factors affecting the capability of small-, medium- and large-sized libraries to attract users amidst the Covid-19 pandemic.FindingsDigitization did not significantly add to the attractiveness of libraries. Users appreciated the enrichment of loan services: more specifically, enabling people to access loan services online boosted the libraries' attractiveness. Furthermore, virtual reading groups, online laboratories and social networking improved the libraries' ability to attract users. Medium-sized libraries involved in literacy promotion reported a larger number of users.Practical implicationsLibraries should reframe their encounter with the audience sticking to a cyber-physical perspective, exploiting digital tools to establish a continuous exchange with users and engage them in a service experience which is aimed at individual and collective empowerment.Originality/valueThe article advances the understanding of the new normality heralded by the Covid-19 pandemic. Moreover, it illuminates avenues for further development to shed light on the libraries' ability to thrive in the post-pandemic era.

Influences on Employment Transitions around the Birth of the First Child: The Experience of Italian Mothers

This article studies mothers’ employment transitions around childbirth. It argues that leaving employment around childbirth and returning after an interruption might depend on multiple influences: the micro-context of individual and household characteristics, the meso-context of women’s jobs and the macro-context of broader cultural and institutional factors. This conceptual model is tested using data from the Italian Institute of Statistics (ISTAT) ‘Family and Social Subjects (2009)’ survey. The findings confirm that mothers’ transitions out of employment are shaped by micro-characteristics such as education, meso-characteristics such as status and security of prior jobs, and macro geographical and temporal factors. Subsequent returns to employment also reflect micro and macro influences, as mothers born before 1950, with low education, and large families are less likely to return; but they seem less dependent upon prior job characteristics. The research highlights the importance of considering multiple levels of influence to understand the enabling factors of maternal employment.

Trends and Methods of Suicide in Italy, 1979 to 2016

The epidemiology of suicide could provide interesting data for societies that are undergoing significant demographic transformations. The main purpose of this study was to analyze the scale of and trends in suicide in Italy during the period 1979 to 2016. The secondary aim was to compare rates and methods of suicide in the elderly with those in other age groups. This was a population-based study on suicide for the period 1979 to 2016. Data on suicide regarding gender and age from the Italian Institute of Statistics and the World Health Organization were examined with linear regression and ANOVA test. The data on the elderly were compared with those for other age groups. Linear regression revealed a significant decline in the overall suicide rate ( F = 180.6; p < .0001). The 45 to 54 age group accounted for the highest suicide rate in recent years (2003–2016). The second highest incidence was among the elderly, with the “young” elderly (65–75 years old) having the highest suicide rate in this group. The male-to-female suicide ratio increased proportionally with age. Hanging was the suicide method most frequently employed independently from age groups. Universal and selective preventive strategies could be developed on the basis of the results of this study. The sensitization of health professionals, families, and friends to specific circumstances could contribute to the decline in the incidence of suicide in specific circumstances of time and place. Further studies are needed in order to better understand social and clinical risk factors related to the risk of suicide in specific age groups.

The quest for attractiveness of publicly owned libraries: a service quality perspective

PurposePublicly owned libraries deliver a fundamental public service, fostering the citizens' access to knowledge. However, little is known about the factors underpinning the public libraries' organizational attractiveness. The article aims to shed light on this issue, investigating how the public libraries' service offering contributes to increasing their attractiveness.Design/methodology/approachSecondary data were collected from the national census study of libraries carried out in 2019 by the Italian Institute of Statistics (ISTAT). More than 4,500 publicly owned libraries established in Italy were involved in the analysis. A linear regression model was designed to examine the implications of public libraries' service offering on the number of people who visited them in 2019. The units of analysis were grouped in three clusters based on their organizational size.FindingsSmall-sized libraries' attractiveness relied on loan services (LS) and catalogs' integration, as well as on the availability of spaces for promoting social exchanges (SE) and interactions. The same was true for medium-sized libraries, whose attractiveness was also fostered by digitization. Large-sized libraries' ability to attract users was primarily affected by LS and by the provision of people-centered cultural services (CS).Practical implicationsPublicly owned libraries should arrange tailored strategies to increase their attractiveness. Small-sized and medium-sized libraries should exploit community-oriented initiatives to establish a co-creating dialog with users. Conversely, large-sized entities should advance the users' access to conventional services and implement people-centered cultural activities, recontextualizing their exchange with users in the digital domain to enhance service quality.Originality/valueThe article originally investigates the factors affecting the attractiveness of publicly owned libraries, providing intriguing insights to managers and practitioners.

Applying Simulated Seismic Damage Scenarios in the Volcanic Region of Mount Etna (Sicily): A Case-Study From the MW 4.9, 2018 Earthquake

An application for a quick earthquake damage scenario assessment is here presented as a potential tool for planning prevention actions or managing seismic emergencies in the volcanic region of Mt. Etna (Italy). As case-study, we considered the December 26, 2018 earthquake that, with a magnitude MW 4.9, represents the largest event occurring in the area during the last 70 years. The QUEST working group (the INGV macroseismic team) carried out a detailed survey in the damage area, collecting data on the number of buildings in the different vulnerability classes and related damage, with the aim to assign intensity. The maximum intensity reached degree VIII EMS along a narrow strip extending for 5 km astride the Fiandaca fault. In this paper, we simulated the damage scenario in the most struck municipalities of the epicentral area by testing different methodological approaches proposed in the literature using the information of the ISTAT census data collected by the Italian Institute of Statistics. We evaluated the damage level of the residential buildings and we validated the results comparing with the real damage data recognized in the field. Our analysis highlighted the difficulty of applying methods calibrated for larger earthquakes in tectonic domains, to small magnitude events in volcanic zones, where some operating assumptions must be introduced. Despite this, the results confirm the potential of the simulations based on statistical damage assessment methods also in these peculiar conditions, opening the way to finalized plans of pre- and post-earthquake interventions.

Impact of Antidepressant Prescriptions on Suicidal Behavior in Times of Severe Financial Strain.

This descriptive study observes the relationship between antidepressant prescriptions and the suicide rate in Italy in the 2000s to the mid-2010s, which includes a period of severe economic crisis. The observation period was from 2000 to 2015. Suicide and unemployment rates disaggregated by age and sex were collected from the Italian Institute of Statistics. Statistical analyses were performed using correlations between suicide rates and the defined daily dose, with reference to selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), and other types of antidepressants. Fixed-effects panel regressions were also run. Increases in SSRIs prescriptions were associated with decreases in suicide rates among both men and women. However, when the analyses were adjusted for the rate of growth of the unemployment rate and for gross domestic product, the associations were weaker. The potential protective factor of SSRIs with respect to suicidal behavior may be reduced by severe recessions, especially when unemployment increases.

Home accidents in the province of Trento. Ten years of observations regarding admissions to the emergency and first aid department.

Home accidents, or domestic accidents, are accidents that occur inside a home or the adjacent areas (stairways, courtyards, gardens, attics, cellars, garages, etc.). In Italy, they are monitored through a number of surveillance systems including the PASSI system and the ISTAT (Italian Institute of Statistics) Multipurpose Survey on Households. Only the SINIACA system (Italian National Information Service on Domestic Accidents), managed by the Istituto Superiore di Sanità (National Institute for Health), provides health-related information regarding such events and their circumstances and consequences, based primarily on Accident & Emergency Departments' data. This is an observational study on the domestic accidents trends in the province of Trento, using data on Accident & Emergency Departments admissions, between 2009 and 2018, combined with mortality and hospital discharge data. The authors extrapolated records regarding admissions for domestic accidents from the digital annual Accident & Emergency admissions archive. For the 2009-2018 period, they analysed: the trend over time, both overall and classified according to gender and age group; and the inflow rate/10,000 inhabitants, broken down according to gender, nationality (Italians and foreign nationals) and age group. The coverage of the additional SINIACA variables regarding the accident dynamic, contingent activity and place of the accident were also analysed. With regard to the case load for 2018, the authors analysed the site and type of the injuries, the level of severity, outcome and the services provided, comparing the 0-14 years and >65 years age groups. Trend significance was analysed using the Cochran-Armitage test for trend and the significance of the differences between the proportions was analysed using the Chi-squared test. We have also calculated the costs of the services provided, overall and by age group. During the study period, a total of 99,386 A&E admissions for domestic accidents were recorded, with an annual average of 9,938 admissions. Between 2009 and 2018, there was a statistically significant increase of 41%, which was due in part to better event recognition and recording. Females prevail over males, especially over the age of 75 years. Over time there is an increase in cases over the age of 65, due to the progressive ageing of the population. Considering the resident population alone, the A&E inflow rate rises from 147 admissions/10,000 inhabitants in 2009 to 197 admissions/10,000 inhabitants in 2018, with a 39.0% increase. Inflow is greater in the two extreme age groups: in 2018, in the 0-4 years age group, the inflow rate is 319 admissions/10,000 inhabitants and in the over 75 years class it rises to 481 admission/10,000 inhabitants, 1.6 and 2.4 times the mean inflow for home accidents in the province of Trento, respectively. Admissions are less amongst foreign nationals than amongst Italians. Generally speaking, the events were of a mild severity, with white triage codes accounting for 16% of cases and green triage codes for 73%. The degree of severity is higher amongst subjects aged over 65, as well as in women and Italian citizens.The level of recording of SINIACA variables increases over time, to reach 100% coverage in 2018. Falls are the most common dynamic in all age ranges; household chores, activities of daily living and DIY are the three most commonly observed activities. Home accidents most commonly occur in the areas adjacent to the home and the kitchen. In over 2/3 of cases, the injuries sustained were to the limbs and the head/face. Head/face injuries prevail in the youngest age group. Wounds, burns and head injuries are the most common types of injury sustained by children in the 0-14 years age group, whereas fractures and dislocations are typical of the older age groups. Diagnostic and care resource consumption is far higher amongst the elderly, which absorb 61% of the total costs of the cases treated in the year 2018. Accident & Emergency facilities provide a privileged observatory for the monitoring of domestic accidents in the population. By comparing our data with the ISTAT data, it can be estimated that 1 in 2 home accidents in the population resulted in an A&E admission. Admissions increase over time, particularly amongst the elderly and they are not higher amongst foreign nationals than amongst Italians. The inflow rate is higher in the extreme age ranges: 0-4 and >75 years; however, there are differences between the two in terms of type of injury, level of severity and outcome. It is essential for A&E admission data to be fully digitalised, and facility and staff sensitisation is also important in order to guarantee the availability of good-quality data. The completeness of A&E data and the possibility of obtaining case stratification based on social and demographic characteristics could make it possible, through a virtuous integration of services, to use these data for the implementation of prevention initiatives. These, if carried out effectively, could also contribute to contain healthcare costs.

Electrification pathways of the Italian residential sector under socio-demographic constrains: Looking towards 2040

What are the required costs to sustain the electrification of the residential sector? What are the achievable primary energy savings? This paper tries to answer these questions, for the Italian residential sector, by providing coupled energetical and economic evaluations of the electrification pathways. To this end, this paper extends MOIRAE, a bottom-up modelling approach previously proposed by the authors. First, the input data have been upgraded by coupling, using ad-hoc statistical methods, different datasets provided by the Italian Institute of Statistics. Second, to estimate households’ time-variation, a socio-demographic model has been developed, validated, and implemented. Third, an economic model of fixed and variable costs for electrical and thermal appliances has been implemented. Subsequently, the modelling approach has been calibrated against detailed consumption data for the different Italian regions and validated against historical data. Finally, MOIRAE has been employed to unveil the electrification pathways with and without household budget constraints, aiming at replacing natural gas, LPG, diesel, and fuel oil energy carriers with electrical energy. For the different scenarios investigated, the changes in primary energy consumptions and the variation of variable and fixed costs have been included to consider both the energetic and the economic point of view.

Modeling Local BES Indicators by Copula-Based Bayesian Networks

In Italy, the measure of the Equitable and Sustainable Well-being is provided by the Italian Institute of Statistics by means of a dashboard of basic and composite indicators. To investigate the dependence structure between the different domains of well-being, we propose the use of Non-Parametric Bayesian Networks based on the normal copula distribution, that allow to explore the conditional independence relationships between the composite indicators. The main advantage of the non-parametric models is that, as opposed to the parametric approach, they do not require any assumption on the marginal distributions of the variables. The proposed model is applied to the Equitable and Sustainable Well-being indicators measured at the provincial level and enriches the analysis of well-being by inspecting similarities and differences between Italian urban areas and territories.

The socio-demographic dimensions of the private transportation emissions

It is known that the transportation sector accounts for a considerable share of the emissions and the primary energy consumption of the countries as a whole, thus determining an increas-ing attention towards the decarbonisation pathways of the transportation sectors. The energy consumption at the country-scale can be interpreted as the integral of the socio-demographic layer and the behavior spectrum. Thus, ad-hoc policy schemes need to rely on multi-scale ap-proaches, describing the household-scale and, subsequently, scaling-up towards the country-scale. In this long-term aim and perspective, the present communication contributes to the ex-isting discussion regarding relationships between the household/socio-demographic character-istics and the transportation patterns. In particular, focusing on the Italian case study, this communication explores the relationships between the household/socio-demographic variables and the carbon dioxide emissions related to the private transportation sector. To this end, this paper build on micro-data obtained by the Italian Institute of statistics and it applies a four-step statistical method to select suitable variables, explore the significant determinants and perform an household segmentation. It is found that the geographic area (in terms of the macro-scale as well as the micro-scale geographic locations) as well as income-related variables are likely to be factors influencing the carbon dioxide emissions related to the private transportation sector.

Contraceptive use in Italian young adults in 2013 and 2017/18

Abstract Background Investigations regarding knowledge and utilization of contraception for the prevention of unwanted pregnancies as well as of sexually transmitted diseases are carried out regularly in low- and middle-income countries. The same might not happen in high-income countries, were these topics could be regarded with less priority. We aimed to asses trends in contraception use among young adults in Italy. Methods From the Italian Institute of Statistics (ISTAT) Survey on Health Status and Use of Health Care, we collected aggregated data on contraception use among Italians aged 18 to 24 years old, by sex, for the year 2013. From the National Fertility Study of the Italian Higher Institute of Health (ISS) we collected aggregated data on contraception use among a nationally representative sample of Italian university students with a mean age of 22 years old, for both sexes, for years 2017 and 2018. We compared the estimates of prevalence of use of different contraceptives across the two surveys, utilizing, for the 2013 survey, the mean of the results for the two sexes. Results The use of at least one type of contraceptive grew from 89.3% in 2013 to 95.0% in 2017-2018, while the use of condoms increased from 69.7% in 2013 to 71.2% in 2017-2018. The use of coitus interruptus increased as well from 15.9% in 2013 to 24.0% in 2017-2018. The use of modern contraceptive methods was not comparable across the two surveys. Conclusions The two surveys from 2013 and 2017-2018 were not comparable for all the estimates of contraception use. While the prevalence of use of at least one type of contraceptive and of condoms increased from 2013 to 2017-2018, the contemporary increase of use of coitus interruptus raises some concerns. There is a need for reproducible surveys conducted at shorter intervals, and also for investigating trends in access and utilization of medical counselling about contraception, especially among young adults. Key messages Use of any kind of contraceptive and of condoms has slightly increased in Italy from 2013 to 2017-2018, but in the same period the use of coitus interruptus increased by around 8%. Surveillance systems for contraception use in Italy should be strengthened through regular surveys with reproducible methods, including assessments of medical counselling about contraception.

MOIRAE – bottom-up MOdel to compute the energy consumption of the Italian REsidential sector: Model design, validation and evaluation of electrification pathways

This paper presents a novel bottom-up modeling approach (MOIRAE) to compute the thermal and electrical energy consumptions of the residential sector, which is later applied to the Italian case. First, the structure of the model has been designed and the energy balance models for the electrical and thermal appliances have been described. The energy balance models have been applied to the micro-data offered by the Italian Institute of Statistics (ISTAT), consisting of a statistical-nationwide-representative sample and providing a comprehensive description of all the Italian households. Subsequently, MOIRAE performance has been assessed considering both global and local validations. On one hand, from a global point of view, MOIRAE has been validated by comparing the numerical outcomes (thermal and electrical energy consumptions) with historical national aggregated data. On the other hand, from a local point of view, MOIRAE has been validated by comparing the numerical outcomes with available micro-data, describing energy expenditure of the different households. Finally, MOIRAE has been employed to elucidate the electrification pathways for the Italian residential sector, aiming at replacing the natural gas, LPG, diesel and fuel oil energy carriers with electrical energy.

Factors associated with increased all-cause mortality during the COVID-19 pandemic in Italy

BackgroundThe number of excess deaths during February–March 2020 in Italy, in comparison with previous years, was considerably higher than the recorded COVID19-related deaths. The present study aimed to explore the association of excess mortality with some indices related to the COVID-19 pandemic and its management. MethodsData on all-cause mortality from 20 February–31 March in the years 2015–2020, and demographic, socioeconomic and healthcare organisation data of each Italian region were obtained from the Italian Institute of Statistics. Non-COVID-19-Imputed Excess Mortality (NCIEM) was calculated as the difference between the excess 2020 mortality and reported COVID-19 mortality. The association of NCIEM with the rate of COVID-19 cases, COVID-19 mortality and other potential moderators was assessed using linear regression models. ResultsThe nationwide number of excess deaths and COVID-19 deaths was 26,701 and 13,710, respectively, with a difference of 12,991. The NCIEM in different regions showed a direct correlation with COVID-19 mortality (r2 = 0.61, p < 0.001) and total cases (r2 = 0.30, p = 0.012), and an inverse correlation with cases/total tests ratio (r2 = 0.49, p = 0.001). Direct correlations were also found with the proportion of institutionalised elderly, whereas inverse correlations were observed with prevalence of diabetes, cardiovascular mortality and density of general practitioners. ConclusionsThe impact of the COVID-19 pandemic on all-cause mortality was considerably greater than that indicated by official counts of victims. Limited testing capacity and causes of death other than COVID-19 could have contributed to the increase in overall mortality rates.

Mortality trend for multiple sclerosis in Italy during the period 1980–2015

BackgroundThe epidemiology of Multiple Sclerosis (MS) is relevant for health-services planning. Most of MS prevalence and incidence studies in Italy referred to specific geographical areas and periods, whereas mortality data are routinely collected at the national level. The aim was to assess MS mortality trend and geographical differences in Italy from 1980 to 2015. MethodsMortality data were provided by the Italian Institute of Statistics. Due to a low number of annual deaths, mortality data were analysed for both the entire period under study and for sub-periods. Temporal trends were first evaluated using age-adjusted mortality rates (AMRs) comparing each sub-period with the initial one. Then, the annual percent change in mortality was estimated through the joinpoint regression model. Spatial differences between 5 main geographical areas were evaluated using standardized mortality ratios (SMRs). ResultsDuring the study period, 4,959 deaths for males and 7,434 for females were observed. The higher overall AMR was observed for females (F:0.71 vs. M: 0.56 per 100,000 persons per year). Analysing mortality by gender and geographical area, SMRs 〈 100 were observed in South Italy for both sexes, and in Central Italy for males only, whereas SMRs 〉 100 for Islands for both sexes, and in North-East and North-West for females only. The analysis of the mortality trend through AMRs calculated for sub-periods revealed no difference between the first and the last period for males, whereas a significant increase in mortality was observed for females. The joinpoint regression analysis showed a significant decrease in mortality up to 1995 for males (APC -3.23%) and up to 1999 for females, (APC -1.01%), followed by a significant increase for both sexes, but more marked for females (APC +1.9% M, +2.34% F). ConclusionThe increasing trend of mortality for MS, especially for females, may reflect the increase in the prevalence of MS and the improvement in the quality of diagnosis or coding of the cause of death.