Standardized Mortality Research Articles

Hygienic aspects of mortality of the population of an industrial city

Introduction. The target indicators of the Federal Project “Clean Air” include a reduction in emissions of chemical pollutants by at least 20%. However, the main socially significant goal remains to improve the medical and demographic situation by reducing environmental and hygienic health risks.
 The purpose of the study was to preliminary assess the reserves for reducing mortality in the city of Omsk by identifying the most unfavourable territories in terms 
 of atmospheric air quality and identify priority chemicals, presumably causing negative trend in mortality.
 Materials and methods. To assess the quality of atmospheric air in the city of Omsk, the results of social and hygienic monitoring, environmental monitoring 
 of Federal Service of Russia on Hydrometeorology and Monitoring of the Environment (RosGidromet) for the multi-year period over 2009–2022 were used. 
 An analysis of the mortality rate of the population of Omsk for 2017–2022 was carried out. The data were studied in the context of municipal districts of the city of Omsk and in dynamics. Statistical methods were used in the study: ANOVA, correlation analysis, assessment of relative mortality risks. 
 Results. The relative risk (RR) of mortality for persons living in the most polluted areas of the city is 23–25% higher than in conditionally clean areas. Strong positive associations have been established: between the levels of actual total mortality and the specific gravity of atmospheric air samples exceeding the maximum single limit concentrations (R = 0.86; p < 0.05); between perennial average annual carbon monoxide concentrations and standardized rates of total mortality 
 (R = 0.93; p<0.05) and male mortality rates from all natural causes (R = 0.89; p<0.05).
 Limitations. The study is limited to the statistical research methods used. 
 Conclusion. The results of the study can become the basis for more efficient use of administrative resources in municipal districts of the city. As additional reserves for reducing mortality, the development of primary prevention measures at the outpatient level is important. It is necessary to optimize methodological approaches in the health control system of the population living in risk areas with developed industry.

IJCM_51A: Comorbidities among COPD patients admitted to a tertiary care hospital in Mangalore

Background: According to WHO, Chronic obstructive pulmonary disease (COPD) associated mortality in India is more than 64.7 estimated age- standardized death rate per 100,000 amongst both sexes. Various studies conducted on COPD, worldwide suggest that patients are more likely to die of comorbid conditions than from COPD. Objective: To find out the various co-morbidities among COPD patientsattending tertiary care hospitals in Mangalore. Methodology: This is a records-based study set in KMC Hospital Attavar, Mangalore. Records of all the COPD patients who attended the hospital in the last 2 years (2016-2017) in KMC Attavar were collected. Case files in which more than 50% of data is incomplete were excluded. Results: A total of 473 COPD patients were admitted in the last two years in KMC Attavar Hospital. The Mean (SD) age of patients was 68 (10) years. Males were found to be affected in a larger proportion than females. Median (IQR) duration of diseases was 2.28(1, 2) years. The maximum duration was 22 years and the minimum was 2 months. GOLD’s classification was available for 66 patients, wherein most of the patients had moderate to severe forms of COPD. Around 408(86%) of the COPD patients had one or the other comorbidities. Most COPD patients suffered from metabolic disorders (58%) common being HTN (66%) and DM (45%). The mortality rate was 5.7% which corresponds to 27 patients, with the most common cause being respiratory failure followed by sepsis. Conclusion: The most common comorbidity among COPD patients was Diabetes mellitus and Hypertension so the patients should also be screened for the same in the hospital. The most common cause of mortality seen among COPD patients was Respiratory failure which is a complication of COPD so it should also be kept in mind during treatment.

Дозовая зависимость смертности от болезней системы кровообращения у работников ядерной индустрии (систематический обзор и pooled-анализ): отсутствие эффекта малых доз и подтверждение порога, установленного НКДАР и МКРЗ при 0,5 Гр

Based on the maintained database (source database) on effects in nuclear workers (NW), a selection of major studies of the relationship between mortality from diseases of the circulatory system (CVD; codes 390–459 according to ICD-9 and I00–I99 according to ICD-10) and external radiation dose. The sample included 30 papers and covered cohorts from 6 countries plus an NW cohort from 15 countries. For the sample, in most cases based on published standardized mortality rates (SMR), the relative risks (RR) of mortality from CVD were calculated for the selected dose groups with subsequent processing of the material for outliers. Initial: n = 207; final sample: n = 199; covers very low (0–10 mSv; 15.8 % of the sample), low (>10–100 mSv; 45.8 %) and moderate (>100–1000 mSv; 36.4 %) doses; data for high doses (>1000 mSv; n = 4; 2 % of the sample), due to dubiousness, were excluded. A systematic review and pooled analysis of the RR for mortality from CVD depending on the dose on an ordinal scale was performed on the final sample. For the entire dose range (0–1000 mSv) and for moderate doses, statistically significant trends in increasing RR were found when expressed in five types of regressions (except for the logarithmic one for the entire range). Although the r values were small (0.230–0.293), the effect was clear. The ERR per 1 Gy (Sv) calculated for moderate doses using linear regression was 0.54. This value is higher than those obtained previously in meta-analyses, but should be considered as the most adequate. No dose relationship was found for the very low + low dose range (0–100 mGy); the r coefficients for the regressions were either negligible or negative at statistical insignificance. For the subthreshold dose range for CVD mortality after exposure (according to UNSCEAR and ICRP: 500 mSv), only a weak trend towards an increase in RR was found, statistically insignificant, despite the large sample size (n = 191), while for the dose range 500–1000 mSv, the highest tendency among the pooled analyzes was revealed to increase the risk depending on the level of exposure (r = 0.297–0.423; statistically insignificant due to the small sample size: n = 8). It is concluded that for mortality from CVD after irradiation, the threshold value of 0.5 Gy established by UNSCEAR and ICRP and confirmed in the present pooled analysis should be strictly adhered to. Due to the lack of effects of low doses, it is inappropriate to raise the issue of low dose effects in the context of these pathologies.

Regional Differences in Standardized Mortality Rate Trends for Peripheral Artery Disease from 2011 to 2020 in the Republic of Croatia

Regional Differences in Standardized Mortality Rate Trends for Peripheral Artery Disease from 2011 to 2020 in the Republic of Croatia

Emerging Insights into Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis Induced by Immune Checkpoint Inhibitor and Tumor-Targeted Therapy.

Anticancer drugs have revolutionized tumor therapy, with cutaneous toxicities such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) being common immune-related adverse events. The debate over the efficacy of systemic corticosteroids in treating these conditions persists, while tumor necrosis factor (TNF)-alpha inhibitors show promise. This study aims to evaluate the effectiveness and safety of combination therapy involving the TNF-α inhibitor adalimumab for SJS/TEN induced by anticancer drugs. A literature review of SJS/TEN cases induced by anticancer drugs from 1992 to 2023 was conducted, alongside an analysis of patients admitted to the First Affiliated Hospital of Fujian Medical University during the same period. Clinical characteristics, skin healing time, mortality, and adverse events were evaluated in two treatment groups: SJS/TEN patients treated with targeted anticancer therapies and immunotherapies. Among the 27 patients studied (18 with SJS or SJS-TEN overlapping and 9 with TEN), combination therapy with adalimumab significantly reduced mucocutaneous reepithelization time and healing duration compared to corticosteroid monotherapy. Patients receiving adalimumab combined with corticosteroids had lower actual mortality rates than those on corticosteroid monotherapy. The combination therapy also showed a trend towards reducing standardized mortality rates based on the Score of Toxic Epidermal Necrolysis (SCORTEN). The findings suggest that adalimumab in combination with corticosteroids provides significant clinical benefits and is safer than corticosteroids alone for treating SJS/TEN induced by targeted anticancer therapies and immunotherapies. This study contributes valuable insights into potential treatment strategies for severe cutaneous adverse reactions to anticancer drugs, highlighting the importance of exploring alternative therapies such as TNF-α inhibitors in managing these conditions effectively.

EPIDEMIOLOGICAL SITUATION OF SKIN CANCER AND MELANOMIA
 IN THE REPUBLIC OF KAZAKHSTAN IN 2012-2022

Relevance: Skin cancer, including melanoma, is a major health problem and one of the most common cancers in the world.
 The study aimed to obtain a complete epidemiological picture of skin cancer and melanoma in the Republic of Kazakhstan for 11 years,
 including analysis of data for 2022, considering various parameters such as age, sex, ethnicity, region, and tumor type.
 Methods: The study used data from patients registered in the national cancer registry of the Republic of Kazakhstan from 2012 to 2022,
 diagnosed with skin carcinoma and skin melanoma (ICD-10 code: C44-C43). The number of skin carcinomas and melanoma cases is presented as absolute and crude rates per 100,000 population. Absolute standardized morbidity and mortality rates were calculated using the world
 standard (World).
 Results: At the end of 2022, 19,714 and 2,689 patients were diagnosed with “Skin Cancer” or “Skin Melanoma” in the Republic of Kazakhstan, respectively. From 2012 to 2022, the incidence of skin cancer increased by 24% and melanoma by 15%. In 2022, the incidence of skin
 cancer and melanoma was higher among women by 24% and 26%, respectively. Mortality from skin cancer is in 23rd place, from melanoma in
 21st place. Mortality rates from skin cancer and melanoma were 0.5 and 0.7 per 100 thousand population, respectively. The peak incidence of skin cancer in 2022 was observed in the age group 65-74 years (36%), and mortality in the age groups 65-74 and 75-84 years (17% each). The
 peak incidence of skin melanoma in 2022 was observed in the age groups 55-64 years and 65-74 years (24% and 25%), and mortality in the
 groups 45-54 years and 35-44 years (14% and 10%).
 Conclusion: There has been a steady increase in the incidence of skin cancer and melanoma, which indicates the seriousness of this problem in the country and underlines the need for further measures to prevent, diagnose and treat skin cancer and melanoma in the Republic of
 Kazakhstan. It should be remembered that many cases of skin cancer can be prevented with simple precautions.

25 year trends in cancer incidence and mortality among adults aged 35-69 years in the UK, 1993-2018: retrospective secondary analysis

ObjectiveTo examine and interpret trends in UK cancer incidence and mortality for all cancers combined and for the most common cancer sites in adults aged 35-69 years.DesignRetrospective secondary data analysis.Data...

Injury death spectrum in children aged 0-14 years and its urban-rural difference in Tianjin, 1999-2021

Objective: To analyze the characteristics, change of injury death spectrum in children aged 0-14 years and its urban-rural difference in Tianjin. Methods: The incidence data of injury death in children aged 0-14 years in Tianjin from 1999 to 2021 were collected from the "Population Based Mortality Surveillance System in Tianjin". We calculated constituent ratio, crude and standardized mortality rates in different subgroups of the population and major injury subtypes, and compared the rural-urban differences. The Cochran-Armitage trend test was used to analyze temporal trends in cause-of-death component ratios. Joinpoint regression model was used to calculate average annual percent change (AAPC). Seasonal difference in injury mortality risk were expressed as mortality ratio and 95% confidence interval. Results: From 1999 to 2021, injury was the third cause of death in children aged 0-14 years in Tianjin. The percentage of children who died in health-care facilities in rural area was 31.08%, which was lower than 37.82% in urban area. There was a downward trend in the standardized mortality rate of injury in children (AAPC=-5.54%, P<0.001). The standardized mortality rates of drowning and road traffic injury declined in both urban area and rural area (P<0.001). The mortality rate of accidental poisoning decreased in rural area (AAPC=-8.09%, P<0.001), but showed no significant change trend in urban area (P>0.05). The standardized mortality rate of suicide showed no significant change trend in urban area, but there was an increasing trend in the standardized mortality rate of suicide in rural children aged 10-14 years (AAPC=4.58%). No significant change trend was observed in mortality rate of falls in urban and rural children (P>0.05). The injury mortality rate showed obvious seasonality in children in Tianjin. Overall injury death risk and risk for drowning-caused death were highest in summer in both urban area and rural area. The risk for road traffic injury-related death was highest in autumn in urban area and in summer in rural area. The risk for death caused by accidental poisoning was highest in winter in both urban area and rural area. Conclusions: In recent decades, the injury mortality rate in children aged 0-14 years in Tianjin showed a decreasing trend. There is still a significant difference in the injury mortality level between urban area and rural area, to which close attention needs to be paid in the future policy development.

Evolving AIDS- and non-AIDS Mortality and Predictors in the PISCIS Cohort of People Living With HIV in Catalonia and the Balearic Islands (Spain), 1998-2020.

Effective antiretroviral therapy (ART) has substantially reduced acquired immunodeficiency syndrome (AIDS)-related deaths, shifting the focus to non-AIDS conditions in people living with human immunodeficiency virus (HIV) (PLWH). We examined mortality trends and predictors of AIDS- and non-AIDS mortality in the Population HIV Cohort from Catalonia and Balearic Islands (PISCIS) cohort of PLWH from 1998 to 2020. We used a modified Coding Causes of Death in HIV protocol, which has been widely adopted by various HIV cohorts to classify mortality causes. We applied standardized mortality rates (SMR) to compare with the general population and used competing risks models to determine AIDS-related and non-AIDS-related mortality predictors. Among 30 394 PLWH (81.5% male, median age at death 47.3), crude mortality was 14.2 per 1000 person-years. All-cause standardized mortality rates dropped from 9.6 (95% confidence interval [CI], 8.45-10.90) in 1998 through 2003 to 3.33 (95% CI, 3.14-3.53) in 2015 through 2020, P for trend = .0001. Major causes were AIDS, non-AIDS cancers, cardiovascular disease, AIDS-defining cancers, viral hepatitis, and nonhepatitis liver disease. Predictors for AIDS-related mortality included being aged ≥40 years, not being a man who have sex with men, history of AIDS-defining illnesses, CD4 < 200 cells/µL, ≥2 comorbidities, and nonreceipt of ART. Non-AIDS mortality increased with age, injection drug use, heterosexual men, socioeconomic deprivation, CD4 200 to 349 cells/µL, nonreceipt of ART, and comorbidities, but migrants had lower risk (adjusted hazard risk, 0.69 [95% CI, .57-.83]). Mortality rates among PLWH have significantly decreased over the past 2 decades, with a notable shift toward non-AIDS-related causes. Continuous monitoring and effective management of these non-AIDS conditions are essential to enhance overall health outcomes.

The trends of mental disorders mortality in China over a 33-year period

ObjectivesWe investigated the variations in the trends of mental disorders mortality by age, period, and cohort, over a 33-year period from 1987 to 2020, to reveal the relationship between age, period, cohort, and mental disorders mortality, as well as providing guidance for resource allocation to prevent mental disorders-related deaths in vulnerable target populations. MethodsThe data of mental disorders mortality 1987–2020 were from five administrative organizations, which collected from the National Health Commission in China with national monitoring by sex and age, covering 31 provinces in China. The International Classification of Diseases (ICD), its 9th Revision (ICD-9) and its 10th Revision were used to code the mental diseases. From 1987–2002, ICD-9 was used, and ICD-10 was used from 2003 to 2020. The age standardized mortality rates (ASMRs) were calculated using the World Standard Population as the reference. We used joinpoint models to assess the trends of mental disorders mortality in China for the period 1987–2020. And the age-period-cohort models were employed to estimate the age-period-cohort effect on mental disorders mortality. ResultsThe age-standardized overall mental disorders mortality rate (ASMR) showed a downward trend from 1987 to 2020. Further, the ASMR of individuals in urban was higher than that in rural from 1987 to 2001, but, post-2002, this urban-rural disparity in ASMR showed a less clear pattern, with urban areas occasionally surpassing rural areas and vice versa. ASMR is less prevalent among females compared to males overall. The contribution of age effects to mental disorders mortality gradually increases with advancing age, the period effects of mental disorders mortality gradually decrease over time. The cohort effect's contribution to mental disorders mortality decreases in the newly born population, while in the older birth cohorts, the cohort effect's contribution to the mortality rate of mental disorders increases. ConclusionsThe ASMR exhibits a decreasing trend from 1987 to 2020, and these change trend showed urban-rural and sex differences. The primary factors contributing to this overall decline are period effects and cohort effects. Our results provide valuable information for shaping mental health policies, designing targeted interventions, and preparing for future changes in disease mortality rates. The focus on different demographic factors allows for a nuanced and tailored approach to mental health promotion and intervention strategies.

Undernutrition, and overweight and obesity: the two faces of malnutrition in Brazil, analysis of the Global Burden of Disease, 1990 to 2019

ObjectivesThe objective of this study was to analyse the global burden of disease attributable to undernutrition and high body mass index (BMI) in Brazil and its 27 states, as well as its association with the socio-demographic index (SDI) from 1990 to 2019. Study designThis is an epidemiological time-series study. MethodsThis study analysed the undernutrition and high BMI estimated by the Global Burden of Disease study conducted from 1990 to 2019 for Brazil and its states, using the following metrics: absolute number of deaths, standardised mortality rate, and disability-adjusted life years (DALYs). This study also analysed the correlation between the percentage variation of mortality rates and SDI. ResultsA decrease in the number of deaths (−75 %), mortality rate (−75.1 %), and DALYS (−72 %) attributable to undernutrition was found in Brazil and in all regions. As regarding the high BMI, an increase in the number of deaths was found (139.6 %); however, the mortality rate (−9.7) and DALYs (−6.4 %) declined in all regions, except in the North and Northeast regions, which showed an increase. A strong correlation was identified between undernutrition and high BMI with SDI. ConclusionOur study observed a double burden of malnutrition in Brazil, with a reduction in the burden of diseases due to malnutrition in Brazil and variation in the burden due to high BMI according to the socioeconomic status of the region. Public policies are necessary in order to guarantee the human right to a healthy and sustainable diet, together with food and nutrition security and a diminishing of social inequality.

Trends in Mortality Due to Malignant Neoplasms of Female Genital Organs in Poland in the Period 2000-2021-A Population-Based Study.

The aim of this study is to assess mortality trends due to malignant neoplasms of female genital organs (MNFGOs) in Poland between 2000 and 2021. For the purpose of the study, the authors used data on all deaths of Polish female inhabitants due to MNFGO between 2000 and 2021, obtained from the Statistics Poland database. The standardised death rates (SDR), potential years of life lost (PYLL), annual percentage change (APC) and average annual percentage change (AAPC) were calculated. Between the years 2000 and 2021, 138,000 women died due to MNFGOs in Poland. Of this number, 54,975 (39.8%) deaths were caused by ovarian cancer, 37,487 (27.2%) by cervix uteri cancer, and 26,231 (19.0%) by corpus uteri cancer. A decrease in mortality due to cervix uteri cancer (APC = -2.4%, p < 0.05) was the most favourable change that occurred in the period 2000-2021, while the least favourable change was an increase in mortality due to corpus uteri cancer for the period 2005-2019 (APC = 5.0%, p < 0.05). SDRs due to ovarian cancer showed a decreasing trend between 2007 and 2021 (APC = -0.5%, p < 0.05). The standardised PYLL index due to cervical cancer was 167.7 per 100,000 women in 2000 and decreased to 75.0 in 2021 (AAPC = -3.7, p < 0.05). The number of lost years of life due to ovarian cancer decreased from 143.8 in 2000 to 109.5 in 2021 (AAPC = -1.3, p < 0.05). High values of death rates due to MNFGO in Poland, compared to other European countries, show that there is a need to promote preventive programmes and continue to monitor changes in mortality.

Analysis of mortality rates from respiratory diseases in the Krasnodar territory over 2014–2020

Introduction. During 2015–2019, there was a tendency to decrease mortality rates from respiratory diseases in the Russian Federation. The COVID-19 pandemic, began in 2020, significantly increased the burden on public health.&#x0D; The purpose is to compare standardized mortality rates from respiratory diseases for the period from 2014–2020 and to determine the contribution of individual nosologies to mortality from respiratory diseases in the Krasnodar Territory.&#x0D; Materials and methods. The study was conducted on the basis of statistical reporting forms S-51 over 2014–2020. The causes of death related to respiratory diseases (class J00–J47) and the causes of death from COVID-19 (codes U07.1, U07.2) for 2020 were selected, standardized mortality rates were calculated. &#x0D; Results. The lowest value of the standardized mortality rate from respiratory diseases was registered in 2019 as 10.3, the rate of decline compared to 2014 — 31.3%. The highest value of the standardized mortality rate from respiratory diseases is 40.3 in 2020, the growth rate compared to the previous year is 268.6%. The proportion of the standardized mortality rate from COVID-19 for 2020 amounted to 7.02%, which is 2.9% higher than from respiratory diseases in general.&#x0D; Limitations of the study. When studying the regional characteristics of respiratory diseases mortality, official statistical data for 2014–2020 were used, which is a sufficient reference sample. &#x0D; Conclusion. The leading causes of death from respiratory diseases in the Krasnodar Territory over 2015–2020 were pneumonia, other chronic lung diseases and purulent and necrotic conditions of the lower respiratory tract.

Re-evaluating the Incidence and Prevalence of Clinical Hypertrophic Cardiomyopathy: An Epidemiological Study of Olmsted County, Minnesota

ObjectiveTo contemporaneously reappraise the incidence-rate, prevalence, and natural history of hypertrophic cardiomyopathy (HCM) in Olmsted County, Minnesota, from 1984 to 2015. Patients and MethodsA validated medical-record linkage system collecting information for residents of Olmsted County was used to identify all cases of HCM between January 1, 1984, and December 31, 2015. After adjudication of records from Mayo Clinic and Olmsted Medical Center, data relating to diagnoses and outcomes were abstracted. The calculated incidence rate and prevalence were standardized to the US 1980 White population (age- and sex-adjusted) and compared with a prior study examining the years 1975-1984. ResultsTwo hundred seventy subjects with HCM were identified. The age- and sex-adjusted incidence rate was 6.6 per 100,000 person-years, and the point prevalence of HCM on January 1, 2016, was 89 per 100,000 population. The incidence rate and point prevalence of HCM on January 1, 2016, standardized to the US 1980 White population (age- and sex-adjusted), were 6.7 (95% CI, 7.1 to 8.8) per 100,000 person-years and 81.5 per 100,000 population, respectively. The incidence rate of HCM increased each decade since the index study. Individuals with HCM had a higher overall standardized mortality rate than the general population with an observed to expected HR of 1.44 (95% CI, 1.21 to 1.71; P<.001) which improved by each decade. ConclusionThe incidence and prevalence of HCM are higher than rates reported from a prior study in the same community examining the years 1975-1984, but lower than other study cohorts. The risk of mortality in HCM remains higher than expected, albeit with improvement in rates of mortality observed each decade during the study period.

Sex-based analysis of NSTEMI processes of care and outcomes by hospital: a nationwide cohort study.

Contemporary studies demonstrate that non-ST-segment elevation myocardial infarction (NSTEMI) processes of care vary according to sex. Little is known regarding variation in practice between geographical areas and centers. We identified 305014 NSTEMI admissions in the United Kingdom (UK) Myocardial Infarction National Audit Project (MINAP), 2010-2017, including female sex (110209). Hierarchical, multivariate logistic regression models were fitted assessing for differences in primary outcomes according to sex. Risk standardized mortality rates (RSMR) were calculated for individual hospitals to illustrate correlation with variables of interest. 'Heat-maps' were plotted to show regional and sex-based variation in opportunity-based quality-indicator score (surrogate for optimal processes of care). Women presented older (77y vs. 69y, P<0.001) and were more often Caucasian (93%vs. 91%, P<0.001). Women were less frequently managed with an invasive coronary angiogram (ICA) (58%vs. 75%, P<0.001) or percutaneous coronary intervention (PCI) (35%vs. 49%, P<0.001)). In our hospital-clustered analysis, we show positive correlation between the RSMR and increasing proportion of women treated for NSTEMI (R2=0.17, P<0.001). There was clear negative correlation between proportion of women who had an optimum OBQI score during their admission and RSMR (R2=0.22, P<0.001), with weaker correlation in men (R2=0.08, P<0.001). Heat-maps according to clinical commissioning group (CCG) demonstrate significant regional variation in OBQI score, with women receiving poorer quality care throughout the UK. There was a significant in variation of the management of patients with NSTEMI according to sex, with widespread geographical variation. Structural changes are required to enable improved care for women.

Impact of the SARS-CoV-2 epidemic on the immigrant population by urbanisation degree in five Italian Regions (Piedmont, Emilia-Romagna, Tuscany, Lazio, and Sicily)

according to the literature, socially disadvantaged strata of the population, including immigrants, have been more vulnerable to the risk of SARS-CoV-2 infection due to greater exposure and less opportunity to protect themselves, and to COVID-19 complications due to metabolic and clinical risk factors as well as to healthcare access barriers. Two Italian projects - coordinated by the Italian National Institute for Health, Migration and Poverty and the Italian National Centre for Disease Prevention and Control - set up an epidemiological surveillance to monitor the temporal trends of the SARS-CoV-2 pandemic in five Italian regions using validated indicators. to identify differences between Italians and immigrants in terms of the epidemic evolution and its health consequences, and to investigate possible differences by urbanisation degree and region of residence. cross sectional study. resident population in five Italian regions: Piedmont, Emilia-Romagna, Tuscany, Lazio, and Sicily. frequencies of positive tests, routine hospitalisations, and deaths related to COVID-19 were collected, with respect to the period between 22.02.2020 and 31.01.2021. Data were aggregated by week, region, degree of urbanisation, gender, age (5-year classes), and citizenship (Italian/foreigner). Crude and standardised rates of the outcomes considered were calculated, stratified by gender, citizenship, region, and aggregated by pandemic macro-period. the study population counts approximately about 23 million residents as of 01.01.2020 (9.4% immigrants). During the period of interest, 1,542,458 cases of infection were recorded, whereas hospitalisations amounted to 175,979, and deaths to 44,867. Lower crude rates of hospitalisations and deaths were observed among immigrants compared to Italians. The age-standardised hospitalisation rates, on the other hand, showed an opposite trend and were significantly higher among immigrants, due to the excess observed in urban areas, especially in periods of epidemic peak, both for males (weekly mean standardised rate: 34.6 per 1,000 of foreign residents vs 24.3 of Italians over the period October 2020-January 2021) and females (23.2 vs 15.1 over the period February-April 2021). These differences seem to be more pronounced in the central regions and tend to disappear for residents in scarcely populated areas. Standardised mortality rates were higher among immigrants, both men and women, from October 2020 and more markedly in February-April 2021 among men. the impact of COVID-19 was stronger among immigrants in relation to hospitalisation, especially during epidemic peak periods and in some regions. The difference in the impact on mortality was smaller. There is some heterogeneity among regions and urban areas that is worth considering in the planning of interventions and integration policies.

Impact of COVID-19 on foreign population resident in urban areas of Italy: selection of indicators, data sources, and definition of geographical stratification levels

to describe indicators, data sources, and levels of geographical stratification used within the framework of the CCM project "Epidemiological Surveillance and Control of COVID-19 in Metropolitan Urban Areas and for the containment of SARS-CoV-2 circulation in the immigrant population in Italy". population-based observational study based on data from the Integrated Covid-19 Surveillance System and the archive of hospital discharge records. interregional collaborative project. Resident population in 5 Italian Regions (Piedmont, Emilia-Romagna, Tuscany, Lazio, and Sicily). crude and age-standardized rates of diagnostic test utilization and positivity, hospitalization (in any department and in intensive care unit), and mortality in COVID-19 cases. starting from the set of 11 indicators from the Italian National Institute for Health, Migration and Poverty (INMP) project "Epidemiology of SARS-CoV-2 Infection (COVID-19) and Use of Health Services in the Immigrant Population and Vulnerable Population Groups in Italy", the five most effective indicators for CCM purposes were identified. The INMP project highlighted higher rates of test access and positivity among Italians compared to foreigners, higher standardized hospitalization rates among foreigners, and higher standardized mortality rates among Italians, with geographical and temporal heterogeneity. The intersection between the DEGURBA (degree of urbanisation) classification and altimetric zones defined five levels of territorial stratification characterized by decreasing population density. Approximately 81% of the population involved in the CCM project resided in the first two levels; 43% of Italians lived in areas with intermediate population density in hilly or plain areas, while 48% of foreigners were concentrated in densely populated areas. sharing the collaborative approach and a research methodology already tested, integrated with the analysis of disaggregated indicators by morphological, functional, and administrative characteristics of the residential territory, allowed for assessing differences in the impact of the pandemic between Italians and foreigners residing in more or less densely populated areas.

The health of immigrants in Italy: the viewpoint of the Italian National Institute for Health, Migration and Poverty (INMP)

The foreign population accounts for 8.6 percent (about 5 million) of the total number of residents, so it is necessary to monitor their health status. Foreigners have standardized mortality rates of about half that of Italians. In terms of hospitalization, rates and causes of hospitalization differ substantially due to the younger average age of foreigners. In particular, a much higher burden of hospitalizations in obstetrical care is observed among foreign women. Maternal and child health is a major concern for foreigners, especially for pregnancy care, which is also reflected in worse health outcomes for newborns.Difficulties in accessing and using basic and specialized territorial services are confirmed by the higher proportion of ordinary emergency hospitalizations among foreigners, the higher risk of being hospitalized for causes that could be treated in an outpatient setting, and the higher frequency of access to emergency rooms with a white/green triage code.The pandemic exacerbated health inequalities because it affected the most disadvantaged social strata of the population, including immigrants, more severely in terms of infection and outcomes.Immigrants could become the least healthy part of the population, similar to what is observed in countries with a longer tradition of migration, even in a country like Italy, where access to care is universally guaranteed.

Disease burden of COPD attributable to PM2.5 in China, Japan and South Korea from 1990 to 2019: a comparative study based on Global Burden of Disease Study 2019

ObjectiveWe hope to reveal the changing trends of chronic obstructive pulmonary disease (COPD) burden attributable to particulate matter pollution (PM2.5) and its age, period and cohort effects in China, Japan...

Has COVID-19 affected regional mortality from acute coronary artery disease? (comparison of two periods of 2017-2019 and 2020-2022)

Aim. To assess the changes of mortality from acute coronary artery disease (CAD) in the Russian regions during the coronavirus disease 2019 (COVID-19) pandemic in 2020-2022 in comparison with the prepandemic period (2017-2019).Material and methods. Rosstat data on the average annual population and mortality rate in one-year age groups for 82 regions Russian were used. In the brief Nomenclature of Causes of Death of Rosstat, the codes of the International Classification of Diseases, 10th revision (ICD-10) are grouped as follows: I21.0-9 (acute primary) myocardial infarction (MI), I22.0-9 (recurrent MI), I20, I24.1-9 (other types of acute coronary artery disease), U07.1 and U07.2 (coronavirus disease 2019 (COVID-19)). The regional average standardized mortality rates (SMR; M±SD) were calculated using the European population standard using the direct standardization method per 100 thousand population. Comparisons were made using the nonparametric Wilcoxon t-test (differences were considered significant at p&lt;0,05).Results. A decrease in the regional average SMR (per 100 thousand population) in the pandemic compared to the pre-pandemic period was revealed: from the sum of all acute CAD types — from 51,24±31,98 to 50,21±33,38 and from repeated MI — from 7,65±5,42 to 4,80±4,84; increase in SMR from acute MI — from 24,00±10,1 to 25,57±11,55, from other acute CAD types — from 19,58±25,23 to 19,83±26,21. Significant regional variability was noted in both the dynamics of the SMR from three acute CAD types, as well as the minimum and maximum SMR. Only in 2 regions in the pandemic period there was an increase in SMR from each of the three acute CAD types compared to the pre-pandemic period. In 18 regions, there was a decrease in SMR from each of the three forms, and in the rest, multidirectional changes were noted. There was no correlation between SMR for COVID-19 and SMR for acute CAD (r=0,034; p=0,76).Conclusion. The COVID-19 pandemic did not have a significant impact on the regional average SMR from acute CAD. The significant decrease in SMR from recurrent MI is likely due to choice of the initial cause of death.