RESUMEN
BACKGROUND: a death number increment compared to the previous years was observed in Italy for the year 2015; its causes are under study. OBJECTIVES: to verify if the mortality occurred in Palermo Province (Sicily Region, Southern Italy) for the year 2015 was greater than the one observed in the previous period (years 2009-2014) and to find which death causes it would be attributable to. DESIGN: observed number of deaths in 2015 were compared with expected numbers calculated with the traditional analysis of direct adjusted rates, and with a 90% predictive interval estimated fitting a Generalized Additive Model (GAM), via a quasi-Poisson distribution of the observed deaths in the period 2009-2014; various measures of the environmental temperature were used as regressor. The latter method was used also to analyse causes of death. SETTING AND PARTICIPANTS: all deaths occurred in residents in Palermo Province in the years 2009-2015. RESULTS: for each population subgroup based on sex and residence, direct adjusted rates for 2015 were lower than those observed in the previous period, but for women resident in towns outside Palermo (observed/estimated ratio: 1.04; 95%IC 1.00-1.08). GAM analysis shows mortality excesses only in men aged more than 64 years; in Palermo residents, excesses were shown in the 2nd week of December; in residents in towns of the Province excesses were shown in the 2nd and 3rd week of February and in the 1st and 2nd week of August. In the death causes analysis, mortality excesses were shown for pneumonia and bronchial pneumonia in the 1st and 2nd weeks of January; 3rd week of February; in the 1st, 2nd and 4th week of August; and in the 1st week of October. For infectious diseases, these excesses were observed in the 1st week of March. CONCLUSIONS: it is plausible that in some weeks of the year 2015 there have been a mortality excess; however, as all-year mortality is lower or equal to that of the previous periods, the Authors believe that there is an harvesting effect, that is a mortality displacement that does not affect total mortality.
Asunto(s)
Mortalidad/tendencias , Adolescente , Adulto , Causas de Muerte/tendencias , Niño , Preescolar , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modelos Estadísticos , Sicilia/epidemiología , Factores de Tiempo , Adulto JovenRESUMEN
OBJECTIVE: to assess whether compositional (education, income index, number of family members) and contextual (area socioeconomic index) risk factors independently predict all cause and specific mortality. DESIGN: a multilevel (hierarchic) logistic regression model was applied to the individual data of a cohort followed up from 01.01.2002 till 31.12.2007. SETTING AND PARTICIPANTS: the study evaluated 40-79 years old people resident in Palermo at 01.01.2002, for whom it was possible to match register office and census data (220,723 people, 74.8% of the same age group total population). MAIN OUTCOMES MEASURES: odds ratios for specific risk factors. RESULTS: mortality was generally lower in people with better socioeconomic conditions and living in more affluent neighbourhoods. Individual risk factors odds ratios do not vary in models with and without area related risk factor. Variance partition component and other between area and total variability ratio index show small values. CONCLUSION: compositional and contextual socioeconomic factors are independent predictors of mortality; area related variability is only a small fraction of total variability.
Asunto(s)
Mortalidad/tendencias , Adulto , Anciano , Femenino , Humanos , Italia , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis de Regresión , Factores de Riesgo , Factores SocioeconómicosRESUMEN
OBJECTIVE: To assess whether mortality rates differ among areas with different values of a socioeconomic index. DESIGN: Ecological mortality study; mortality rates were compared among four areas joining census tracts categorized by quartiles of a socioeconomic status index. This index was calculated using individual 2001 census data in a factorial analysis. SETTING: The study was conducted in Palermo (Italy) a city with 668,996 inhabitants in 2006. MAIN OUTCOMES MEASURES: Sex, age group, cause specific standardized mortality rates and rate ratios, expected life years. RESULTS: The area with the lowest value of the socioeconomic index had mortality rates higher than the area with the uppermost value. This occurred in both sexes, all age groups and for most mortality causes (with few exceptions): not all rate ratios were always statistically significant. CONCLUSION: Despite limitations due to the use of an area-based index, results suggest that the welfare system is not successful in compensating health inequalities caused by socioeconomic inequalities.