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Wolf S, Schievano E, Amidei CB, Kucher N, Valerio L, Barco S, Fedeli U. Mortality trend of ischemic heart disease (2008-2022): A retrospective analysis of epidemiological data. Int J Cardiol 2024; 406:132042. [PMID: 38614362 DOI: 10.1016/j.ijcard.2024.132042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/21/2024] [Accepted: 04/10/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Age-sex specific trend analyses of ischemic heart disease (IHD)-related mortality and prevalent risk factors can improve our understanding and approach to the disease. METHODS We performed a 15-year retrospective epidemiological analysis of acute and chronic IHD-related mortality and prevalent cardiovascular risk factors using administrative data from Veneto, a socio-economically homogeneous Italian region. Standard mortality statistics using the underlying cause of death (UCOD) and deaths with any mention of IHD in death certificates (MCOD) from ICD-10 codes I20-I25 was performed between 2008 and 2022. RESULTS A total of 134,327 death certificates reported IHD-related deaths, representing 18.6% of all deaths. Proportional mortality decreased from 14.6% in 2008 to 7.8% in 2022 for deaths with IHD as the UCOD and from 23.5% to 14.6% for deaths with IHD among the MCOD. A more pronounced decline of proportionate and case-specific mortality rate was seen in women. The decline in mortality over the whole study period was larger for acute (vs. chronic) IHD. The COVID-19 pandemic led to a marked increase in mortality in 2020 (+12.2%) with a subsequent further decline. IHD-related deaths displayed a typical seasonal pattern with more deaths during winter. The prevalence of cardiovascular risk factors was higher in IHD (vs. no IHD) deaths: this association appeared more pronounced in younger adults. CONCLUSIONS We provided an analysis of epidemiological trends in IHD-related mortality and prevalence of risk factors. Our findings indicate a change in the pattern of cardiovascular deaths and may suggest a switch in death from acute to chronic conditions.
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Affiliation(s)
- Simon Wolf
- Department of Angiology, University Hospital Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland.
| | - Elena Schievano
- Epidemiological Department, Azienda Zero, Veneto Region, Padua, Italy
| | | | - Nils Kucher
- Department of Angiology, University Hospital Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland
| | - Luca Valerio
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Stefano Barco
- Department of Angiology, University Hospital Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland; Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Ugo Fedeli
- Epidemiological Department, Azienda Zero, Veneto Region, Padua, Italy
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Gagliotti C, Banchelli F, De Paoli A, Buttazzi R, Narne E, Ricchizzi E, Schievano E, Bellio S, Pitter G, Tonon M, Canziani LM, Rolli M, Tacconelli E, Berti E, Russo F, Moro ML. The incidence and risk factors of selected drug prescriptions and outpatient care after SARS-CoV-2 infection in low-risk subjects: a multicenter population-based cohort study. Front Public Health 2023; 11:1241401. [PMID: 37860802 PMCID: PMC10582710 DOI: 10.3389/fpubh.2023.1241401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/20/2023] [Indexed: 10/21/2023] Open
Abstract
Background Knowledge about the dynamics of transmission of SARS-CoV-2 and the clinical aspects of COVID-19 has steadily increased over time, although evidence of the determinants of disease severity and duration is still limited and mainly focused on older adult and fragile populations. Methods The present study was conceived and carried out in the Emilia-Romagna (E-R) and Veneto Regions, Italy, within the context of the EU's Horizon 2020 research project called ORCHESTRA (Connecting European Cohorts to increase common and effective response to SARS-CoV-2 pandemic) (www.orchestra-cohort.eu). The study has a multicenter retrospective population-based cohort design and aimed to investigate the incidence and risk factors of access to specific healthcare services (outpatient visits and diagnostics, drug prescriptions) during the post-acute phase from day-31 to day-365 after SARS-CoV-2 infection, in a healthy population at low risk of severe acute COVID-19. The study made use of previously recorded large-scale healthcare data available in the administrative databases of the two Italian Regions. The statistical analysis made use of methods for competing risks. Risk factors were assessed separately in the two Regions and results were pooled using random effects meta-analysis. Results There were 35,128 subjects in E-R and 88,881 in Veneto who were included in the data analysis. The outcome (access to selected health services) occurred in a high percentage of subjects in the post-acute phase (25% in E-R and 21% in Veneto). Outpatient care was observed more frequently than drug prescriptions (18% vs. 12% in E-R and 15% vs. 10% in Veneto). Risk factors associated with the outcome were female sex, age greater than 40 years, baseline risk of hospitalization and death, moderate to severe acute COVID-19, and acute extrapulmonary complications. Conclusion The outcome of interest may be considered as a proxy for long-term effects of COVID-19 needing clinical attention. Our data suggest that this outcome occurs in a substantial percentage of cases, even among a previously healthy population with low or mild severity of acute COVID-19. The study results provide useful insights into planning COVID-19-related services.
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Affiliation(s)
- Carlo Gagliotti
- Department of Innovation in Healthcare and Social Services, Emilia-Romagna Region, Bologna, Italy
| | - Federico Banchelli
- Department of Innovation in Healthcare and Social Services, Emilia-Romagna Region, Bologna, Italy
| | | | - Rossella Buttazzi
- Department of Innovation in Healthcare and Social Services, Emilia-Romagna Region, Bologna, Italy
| | | | - Enrico Ricchizzi
- Department of Innovation in Healthcare and Social Services, Emilia-Romagna Region, Bologna, Italy
| | | | | | | | - Michele Tonon
- Directorate of Prevention, Food Safety, and Veterinary Public Health, Venezia, Italy
| | | | - Maurizia Rolli
- Department of Innovation in Healthcare and Social Services, Emilia-Romagna Region, Bologna, Italy
| | - Evelina Tacconelli
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Elena Berti
- Department of Innovation in Healthcare and Social Services, Emilia-Romagna Region, Bologna, Italy
| | - Francesca Russo
- Directorate of Prevention, Food Safety, and Veterinary Public Health, Venezia, Italy
| | - Maria Luisa Moro
- Department of Innovation in Healthcare and Social Services, Emilia-Romagna Region, Bologna, Italy
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Fedeli U, Amidei CB, Casotto V, Schievano E, Zoppini G. Excess diabetes-related deaths: The role of comorbidities through different phases of the COVID-19 pandemic. Nutr Metab Cardiovasc Dis 2023; 33:1709-1715. [PMID: 37407311 PMCID: PMC10228157 DOI: 10.1016/j.numecd.2023.05.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/28/2023] [Accepted: 05/26/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND AND AIMS Diabetes confers an excess risk of death to COVID-19 patients. Causes of death are now available for different phases of the pandemic, encompassing different viral variants and COVID-19 vaccination. The aims of the present study were to update multiple causes of death data on diabetes-related mortality during the pandemic and to estimate the impact of common diabetic comorbidities on excess mortality. METHODS AND RESULTS Diabetes-related deaths in 2020-2021 were compared with the 2018-2019 average; furthermore, age-standardized rates observed during the pandemic were compared with expected figures obtained from the 2008-2019 time series through generalized estimating equation models. Changes in diabetes mortality associated with specific comorbidities were also computed. Excess diabetes-related mortality was +26% in 2020 and +18% in 2021, after the initiation of the vaccination campaign. The presence of diabetes and hypertensive diseases was associated with the highest mortality increase, especially in subjects aged 40-79 years, +41% in 2020 and +30% in 2021. CONCLUSION The increase in diabetes-related deaths exceeded that observed for all-cause mortality, and the risk was higher when diabetes was associated with hypertensive diseases. Notably, the excess mortality decreased in 2021, after the implementation of vaccination against COVID-19.
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Affiliation(s)
- Ugo Fedeli
- Department of Epidemiology, Azienda Zero, Veneto Region, Padua, Italy
| | | | - Veronica Casotto
- Department of Epidemiology, Azienda Zero, Veneto Region, Padua, Italy
| | - Elena Schievano
- Department of Epidemiology, Azienda Zero, Veneto Region, Padua, Italy
| | - Giacomo Zoppini
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy.
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Fedeli U, Barbiellini Amidei C, Avossa F, Schievano E, Kingwell E. Association of multiple-sclerosis-related mortality with COVID-19 and other common infections: a multiple causes of death analysis. Eur J Neurol 2023; 30:2870-2873. [PMID: 37306563 DOI: 10.1111/ene.15912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 05/26/2023] [Accepted: 06/05/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND PURPOSE People with multiple sclerosis (MS) suffer from higher infection-related mortality compared to the general population; however, sparse data are available on the increased risk of death associated with coronavirus disease 2019 (COVID-19) and other common types of infections. METHODS All mortality records and multiple-cause-of-death data in 2010-2021 of residents in the Veneto region (northeastern Italy) were extracted. Mention of specific infections was compared between death certificates reporting MS or not. Odds ratios (OR) with 95% confidence intervals (95% CI) were estimated by conditional logistic regression matching by age, sex and calendar year. The bimonthly averages of MS-related deaths in 2010-2019 were compared with those registered during the pandemic (2020-2021). RESULTS Of 580,015 deaths through 2010-2021, MS was mentioned in 850 cases (0.15%), 59.3% women. Influenza and pneumonia were reported in 18.4% of MS-related compared to 11.0% non-MS-related deaths (OR 2.72, 95% CI 2.28-3.25). The odds of mention of urinary tract infections was significantly greater in MS-related deaths of men (OR 8.16, 95% CI 5.23-12.7) than women (OR 3.03, 95% CI 1.82-5.02). Aspiration pneumonia, pressure ulcers/skin infections and sepsis were also significantly associated with MS-related deaths. Reporting of COVID-19 as a cause of death did not significantly differ between deaths with and without mention of MS (approximately 11% of both). However, compared to 2010-2019, peaks in MS-related deaths were observed during the pandemic waves. CONCLUSIONS Infections continue to play a significant role in MS-related deaths, underlying the need to improve prevention and management strategies.
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Affiliation(s)
- Ugo Fedeli
- Epidemiological Department, Azienda Zero, Veneto Region, Italy
| | | | | | - Elena Schievano
- Epidemiological Department, Azienda Zero, Veneto Region, Italy
| | - Elaine Kingwell
- Research Department of Primary Care and Population Health, University College London, London, UK
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Barbiellini Amidei C, Fedeli U, Gennaro N, Cestari L, Schievano E, Zorzi M, Girardi P, Casotto V. Estimating Overall and Cause-Specific Excess Mortality during the COVID-19 Pandemic: Methodological Approaches Compared. Int J Environ Res Public Health 2023; 20:5941. [PMID: 37297545 PMCID: PMC10252246 DOI: 10.3390/ijerph20115941] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/14/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023]
Abstract
During the COVID-19 pandemic, excess mortality has been reported worldwide, but its magnitude has varied depending on methodological differences that hinder between-study comparability. Our aim was to estimate variability attributable to different methods, focusing on specific causes of death with different pre-pandemic trends. Monthly mortality figures observed in 2020 in the Veneto Region (Italy) were compared with those forecasted using: (1) 2018-2019 monthly average number of deaths; (2) 2015-2019 monthly average age-standardized mortality rates; (3) Seasonal Autoregressive Integrated Moving Average (SARIMA) models; (4) Generalized Estimating Equations (GEE) models. We analyzed deaths due to all-causes, circulatory diseases, cancer, and neurologic/mental disorders. Excess all-cause mortality estimates in 2020 across the four approaches were: +17.2% (2018-2019 average number of deaths), +9.5% (five-year average age-standardized rates), +15.2% (SARIMA), and +15.7% (GEE). For circulatory diseases (strong pre-pandemic decreasing trend), estimates were +7.1%, -4.4%, +8.4%, and +7.2%, respectively. Cancer mortality showed no relevant variations (ranging from -1.6% to -0.1%), except for the simple comparison of age-standardized mortality rates (-5.5%). The neurologic/mental disorders (with a pre-pandemic growing trend) estimated excess corresponded to +4.0%/+5.1% based on the first two approaches, while no major change could be detected based on the SARIMA and GEE models (-1.3%/+0.3%). The magnitude of excess mortality varied largely based on the methods applied to forecast mortality figures. The comparison with average age-standardized mortality rates in the previous five years diverged from the other approaches due to the lack of control over pre-existing trends. Differences across other methods were more limited, with GEE models probably representing the most versatile option.
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Affiliation(s)
| | - Ugo Fedeli
- Epidemiological Department, Azienda Zero, Veneto Region, 35131 Padova, Italy
| | - Nicola Gennaro
- Epidemiological Department, Azienda Zero, Veneto Region, 35131 Padova, Italy
| | - Laura Cestari
- Epidemiological Department, Azienda Zero, Veneto Region, 35131 Padova, Italy
| | - Elena Schievano
- Epidemiological Department, Azienda Zero, Veneto Region, 35131 Padova, Italy
| | - Manuel Zorzi
- Epidemiological Department, Azienda Zero, Veneto Region, 35131 Padova, Italy
| | - Paolo Girardi
- Department of Environmental Sciences, Informatics and Statistics, Ca’ Foscari University of Venice, 30172 Venice, Italy
| | - Veronica Casotto
- Epidemiological Department, Azienda Zero, Veneto Region, 35131 Padova, Italy
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Voci D, Fedeli U, Valerio L, Schievano E, Righini M, Kucher N, Spirk D, Barco S. Mortality rate related to peripheral arterial disease: A retrospective analysis of epidemiological data (years 2008-2019). Nutr Metab Cardiovasc Dis 2023; 33:516-522. [PMID: 36642604 DOI: 10.1016/j.numecd.2022.11.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 09/16/2022] [Accepted: 11/21/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Peripheral arterial disease (PAD) is one of the most prevalent cardiovascular diseases with more than 230 million people being affected worldwide. As highlighted by the recent European Society of Cardiology guidelines, data on the epidemiology of PAD is urgently needed. METHODS AND RESULTS We accessed the vital registration data of the Veneto region (Northern Italy, approximately five millions inhabitants) covering the period 2008-2019. We computed annual age-standardized rates for PAD reported as the underlying cause of death (UCOD) or as one of multiple causes of death (MCOD). Age-adjusted odds ratios (OR) served to study the association between PAD and cardiovascular comorbidities. The age-standardized mortality rate for PAD as MCOD slightly declined from 19.6 to 17.8 in men and from 10.8 to 9.1 deaths per 100,000 population-years in women. The age-standardized PAD-specific mortality rate (UCOD) remained stable: 3.1 to 3.7 per 100,000 person-years in women (Average Annual Percent Change 1.3, 95% CI -0.8; 3.4%) and 4.4 to 4.3 per 100,000 person-years (Average Annual Percent Change -0.2, 95% CI -3.6; 3.4%) in men. PAD contributed to 1.6% of all deaths recorded in the region. Ischemic heart disease, diabetes mellitus and neoplasms were the most prevalent UCOD among PAD patients. PAD was associated with diabetes mellitus (OR 3.79, 95%CI 3.55-4.06) and chronic kidney diseases (OR 2.73, 95%CI 2.51-2.97) in men, and with atrial fibrillation (OR 2.26, 95%CI 2.10-2.44) in women. CONCLUSION PAD remains a substantial cause of death in the general population of this high-income region of Western Europe with marked sex-specific differences.
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Affiliation(s)
- Davide Voci
- Department of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Ugo Fedeli
- Epidemiological Department, Azienda Zero, Veneto Region, Padua, Italy
| | - Luca Valerio
- Center for Thrombosis and Hemostasis, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Elena Schievano
- Epidemiological Department, Azienda Zero, Veneto Region, Padua, Italy
| | - Marc Righini
- Division of Angiology and Hemostasis, Department of Medical Specialties, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
| | - Nils Kucher
- Department of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - David Spirk
- Institute of Pharmacology, University of Bern, Bern, Switzerland
| | - Stefano Barco
- Department of Angiology, University Hospital Zurich, Zurich, Switzerland; Center for Thrombosis and Hemostasis, Johannes Gutenberg University Mainz, Mainz, Germany.
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Basso C, Barbiellini Amidei C, Casotto V, Schievano E, Dotto M, Tiozzo Netti S, Zorzi M, Fedeli U. Veneto Region dementia-related mortality during the COVID-19 pandemic: multiple causes of death and time series analysis. Eur J Public Health 2023; 33:190-195. [PMID: 36847686 PMCID: PMC10066484 DOI: 10.1093/eurpub/ckad005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Older individuals with dementia have been severely affected by the COVID-19 pandemic. There is a lack of in-depth evaluation of mortality trends using both the underlying cause of death (UCOD) and the multiple causes of death (MCOD) approaches. The objective of this study was to determine the impact of the COVID-19 pandemic on dementia-related deaths considering comorbidities and the place of death. METHODS This retrospective, population-based study was conducted in Veneto, Italy. All the death certificates of individuals aged ≥65 years issued from 2008 to 2020 were analyzed for dementia-related mortality using age-standardized sex-stratified rates of dementia as UCOD and MCOD. Excess in monthly dementia-related mortality in 2020 was estimated by applying Seasonal Autoregressive Integrated Moving Average (SARIMA) model. RESULTS Overall, 70 301 death certificates reported dementia (MCOD proportional mortality: 12.9%), and 37 604 cases identified it as UCOD (proportional mortality: 6.9%). In 2020, the MCOD proportional mortality increased to 14.3% whereas that of UCOD remained static (7.0%). Compared to the SARIMA prediction, MCOD increased by 15.5% in males and 18.3% in females in 2020. Compared to the 2018-19 average, deaths in nursing homes increased by 32% in 2020, at home by 26% and in hospitals by 12%. CONCLUSIONS An increase in dementia-related mortality during the first months of the COVID-19 pandemic could only be detected using the MCOD approach. MCOD proved to be more robust, and hence, should be included in future analyses. Nursing homes appeared to be the most critical setting which should guide establishing protective measures for similar situations.
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Affiliation(s)
- Cristina Basso
- Correspondence: C. Basso, Epidemiological Department, Azienda Zero, Veneto Region, Via Jacopo Avanzo 35, 35132 Padova, Italy, Tel: +39 049 8778330, e-mail:
| | | | | | | | - Matilde Dotto
- Epidemiological Department, Azienda Zero, Padova, Italy
| | | | - Manuel Zorzi
- Epidemiological Department, Azienda Zero, Padova, Italy
| | - Ugo Fedeli
- Epidemiological Department, Azienda Zero, Padova, Italy
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Fedeli U, Casotto V, Schievano E, Bonora E, Zoppini G. Diabetes as a cause of death across different COVID-19 epidemic waves. Diabetes Res Clin Pract 2022; 190:109984. [PMID: 35803315 PMCID: PMC9258691 DOI: 10.1016/j.diabres.2022.109984] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 06/29/2022] [Accepted: 07/03/2022] [Indexed: 11/25/2022]
Abstract
AIMS The aim of this study is to assess the role of diabetes as a cause of death through different epidemic waves of COVID-19. METHODS The annual percentage change in age-standardized rates (APC) was estimated for diabetes as the underlying (UCOD) and as multiple causes of death (MCOD) in 2008-2019. Diabetes-related deaths in 2020 were compared to the 2018-2019 average. SARIMA models were applied to monthly excess in mortality considering seasonality and long-term trends. RESULTS 2018-2019-Age-standardized mortality rates decreased, especially among females (MCOD: APC -2.49, 95%CI -3.01/-1.97%). In 2020, deaths increased by 19% (95%CI 13-25%) for UCOD, and by 27% (95%CI 24-30%) for MCOD. Diabetes and COVID-19 accounted for 74% of such excess. During the first epidemic wave, the increase in observed rates vs predicted by the model was larger in males (March +39%, April +46%) than in females (+30% and +32%). In the second wave, a huge excess of similar magnitude was observed in the two sexes; rates in December exceeded those predicted by more than 100%. CONCLUSIONS The COVID-19 pandemic abruptly interrupted a long-term declining trend in mortality associated to diabetes. MCOD analyses are warranted to fully estimate the impact of epidemic waves on diabetes-related mortality.
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Affiliation(s)
- Ugo Fedeli
- Epidemiological Department, Azienda Zero, Veneto Region, Italy
| | | | - Elena Schievano
- Epidemiological Department, Azienda Zero, Veneto Region, Italy
| | - Enzo Bonora
- Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy
| | - Giacomo Zoppini
- Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy.
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Fedeli U, Casotto V, Barbiellini Amidei C, Saia M, Tiozzo SN, Basso C, Schievano E. Parkinson's disease related mortality: Long-term trends and impact of COVID-19 pandemic waves. Parkinsonism Relat Disord 2022; 98:75-77. [PMID: 35490543 PMCID: PMC9040425 DOI: 10.1016/j.parkreldis.2022.04.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/01/2022] [Accepted: 04/19/2022] [Indexed: 11/22/2022]
Abstract
Introduction Parkinson's disease (PD) mortality burden is increasing worldwide, but accurate estimates on the magnitude of the impact of the COVID-19 pandemic are missing. Mortality rates vary largely when considering PD as underlying cause of death (UCOD), or as one among multiple causes reported in death certificates (MCOD). The aim of this study is to assess COVID-19 impact on PD-related mortality trends using the UCOD and MCOD approach. Methods Mortality records between 01/2008-12/2020 of residents aged ≥45 years in Veneto Region (Northeastern Italy) with any mention of PD were collected. Age-standardized sex-specific mortality rates were estimated for PD-related deaths as UCOD and MCOD to assess time trends. The average annual percentage change in age-standardized rates (AAPC) was estimated by linear regression models. Monthly mortality in 2020, the first year of the pandemic, was plotted against the 2018–2019 average. Results Overall, 13,746 PD-related deaths (2.3% of all deaths) were identified, 52% males, median age 84 years. Proportional mortality increased from 1.9% (2008) to 2.8% (2020). AAPC through 2008–2019 was +5.2% for males and +5.3% for females in analyses of the UCOD, and +1.4% in both genders based on MCOD. Excess in PD-related mortality during 2020 corresponded to 19% for UCOD and 28% for MCOD, with the latter showing two peaks corresponding to the first (28%) and second (59%) pandemic waves. Conclusion Age-standardized PD-related mortality rates have steeply increased during COVID-19 pandemic, amplifying a pre-existing long-term trend. Hence, surveillance of mortality associated to PD is warranted in the forthcoming pandemic and post-pandemic years.
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Affiliation(s)
- Ugo Fedeli
- Epidemiological Department, Azienda Zero, Veneto Region, Italy
| | | | | | - Mario Saia
- Clinical Governance Unit, Azienda Zero, Veneto Region, Italy
| | | | - Cristina Basso
- Epidemiological Department, Azienda Zero, Veneto Region, Italy
| | - Elena Schievano
- Epidemiological Department, Azienda Zero, Veneto Region, Italy.
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Basso C, Gennaro N, Dotto M, Ferroni E, Noale M, Avossa F, Schievano E, Aceto P, Tommasino C, Crucitti A, Incalzi RA, Volpato S, Petrini F, Carron M, Pace MC, Bettelli G, Chiumiento F, Corcione A, Montorsi M, Trabucchi M, Maggi S, Corti MC. Congestive heart failure and comorbidity as determinants of colorectal cancer perioperative outcomes. Updates Surg 2022; 74:609-617. [PMID: 34115323 PMCID: PMC8995267 DOI: 10.1007/s13304-021-01086-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/10/2021] [Indexed: 12/03/2022]
Abstract
There has been an increase in surgical interventions in frailer elderly with concomitant chronic diseases. The purpose of this paper was to evaluate the impact of aging and comorbidities on outcomes in patients who underwent surgery for the treatment of colorectal cancer (CRC) in Veneto Region (Northeastern Italy). This is a retrospective cohort study in patients ≥ 40 years who underwent elective or urgent CRC surgical resection between January 2013 and December 2015. Independent variables included: age, sex, and comorbidities. We analyzed variables associated with the surgical procedure, such as stoma creation, hospitalization during the year before the index surgery, the surgical approach used, the American Society of Anesthesiologists (ASA) score, and the Charlson Comorbidity Index score. Eight thousand four hundred and forty-seven patients with CRC underwent surgical resection. Patient age affected both pre- and post-resection LOS as well as the overall survival (OS); however, it did not affect the 30-day readmission and reoperation rates. Multivariate analysis showed that age represented a risk factor for longer preoperative and postoperative LOS as well as for 30-day and 365-day mortality, but it was not associated with an increased risk of 30-day reoperation and 30-day readmission. Chronic Heart Failure increased the 30-day mortality risk by four times, the preoperative LOS by 51%, and the postoperative LOS by 33%. Chronic renal failure was associated with a 74% higher 30-day readmission rate. Advanced age and comorbidities require a careful preoperative evaluation and appropriate perioperative management to improve surgical outcomes in older patients undergoing elective or urgent CRC resection.
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Affiliation(s)
- Cristina Basso
- Epidemiological Department (SER), Azienda Zero, Via Jacopo Avanzo 35, Veneto Region, 35132, Padua, Italy.
| | - Nicola Gennaro
- Epidemiological Department (SER), Azienda Zero, Via Jacopo Avanzo 35, Veneto Region, 35132, Padua, Italy
| | - Matilde Dotto
- Epidemiological Department (SER), Azienda Zero, Via Jacopo Avanzo 35, Veneto Region, 35132, Padua, Italy
| | - Eliana Ferroni
- Epidemiological Department (SER), Azienda Zero, Via Jacopo Avanzo 35, Veneto Region, 35132, Padua, Italy
| | - Marianna Noale
- National Research Council (CNR), Neuroscience Institute, Aging Branch, Padua, Italy
- Consorzio di Ricerca "Luigi Amaducci", Padua, Italy
| | - Francesco Avossa
- Epidemiological Department (SER), Azienda Zero, Via Jacopo Avanzo 35, Veneto Region, 35132, Padua, Italy
| | - Elena Schievano
- Epidemiological Department (SER), Azienda Zero, Via Jacopo Avanzo 35, Veneto Region, 35132, Padua, Italy
| | - Paola Aceto
- SIAARTI, Italian Society of Anaesthesia, Analgesia, Resuscitation and Intensive Care, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Concezione Tommasino
- SIAARTI, Italian Society of Anaesthesia, Analgesia, Resuscitation and Intensive Care, Rome, Italy
- Department of Biomedical, Surgical and Odontoiatric Sciences, University of Milano, Anaesthesia and Intensive Care, Polo Universitario Ospedale San Paolo, Milan, Italy
| | - Antonio Crucitti
- SICG, Società Italiana di Chirurgia Geriatrica, Naples, Italy
- Cristo Re Hospital, Catholic University Rome, Rome, Italy
| | - Raffaele Antonelli Incalzi
- SIGG, Società Italiana di Geriatria e Gerontologia, Florence, Italy
- AIP, Società Italiana di Psicogeriatria, Brescia, Italy
- Cattedra di Medicina Interna e Geriatria, Università Campus Bio-Medico, Rome, Italy
| | - Stefano Volpato
- SIGG, Società Italiana di Geriatria e Gerontologia, Florence, Italy
- AIP, Società Italiana di Psicogeriatria, Brescia, Italy
- Dipartimento di Scienze Mediche, Università di Ferrara, Ferrara, Italy
| | - Flavia Petrini
- SIAARTI, Italian Society of Anaesthesia, Analgesia, Resuscitation and Intensive Care, Rome, Italy
- Perioperative Medicine, Pain Therapy, ICU and Emergency Department, Chieti-Pescara University, Pescara, Italy
| | - Michele Carron
- SIAARTI, Italian Society of Anaesthesia, Analgesia, Resuscitation and Intensive Care, Rome, Italy
- Department of Medicine, DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Padua, Italy
| | - Maria Caterina Pace
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontostomatologiche, Università di Milano, Milan, Italy
| | - Gabriella Bettelli
- SIAARTI, Italian Society of Anaesthesia, Analgesia, Resuscitation and Intensive Care, Rome, Italy
- University of San Marino, San Marino, San Marino
- Department of Anaestesia, Intensive Care, Day Surgery and Pain Therapy and Geriatric Surgery Area, IRCCS INRCA, Italian National Research Centres on Aging, Ancona, Italy
| | - Fernando Chiumiento
- SIAARTI, Italian Society of Anaesthesia, Analgesia, Resuscitation and Intensive Care, Rome, Italy
- Dipartimento Area Critica, ASL Salerno, Salerno, Italy
| | - Antonio Corcione
- Dipartimento di Area Critica UOC Anestesia e TIPO, AORN dei Colli-Monaldi, Naples, Italy
| | - Marco Montorsi
- SIC, Società Italiana di Chirurgia, Rome, Italy
- Humanitas University and Research Hospital IRCCS, Milan, Italy
| | | | - Stefania Maggi
- National Research Council (CNR), Neuroscience Institute, Aging Branch, Padua, Italy
- Consorzio di Ricerca "Luigi Amaducci", Padua, Italy
| | - Maria Chiara Corti
- Epidemiological Department (SER), Azienda Zero, Via Jacopo Avanzo 35, Veneto Region, 35132, Padua, Italy
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11
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Voci D, Fedeli U, Farmakis IT, Hobohm L, Keller K, Valerio L, Schievano E, Barbiellini Amidei C, Konstantinides SV, Kucher N, Barco S. Deaths related to pulmonary embolism and cardiovascular events before and during the 2020 COVID-19 pandemic: An epidemiological analysis of data from an Italian high-risk area. Thromb Res 2022; 212:44-50. [PMID: 35219931 PMCID: PMC8858636 DOI: 10.1016/j.thromres.2022.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Pulmonary embolism is a known complication of coronavirus disease 2019 (COVID-19). Epidemiological population data focusing on pulmonary embolism-related mortality is limited. METHODS Veneto is a region in Northern Italy counting 4,879,133 inhabitants in 2020. All ICD-10 codes from death certificates (1st January 2018 to 31st December 2020) were examined. Comparisons were made between 2020 (COVID-19 outbreak) and the average of the two-year period 2018-2019. All-cause, COVID-19-related and the following cardiovascular deaths have been studied: pulmonary embolism, hypertensive disease, ischemic heart disease, atrial fibrillation/flutter, and cerebrovascular diseases. RESULTS In 2020, a total of 56,412 deaths were recorded, corresponding to a 16% (n = 7806) increase compared to the period 2018-2019. The relative percentage increase during the so-called first and second waves was 19% and 44%, respectively. Of 7806 excess deaths, COVID-19 codes were reported in 90% of death certificates. The percentage increase in pulmonary embolism-related deaths was 27% (95%CI 19-35%), 1018 deaths during the year 2020, compared to 804 mean annual deaths in the period 2018-2019. This was more evident among men, who experience an absolute increase of 147 deaths (+45%), than in women (+67 deaths; +14%). The increase was primarily driven by deaths recorded during the second wave (+91% in October-December). An excess of deaths, particularly among men and during the second wave, was also observed for other cardiovascular diseases, notably hypertensive disease, atrial fibrillation, cerebrovascular disease, and ischemic heart disease. CONCLUSIONS We observed a considerable increase of all-cause mortality during the year 2020. This was mainly driven by COVID-19 and its complications. The relative increase in the number of pulmonary embolism-related deaths was more prominent during the second wave, suggesting a possible underdiagnosis during the first wave.
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Affiliation(s)
- Davide Voci
- Department of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Ugo Fedeli
- Epidemiological Department, Azienda Zero, Veneto Region, Padua, Italy
| | - Ioannis T. Farmakis
- Center for Thrombosis and Hemostasis, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Lukas Hobohm
- Center for Thrombosis and Hemostasis, Johannes Gutenberg University Mainz, Mainz, Germany,Department of Cardiology, Cardiology I, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Karsten Keller
- Center for Thrombosis and Hemostasis, Johannes Gutenberg University Mainz, Mainz, Germany,Department of Cardiology, Cardiology I, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Luca Valerio
- Center for Thrombosis and Hemostasis, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Elena Schievano
- Epidemiological Department, Azienda Zero, Veneto Region, Padua, Italy
| | - Claudio Barbiellini Amidei
- Department of Cardiologic, Vascular and Thoracic Sciences and Public Health, University of Padova, Padova, Italy
| | - Stavros V. Konstantinides
- Center for Thrombosis and Hemostasis, Johannes Gutenberg University Mainz, Mainz, Germany,Department of Cardiology, Democritus University of Thrace, Greece
| | - Nils Kucher
- Department of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Stefano Barco
- Department of Angiology, University Hospital Zurich, Zurich, Switzerland,Center for Thrombosis and Hemostasis, Johannes Gutenberg University Mainz, Mainz, Germany,Corresponding author at: Department of Angiology, University Hospital Zurich, Raemistrasse 100, RAE C 19, 8091 Zurich, Switzerland
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12
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Abstract
PURPOSE Diabetes is a growing health problem. The aim of this study was to capture time trends in mortality associated with diabetes. METHODS The mortality database of the Veneto region (Italy) includes both the underlying causes of death, and all the diseases mentioned in the death certificate. The annual percent change (APC) in age-standardized rates from 2008 to 2017 was computed by the Joinpoint Regression Program. RESULTS Overall 453,972 deaths (56,074 with mention of diabetes) were observed among subjects aged ≥ 40 years. Mortality rates declined for diabetes as the underlying cause of death and from diabetes-related circulatory diseases. The latter declined especially in females - 4.4 (CI 95% - 5.3/- 3.4), while in males the APC was - 2.8 (CI 95% - 4.0/- 1.6). CONCLUSION We observed a significant reduction in mortality during the period 2008-2017 in diabetes either as underlying cause of death or when all mentions of diabetes in the death certificate were considered.
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Affiliation(s)
- U Fedeli
- Epidemiological Department, Azienda Zero, Veneto Region, Italy
| | - E Schievano
- Epidemiological Department, Azienda Zero, Veneto Region, Italy
| | - S Masotto
- Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Hospital Trust of Verona, Università di Verona, Piazzale Stefani, 1, 37126, Verona, Italy
| | - E Bonora
- Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Hospital Trust of Verona, Università di Verona, Piazzale Stefani, 1, 37126, Verona, Italy
| | - G Zoppini
- Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Hospital Trust of Verona, Università di Verona, Piazzale Stefani, 1, 37126, Verona, Italy.
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13
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Turatti G, Fedeli U, Valerio L, Klok FA, Cohen AT, Hunt BJ, Simioni P, Middeldorp S, Ageno W, Kucher N, Konstantinides SV, Schievano E, Barco S. Splanchnic vein thrombosis-related mortality in the Veneto region (Italy), 2008-2019: Retrospective analysis of epidemiological data. Thromb Res 2021; 209:41-46. [PMID: 34856495 DOI: 10.1016/j.thromres.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/31/2021] [Accepted: 11/11/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Splanchnic vein thrombosis (SVT) is an uncommon manifestation of venous thromboembolism. Epidemiological data on SVT-related mortality rate is not available to date. METHODS We investigated time trends in SVT-related mortality rate, 2008-2019, in Veneto, an Italian high-income region of approximatively 5,000,000 inhabitants. SVT-related deaths were identified by the following ICD-10 codes: I81 (portal vein thrombosis), K75.1 (phlebitis of portal vein), K76.3 (liver infarction), K76.5 (hepatic veno-occlusive disease) or I82.0 (Budd-Chiari syndrome). RESULTS During the study period, a total of 557,932 deaths were recorded. SVT was reported in 823 cases; 776 (94%) consisted of portal vein thrombosis. The age-standardized SVT-related mortality rate varied from 1.47 (year 2008) to 1.52 (year 2019) per 100,000 person-years. An increase in the cause-specific annual mortality rate was observed in women (0.56 in 2008 to 1.04 per 100,000 person-years in 2019; average annual percent change +5.7%, 95%CI +3.1; +8.3%). In men, the cause-specific mortality rate moved from 2.53 in 2008 to 2.03 per 100,000 person-years in 2019 (average annual percent change -1.2%, 95%CI -4.0; +1.6%). After conditioning for age and sex, the odds of having a concomitant liver disease were higher for SVT-related deaths (OR 31.6; 95%CI 17.1-37.0) compared with non-SVT-related deaths. This also applies to gastrointestinal cancers (OR 1.28; 95%CI 1.07-1.55), although to a lesser extent. CONCLUSIONS We report first epidemiological estimates of SVT-related mortality in a Western country. These values will serve as a reference to weight novel potential factors associated with SVT-related death and interpret them from an epidemiological perspective.
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Affiliation(s)
- Giacomo Turatti
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany; General Internal Medicine and Thrombotic and Haemorrhagic Diseases Unit, Department of Medicine, University of Padua Medical School, Padua, Italy
| | - Ugo Fedeli
- Epidemiological Department, Azienda Zero, Padova, Veneto Region, Italy
| | - Luca Valerio
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
| | - Frederikus A Klok
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany; Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - Alexander T Cohen
- Department of Haematology, Thrombosis & Haemophilia Centre, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, United Kingdom
| | - Beverley J Hunt
- Thrombosis & Haemophilia Centre, Guys & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Paolo Simioni
- General Internal Medicine and Thrombotic and Haemorrhagic Diseases Unit, Department of Medicine, University of Padua Medical School, Padua, Italy
| | - Saskia Middeldorp
- Department of Internal Medicine & Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Walter Ageno
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Nils Kucher
- Department of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Stavros V Konstantinides
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany; Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Elena Schievano
- Epidemiological Department, Azienda Zero, Padova, Veneto Region, Italy
| | - Stefano Barco
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany; Department of Angiology, University Hospital Zurich, Zurich, Switzerland.
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14
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Bonora E, Fedeli U, Schievano E, Trombetta M, Saia M, Scroccaro G, Tacconelli E, Zoppini G. SARS-CoV-2 and COVID-19 in diabetes mellitus. Population-based study on ascertained infections, hospital admissions and mortality in an Italian region with ∼5 million inhabitants and ∼250,000 diabetic people. Nutr Metab Cardiovasc Dis 2021; 31:2612-2618. [PMID: 34348880 PMCID: PMC8239199 DOI: 10.1016/j.numecd.2021.06.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Diabetes conveys an increased risk of infectious diseases and related mortality. We investigated risk of ascertained SARS-CoV-2 infection in diabetes subjects from the Veneto Region, Northeastern Italy, as well as the risk of being admitted to hospital or intensive care unit (ICU), or mortality for COVID-19. METHODS AND RESULTS Diabetic subjects were identified by linkage of multiple health archives. The rest of the population served as reference. Information on ascertained infection by SARS-CoV-2, admission to hospital, admission to ICU and mortality in the period from February 21 to July 31, 2020 were retrieved from the regional registry of COVID-19. Subjects with ascertained diabetes were 269,830 (55.2% men; median age 72 years). Reference subjects were 4,681,239 (men 48.6%, median age 46 years). Ratios of age- and gender-standardized rates (RR) [95% CI] for ascertained infection, admission to hospital, admission to ICU and disease-related death in diabetic subjects were 1.31 [1.19-1.45], 2.11 [1.83-2.44], 2.45 [1.96-3.07], 1.87 [1.68-2.09], all p < 0.001. The highest RR of ascertained infection was observed in diabetic men aged 20-39 years: 1.90 [1.04-3.21]. The highest RR of ICU admission and death were observed in diabetic men aged 40-59 years: 3.47 [2.00-5.70] and 5.54 [2.23-12.1], respectively. CONCLUSIONS These data, observed in a large population of ∼5 million people of whom ∼250,000 with diabetes, show that diabetes not only conveys a poorer outcome in COVID-19 but also confers an increased risk of ascertained infection from SARS-CoV-2. Men of young or mature age have the highest relative risks.
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Affiliation(s)
- Enzo Bonora
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy.
| | - Ugo Fedeli
- Department of Epidemiology, Azienda Zero, Veneto Region, Padua, Italy
| | - Elena Schievano
- Department of Epidemiology, Azienda Zero, Veneto Region, Padua, Italy
| | - Maddalena Trombetta
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy
| | - Mario Saia
- Azienda Zero, Veneto Region, Padua, Italy
| | | | - Evelina Tacconelli
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Verona, Italy
| | - Giacomo Zoppini
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy
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15
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Valerio L, Fedeli U, Schievano E, Avossa F, Barco S. Decline in Overall Pulmonary Embolism-Related Mortality and Increasing Prevalence of Cancer-Associated Events in the Veneto Region (Italy), 2008-2019. Thromb Haemost 2021; 122:789-795. [PMID: 34255341 DOI: 10.1055/a-1548-4948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Despite evidence of ongoing epidemiological changes in deaths from venous thromboembolism in high-income countries, little recent information is available on the time trends in mortality related to pulmonary embolism (PE) as underlying or concomitant cause of death in Europe. METHODS We accessed the regional database of death certificates of Veneto Region (Northern Italy, population 4,900,000) from 2008 to 2019. We analyzed the trends in crude and age-adjusted annual rates of mortality related to PE (reported either as underlying cause or in any position in the death certificate) using Joinpoint regression; in the contribution of PE to mortality (proportionate mortality); and, using logistic regression, in the association between PE and cancer at death. RESULTS Between 2008 and 2019, the annual age-standardized mortality rate related to PE in Veneto decreased from 20.7 to 12.6 deaths per 100,000 population for PE in any position of the death certificate, and from 4.6 to 2.2 deaths per 100,000 population for PE as underlying cause of death. PE-related proportionate mortality remained up to twice as high in women. The age- and sex-adjusted odds ratio for cancer in deaths with versus without PE constantly increased from 1.01 (95% confidence interval [CI]: 0.88-1.16) in 2008 to 1.58 (95% CI: 1.35-1.83) in 2019. CONCLUSION The descending trends in PE-related mortality reported for Europe up to 2015 for both sexes continued thereafter in this high-income region of Northern Italy. However, sex differences in proportionate mortality persist. The increasing strength in the association between cancer and PE may indicate a change in risk factor distribution, calling for tailored management practices in this patient group.
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Affiliation(s)
- Luca Valerio
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
| | - Ugo Fedeli
- Epidemiological Department, Azienda Zero, Veneto Region, Padua, Italy
| | - Elena Schievano
- Epidemiological Department, Azienda Zero, Veneto Region, Padua, Italy
| | - Francesco Avossa
- Epidemiological Department, Azienda Zero, Veneto Region, Padua, Italy
| | - Stefano Barco
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany.,Clinic of Angiology, University Hospital Zurich, Zurich, Zurich, Switzerland
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16
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Fedeli U, Schievano E, Avossa F, Pitter G, Barbiellini Amidei C, Grande E, Grippo F. Different approaches to the analysis of causes of death during the COVID-19 epidemic. Eur Rev Med Pharmacol Sci 2021; 25:3610-3613. [PMID: 34002836 DOI: 10.26355/eurrev_202105_25844] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The aim of the study is to assess the impact of the COVID-19 pandemic on causes of mortality through multiple methodological approaches. MATERIALS AND METHODS The causes of mortality in the Veneto region (Italy) during the first epidemic wave, March-April 2020, were compared with the corresponding months of the previous two years. Both the underlying cause of death (UCOD), and all diseases reported in the death certificate (multiple causes of death) were investigated; a further analysis was carried out through a simulation where the UCOD was selected after substituting ICD-10 codes for COVID with unspecified pneumonia. RESULTS Overall 10,222 deaths were registered in March-April 2020, corresponding to a 24% increase compared to the previous two years. COVID-19 was mentioned in 1,444 certificates, and selected as the UCOD in 1,207 deaths. Based on the UCOD, the increases in mortality were observed for COVID and related respiratory conditions, diabetes mellitus, hypertensive heart diseases, cerebrovascular diseases, and ill-defined causes. Multiple causes of death and the simulation analysis demonstrated further increases in mortality related to dementia/Alzheimer and chronic lower respiratory diseases. CONCLUSIONS This first report demonstrates an increase of several causes of death during the pandemic, underlying the need of a continuous surveillance of mortality records through different analytic strategies.
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Affiliation(s)
- U Fedeli
- Epidemiological Department, Azienda Zero, Veneto Region, Italy.
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17
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Girardi P, Schievano E, Fedeli U, Braggion M, Nuti M, Amaddeo F. Causes of mortality in a large population-based cohort of psychiatric patients in Southern Europe. J Psychiatr Res 2021; 136:167-172. [PMID: 33601168 DOI: 10.1016/j.jpsychires.2021.01.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/26/2021] [Accepted: 01/29/2021] [Indexed: 12/25/2022]
Abstract
The World Health Organization considers excess morbidity and mortality among people with mental disorders as a high public health priority. This study aims to estimate the mortality risk and causes of death among a large population-based cohort of psychiatric patients. All residents in Veneto (Northeastern Italy) aged between 18 and 84 years with a contact with Community Mental Health Centers in 2008 and a psychiatric diagnosis (n = 54,350) were followed-up for 10 years. Standardized Mortality Ratios (SMR) and excess mortality were computed, with the general regional population as a reference. Mortality was more than doubled (males SMR = 2.4; females SMR = 2.2) and the relative increase in mortality was much larger in young and middle-aged adults (18-44 and 45-64 years) across all diagnostic groups. The most frequent causes were circulatory diseases (27%) and neoplasms (26%). Although the risk was increased by about tenfold, deaths from suicide were limited to 6% and 4% of all decedents in males and females, respectively. Patients with schizophrenia showed a very high risk for mortality for diabetes and cardiovascular disorders. A large excess was found also for respiratory diseases and a two-fold increase for lung cancer in males and breast cancer in females. Although chronic physical disorders are known to be the main causes of mortality in such patients, they receive far less attention than suicide or accidents. Our results suggest that there is still a need to plan actions to prevent excess mortality and to improve the quality of life of patients with mental disorders.
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Affiliation(s)
- Paolo Girardi
- Department of Developmental Psychology and Socialization, University of Padua, Via Venezia 8, 35131, Padua, Italy.
| | - Elena Schievano
- Epidemiological Department, Azienda Zero, Veneto Region, Via Jacopo d'Avanzo 35, 35132, Padua, Italy.
| | - Ugo Fedeli
- Epidemiological Department, Azienda Zero, Veneto Region, Via Jacopo d'Avanzo 35, 35132, Padua, Italy.
| | - Marco Braggion
- Epidemiological Department, Azienda Zero, Veneto Region, Via Jacopo d'Avanzo 35, 35132, Padua, Italy.
| | - Marco Nuti
- Mental Health and Penitentiary Health Care Unit, Veneto Region, Rio Novo, Dorsoduro 3493, 30123, Venice, Italy.
| | - Francesco Amaddeo
- Department of Neurosciences, Biomedicine and Movement, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy.
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18
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Fedeli U, Porreca A, Colicchia M, Schievano E, Artibani W, Biasio LR, Palù G. Intravescical instillation of Calmette-Guérin bacillus and COVID-19 risk. Hum Vaccin Immunother 2020; 17:416-417. [PMID: 32880510 DOI: 10.1080/21645515.2020.1805994] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
It has been theorized that Calmette-Guérin bacillus may prevent or reduce the severity of COVID-19 through a nonspecific stimulation of the immune system. A preliminary assessment of SARS-CoV-2 infection rates and outcomes among 2803 individuals affected with high risk non-muscle-invasive bladder cancer and treated with intra-bladder instillation of BCG, showed no evidence of a protective effect. However, the interpretation of these data need some caution, due to the low prevalence of infection (<1%) observed within this population, along with the fact that intra-bladder administration cannot mirror the usual intradermal administration of BCG, in particular in patients partially immunocompromised. Confirmation by larger prospective studies is required.
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Affiliation(s)
- Ugo Fedeli
- Epidemiological Department, Azienda Zero Veneto Region , Padua, Italy
| | - Angelo Porreca
- Department of Urology, Policlinico Abano Terme , Padua, Italy
| | | | - Elena Schievano
- Epidemiological Department, Azienda Zero Veneto Region , Padua, Italy
| | - Walter Artibani
- Department of Urology, Policlinico Abano Terme , Padua, Italy
| | | | - Giorgio Palù
- Epidemiological Department, Azienda Zero Veneto Region , Padua, Italy.,Department of Molecular Medicine, University of Padua , Padua, Italy
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19
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Plebani M, Padoan A, Fedeli U, Schievano E, Vecchiato E, Lippi G, Lo Cascio G, Porru S, Palù G. SARS-CoV-2 serosurvey in health care workers of the Veneto Region. Clin Chem Lab Med 2020; 58:2107-2111. [PMID: 32845861 DOI: 10.1515/cclm-2020-1236] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 08/17/2020] [Indexed: 12/12/2022]
Abstract
Objectives The ongoing outbreak of coronavirus disease (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) poses formidable challenges to all health care systems. Serological assays may be used for improving disease management when appropriately applied, for investigating the antibody responses mounted against SARS-CoV-2 infection and for assessing its real prevalence. Although testing the whole population is impractical, well-designed serosurveys in selected subpopulations in specific risk groups may provide valuable information. We evaluated the prevalence of SARS-CoV-2 infection in health care workers (HCW) who underwent molecular testing with reverse transcription real-time polymerase chain reaction (rRT-PCR) in the main hospitals of the Veneto Region of Italy by measuring specific antibodies (Abs). Methods Both immunoglobulin (Ig)M and IgG antibodies against SARS-Cov-2 S-antigen and N-protein were measured using a validated chemiluminescent analytical system (CLIA) called Maglumi™ 2000 Plus (New Industries Biomedical Engineering Co., Ltd [Snibe], Shenzhen, China). Results A total of 8,285 HCW were tested. SARS-CoV-2 specific antibodies (IgM, IgG or both) were detectable in 378 cases (4.6%, 95% CI 4.1-5.0%). Seroconversion was observed in 4.4% of women vs. 5.0% of men, but this difference was not significant. Although detectable antibodies were found in all HCW who developed severe COVID-19 infection (100%), lower seropositivity was found in mild disease (83%) and the lowest prevalence (58%) was observed in asymptomatic subjects. Conclusions Seroprevalence surveys are of utmost importance for understanding the rate of population that has already developed antibodies against SARS-CoV-2. The present study defined precisely the circulation of SARS-CoV-2 in a cohort of HCW in the Veneto Region, with its prevalence (4.6%) reflecting a relatively low circulation. Symptomatic individuals or those hospitalized for medical care were 100% antibody positive, whilst Abs were only detectable in 58% of asymptomatic carriers.
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Affiliation(s)
- Mario Plebani
- Department of Laboratory Medicine, University Hospital of Padova, Padova, Italy.,Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Andrea Padoan
- Department of Laboratory Medicine, University Hospital of Padova, Padova, Italy.,Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Ugo Fedeli
- Epidemiological Department, Azienda Zero, Veneto Region, Padova, Italy
| | - Elena Schievano
- Epidemiological Department, Azienda Zero, Veneto Region, Padova, Italy
| | - Elena Vecchiato
- Department of Information Technology, Azienda Zero, Veneto Region, Padova, Italy
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Giuliana Lo Cascio
- Department of Microbiology and Virology, University of Verona, Verona, Italy
| | - Stefano Porru
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Giorgio Palù
- University of Padova, Azienda Zero, Veneto Region, Padova, Italy
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Fedeli U, Schievano E, Targher G, Bonora E, Corti MC, Zoppini G. Estimating the real burden of cardiovascular mortality in diabetes. Eur Rev Med Pharmacol Sci 2019; 23:6700-6706. [PMID: 31378913 DOI: 10.26355/eurrev_201908_18561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To compare different methods assessing the burden of cardiovascular mortality in diabetes mellitus, which is usually underestimated by standard mortality statistics based on the underlying cause of death. PATIENTS AND METHODS All residents in the Veneto Region (Italy) aged 30-89 years with co-payment exemption for diabetes in January 2010 (n=185,341) were identified and linked with mortality records (2010-2015). The underlying causes of death, as well as all the diseases mentioned in the death certificate (multiple causes), were extracted. The standardized mortality ratios (SMR) were computed with regional rates as a reference. RESULTS After grouping diabetes and circulatory diseases as the underlying cause of death, the mortality rates were highly increased, especially among patients aged 30-54 years: SMR 4.24 (95% confidence interval 3.57-5.00) and 9.84 (7.47-12.72) in males and females, respectively. After re-assignment of the underlying cause in deaths from diabetes, the percentage of overall mortality caused by circulatory diseases increased from 33.8% to 41.7%. Based on multiple causes, the risk of death was increased for several cardiovascular diseases, including causes rarely emerging from standard mortality statistics such as atrial fibrillation/flutter. CONCLUSIONS The re-assignment of the underlying cause and the analyses of the multiple causes of death allowed to estimate the whole burden of mortality associated with cardiovascular diseases.
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Affiliation(s)
- U Fedeli
- Epidemiological Department, Veneto Region, Italy.
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21
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Buja A, Rivera M, Soattin M, Corti MC, Avossa F, Schievano E, Rigon S, Baldo V, Boccuzzo G, Damiani G, Ebell MH. Impactibility Model for Population Health Management in High-Cost Elderly Heart Failure Patients: A Capture Method Using the ACG System. Popul Health Manag 2019; 22:495-502. [PMID: 31013467 DOI: 10.1089/pop.2018.0190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The aim of the present study is to use the ACG (Adjusted Clinical Groups) System to create an impactibility model by identifying homogeneous clinical subgroups of patients with high risk of an adverse health outcome in a population of heart failure patients with complex health care needs (PCHCN). This method will allow policy makers to target and prioritize services for the highest risk PCHCN in the context of limited health care resources, by identifying relatively homogeneous groups of patients with similar comorbidities. Subjects classified in 2012 as PCHCN in a local health unit by the ACG System were linked with hospital discharge records in 2013. The authors applied the Apriori algorithm to identify the most common sets of the most predictive diseases for the following outcomes of interest: at least 1 admission and at least 1 preventable admission in the year. Predictive performance for the former outcome was compared between the impactability model with the available ACG's individual risk score. The Apriori algorithm also was applied to predict the latter outcome as an example of an event that a policy maker would be able to prevent. Evidence showed no statistically significant difference between the 2 methods. The present model also displayed evidence of good calibration. The Apriori algorithm was applied as an impactibility model, built based on the ACG System, that allowed the authors to obtain an "ACG-based group risk score" and use it to identify clinically homogeneous subgroups of PCHCN. This will help policy makers develop "tool kits" for homogeneous groups of patients that improve health outcomes.
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Affiliation(s)
- Alessandra Buja
- Department of Cardiologic, Vascular, Thoracic Sciences and Public Health, University of Padova, Padova, Italy
| | - Michele Rivera
- Department of Cardiologic, Vascular, Thoracic Sciences and Public Health, University of Padova, Padova, Italy
| | - Marta Soattin
- Department of Cardiologic, Vascular, Thoracic Sciences and Public Health, University of Padova, Padova, Italy
| | | | | | | | | | - Vincenzo Baldo
- Department of Cardiologic, Vascular, Thoracic Sciences and Public Health, University of Padova, Padova, Italy
| | - Giovanna Boccuzzo
- Department of Statistical Sciences, University of Padova, Padova, Italy
| | - Gianfranco Damiani
- Fondazione Policlinico Agostino Gemelli IRCSS. Rome, Italy.,Università Cattolica del Sacro Cuore. Rome, Italy
| | - Mark H Ebell
- College of Public Health, University of Georgia, Athens, Georgia
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22
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Tiozzo SN, Basso C, Capodaglio G, Schievano E, Dotto M, Avossa F, Fedeli U, Corti MC. Effectiveness of a community care management program for multimorbid elderly patients with heart failure in the Veneto Region. Aging Clin Exp Res 2019; 31:241-247. [PMID: 30617857 DOI: 10.1007/s40520-018-1102-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 12/13/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND The rapidly growing population of elderly subjects with multimorbidity is at risk of receiving fragmented and uncoordinated care, and have frequent hospitalizations and emergency room (ER) visits. AIMS The study aims to describe the impact of a care management program (CMP) developed in the Veneto region (Northeastern Italy) for patients affected by chronic heart failure (CHF) and multimorbidity. METHODS The CMP was provided to 330 patients > 65 years suffering from CHF and multimorbidity. They were compared to a propensity score matched reference group who received usual care. The intervention was provided by care manager nurses and General Practitioners working in the community. The quality of care from the patients' perspective was assessed by means of the Patient Assessment of Chronic Illness Care (PACIC). The effectiveness of the CMP has been evaluated comparing time changes in hospital admissions in the medical area and ER visits between the intervention and the reference group. RESULTS The median PACIC overall score was 4 out of 5. The intervention group showed a reduction over time by 39% in hospitalization rates and by 33% in ER visits. The recourse to hospital care and ER did not change in the reference group. DISCUSSION The current results indicate that a CMP can reduce Emergency Room visits and hospital admissions for elderly patients with CHF and multimorbidity. CONCLUSIONS The CMP by emphasizing prevention, self-management, continuity and coordination of care, is beneficial among older community-dwelling multimorbid persons as compared to usual care.
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Affiliation(s)
- Silvia Netti Tiozzo
- Epidemiological Service of the Veneto Region, Azienda Zero, 35131, Padua, PD, Italy.
| | - Cristina Basso
- Epidemiological Service of the Veneto Region, Azienda Zero, 35131, Padua, PD, Italy
| | - Giulia Capodaglio
- Epidemiological Service of the Veneto Region, Azienda Zero, 35131, Padua, PD, Italy
| | - Elena Schievano
- Epidemiological Service of the Veneto Region, Azienda Zero, 35131, Padua, PD, Italy
| | - Matilde Dotto
- Epidemiological Service of the Veneto Region, Azienda Zero, 35131, Padua, PD, Italy
| | - Francesco Avossa
- Epidemiological Service of the Veneto Region, Azienda Zero, 35131, Padua, PD, Italy
| | - Ugo Fedeli
- Epidemiological Service of the Veneto Region, Azienda Zero, 35131, Padua, PD, Italy
| | - Maria Chiara Corti
- Epidemiological Service of the Veneto Region, Azienda Zero, 35131, Padua, PD, Italy
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23
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Buja A, Claus M, Perin L, Rivera M, Corti MC, Avossa F, Schievano E, Rigon S, Toffanin R, Baldo V, Boccuzzo G. Multimorbidity patterns in high-need, high-cost elderly patients. PLoS One 2018; 13:e0208875. [PMID: 30557384 PMCID: PMC6296662 DOI: 10.1371/journal.pone.0208875] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 11/27/2018] [Indexed: 11/28/2022] Open
Abstract
Introduction Patients with complex health care needs (PCHCN) are individuals who require numerous, costly care services and have been shown to place a heavy burden on health care resources. It has been argued that an important issue in providing value-based primary care concerns how to identify groups of patients with similar needs (who pose similar challenges) so that care teams and care delivery processes can be tailored to each patient subgroup. Our study aims to describe the most common chronic conditions and their combinations in a cohort of elderly PCHCN. Methods We focused on a cohort of PCHCN residing in an area served by a local public health unit (the “Azienda ULSS4-Veneto”) and belonging to Resource Utilization Bands 4 and 5 according to the ACG System. For each patient we extracted Expanded Diagnosis Clusters, and combined them with information available from Rx-MGs diagnoses. For the present work we focused on 15 diseases/disorders, analyzing their combinations as dyads and triads. Latent class analysis was used to elucidate the patterns of the morbidities considered in the PCHCN. Results Five disease clusters were identified: one concerned metabolic-ischemic heart diseases; one was labelled as neurological and mental disorders; one mainly comprised cardiac diseases such as congestive heart failure and atrial fibrillation; one was largely associated with respiratory conditions; and one involved neoplasms. Conclusions Our study showed specific common associations between certain chronic diseases, shedding light on the patterns of multimorbidity often seen in PCHCN. Studying these patterns in more depth may help to better organize the intervention needed to deal with these patients.
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Affiliation(s)
- Alessandra Buja
- Department of Cardiologic, Vascular, and Thoracic Sciences and Public Health, University of Padova, Padova, Italy
| | - Mirko Claus
- Department of Cardiologic, Vascular, and Thoracic Sciences and Public Health, University of Padova, Padova, Italy
| | - Lucia Perin
- Department of Statistical Sciences, University of Padova, Padova, Italy
| | - Michele Rivera
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
- * E-mail:
| | | | | | | | | | | | - Vincenzo Baldo
- Department of Cardiologic, Vascular, and Thoracic Sciences and Public Health, University of Padova, Padova, Italy
| | - Giovanna Boccuzzo
- Department of Statistical Sciences, University of Padova, Padova, Italy
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Buja A, Rivera M, De Battisti E, Corti MC, Avossa F, Schievano E, Rigon S, Baldo V, Boccuzzo G, Ebell MH. Multimorbidity and Hospital Admissions in High-Need, High-Cost Elderly Patients. J Aging Health 2018; 32:259-268. [PMID: 30522388 DOI: 10.1177/0898264318817091] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: The aim was to clarify which pairs or clusters of diseases predict the hospital-related events and death in a population of patients with complex health care needs (PCHCN). Method: Subjects classified in 2012 as PCHCN in a local health unit by ACG® (Adjusted Clinical Groups) System were linked with hospital discharge records in 2013 to identify those who experienced any of a series of hospital admission events and death. Number of comorbidities, comorbidities dyads, and latent classes were used as exposure variable. Regression analyses were applied to examine the associations between dependent and exposure variables. Results: Besides the fact that larger number of chronic conditions is associated with higher odds of hospital admission or death, we showed that certain dyads and classes of diseases have a particularly strong association with these outcomes. Discussion: Unlike morbidity counts, analyzing morbidity clusters and dyads reveals which combinations of morbidities are associated with the highest hospitalization rates or death.
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25
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De Battisti E, Buja A, Rivera M, Corti MC, Avossa F, Schievano E, Rigon S, Baldo V, Boccuzzo G, Ebell MH. Multimorbidity and health outcomes in high-need, high-cost elderly patients. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky214.241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - A Buja
- University of Padua, Padua, Italy
| | - M Rivera
- University of Padua, Padua, Italy
| | - MC Corti
- Veneto Regional Authority, Venice, Italy
| | - F Avossa
- Veneto Regional Authority, Venice, Italy
| | | | - S Rigon
- Veneto Regional Authority, Venice, Italy
| | - V Baldo
- University of Padua, Padua, Italy
| | | | - MH Ebell
- University of Georgia, Athens, USA
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26
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Corti MC, Avossa F, Schievano E, Gallina P, Ferroni E, Alba N, Dotto M, Basso C, Netti ST, Fedeli U, Mantoan D. A case-mix classification system for explaining healthcare costs using administrative data in Italy. Eur J Intern Med 2018. [PMID: 29514743 DOI: 10.1016/j.ejim.2018.02.035] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND The Italian National Health Service (NHS) provides universal coverage to all citizens, granting primary and hospital care with a copayment system for outpatient and drug services. Financing of Local Health Trusts (LHTs) is based on a capitation system adjusted only for age, gender and area of residence. We applied a risk-adjustment system (Johns Hopkins Adjusted Clinical Groups System, ACG® System) in order to explain health care costs using routinely collected administrative data in the Veneto Region (North-eastern Italy). METHODS All residents in the Veneto Region were included in the study. The ACG system was applied to classify the regional population based on the following information sources for the year 2015: Hospital Discharges, Emergency Room visits, Chronic disease registry for copayment exemptions, ambulatory visits, medications, the Home care database, and drug prescriptions. Simple linear regressions were used to contrast an age-gender model to models incorporating more comprehensive risk measures aimed at predicting health care costs. RESULTS A simple age-gender model explained only 8% of the variance of 2015 total costs. Adding diagnoses-related variables provided a 23% increase, while pharmacy based variables provided an additional 17% increase in explained variance. The adjusted R-squared of the comprehensive model was 6 times that of the simple age-gender model. CONCLUSIONS ACG System provides substantial improvement in predicting health care costs when compared to simple age-gender adjustments. Aging itself is not the main determinant of the increase of health care costs, which is better explained by the accumulation of chronic conditions and the resulting multimorbidity.
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Affiliation(s)
| | | | | | | | - Eliana Ferroni
- Epidemiological System of the Veneto Region, Padua, Italy.
| | | | - Matilde Dotto
- Epidemiological System of the Veneto Region, Padua, Italy
| | - Cristina Basso
- Intermediate Care Unit of The Veneto Region, Venice, Italy
| | | | - Ugo Fedeli
- Epidemiological System of the Veneto Region, Padua, Italy
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27
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Zoppini G, Fedeli U, Schievano E, Dauriz M, Targher G, Bonora E, Corti MC. Mortality from infectious diseases in diabetes. Nutr Metab Cardiovasc Dis 2018; 28:444-450. [PMID: 29519560 DOI: 10.1016/j.numecd.2017.12.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 12/12/2017] [Accepted: 12/18/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIMS To investigate the risk of mortality from infections by comparing the underlying causes of death versus the multiple causes of death in known diabetic subjects living in the Veneto region of Northern Italy. METHODS AND RESULTS A total of 185,341 subjects with diabetes aged 30-89 years were identified in the year 2010, and causes of death were assessed from 2010 to 2015. Standardized Mortality Ratios (SMRs) with 95% confidence intervals (CIs) were computed with regional mortality rates as reference. The underlying causes of death and all the diseases reported in the death certificates were scrutinized. At the end of the follow-up, 36,382 subjects had deceased. We observed an increased risk of death from infection-related causes in subjects with diabetes with a SMR of 1.83 (95% CI, 1.71-1.94). The SMR for death from septicemia was 1.91 (95% CI, 1.76-2.06) and from pneumonia was 1.47 (95% CI, 1.36-1.59). The use of the multiple causes of death approach emphasized the association of infectious diseases with mortality. CONCLUSION The results of the present study demonstrate an excess mortality due to infection-related diseases in patients with diabetes; more interestingly, by routine mortality analyses, the results show a possible underestimation of the effect of these diseases on mortality.
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Affiliation(s)
- G Zoppini
- Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy.
| | - U Fedeli
- Regional Epidemiology Service, Veneto Region, Italy
| | - E Schievano
- Regional Epidemiology Service, Veneto Region, Italy
| | - M Dauriz
- Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy
| | - G Targher
- Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy
| | - E Bonora
- Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy
| | - M C Corti
- Regional Epidemiology Service, Veneto Region, Italy
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Fedeli U, Capodaglio G, Schievano E, Ferroni E, Corti MC. Excess mortality in 2015: a time series and cause-of-death analysis in Northern Italy. Aging Clin Exp Res 2017; 29:1291-1294. [PMID: 28523608 DOI: 10.1007/s40520-017-0773-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 05/10/2017] [Indexed: 11/30/2022]
Abstract
AIMS To investigate the excess mortality registered in the Veneto Region (Northern Italy) in 2015. METHODS A Seasonal Autoregressive Integrated Moving Average Model was applied to predict overall mortality expected in 2014-2015 based on that observed in 2000-2013. The annual percent change in age-standardized rates (APC) was estimated for specific causes of death in 2007-2015. RESULTS Compared to 2014, the number of deaths and the overall age-standardized mortality increased in 2015 by 7.8 and 4.5%, respectively. When accounting for time trends, the observed mortality was lower than expected in 2014 (-4.5%) and slightly higher in 2015 (+1.1%). In 2015, mortality increased especially for causes with an already rising trend: neurologic/psychiatric (APC = 1.2; 95% Confidence Interval 0.3-2.0%) and infectious diseases (APC = 5.9; 3.6-8.2%). CONCLUSIONS Short-term changes and long-term trends in mortality must be interpreted within the frame of a rapid growth in the population of elderly subjects affected by multiple comorbidities.
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Affiliation(s)
- Ugo Fedeli
- SER-Epidemiological Department, Veneto Region, Passaggio Gaudenzio 1, 35131, Padua (PD), Italy.
| | - Giulia Capodaglio
- SER-Epidemiological Department, Veneto Region, Passaggio Gaudenzio 1, 35131, Padua (PD), Italy
| | - Elena Schievano
- SER-Epidemiological Department, Veneto Region, Passaggio Gaudenzio 1, 35131, Padua (PD), Italy
| | - Eliana Ferroni
- SER-Epidemiological Department, Veneto Region, Passaggio Gaudenzio 1, 35131, Padua (PD), Italy
| | - Maria Chiara Corti
- SER-Epidemiological Department, Veneto Region, Passaggio Gaudenzio 1, 35131, Padua (PD), Italy
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Zuccato V, Finotello C, Menegazzo I, Peccolo G, Schievano E. Entomological authentication of stingless bee honey by 1H NMR-based metabolomics approach. Food Control 2017. [DOI: 10.1016/j.foodcont.2017.06.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Pellizzari M, Rolfini M, Ferroni E, Savioli V, Gennaro N, Schievano E, Avossa F, Pinato E, Ghiotto MC, Figoli F, Mantoan D, Brambilla A, Fedeli U, Saugo M. Intensity of integrated cancer palliative care plans and end-of-life acute medical hospitalisation among cancer patient in Northern Italy. Eur J Cancer Care (Engl) 2017; 27. [PMID: 28809459 DOI: 10.1111/ecc.12742] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2017] [Indexed: 11/28/2022]
Abstract
A high hospital utilisation at the end of life (EOL) is an indicator of suboptimal quality of health care. We evaluated the impact of the intensity of different Integrated Cancer Palliative Care (ICPC) plans on EOL acute medical hospitalisation among cancer decedents. Decedents of cancer aged 18-84 years, who were residents in two Italian regions, were investigated through integrated administrative data. Outcomes considered were prolonged hospital stay for medical reasons, 2+ hospitalisations during the last month of life and hospital death. The ICPC plans instituted 90 to 31 days before death represented the main exposure of interest. Other variables considered were gender, age class at death, marital status, recent hospitalisation and primary cancer site. Among 6,698 patients included in ICPC plans, 44.3% presented at least one critical outcome indicator; among these, 76.5% died in hospital, 60.3% had a prolonged (12+ days) medical hospitalisation, 19.1% had 2+ hospitalisations at the EOL. These outcomes showed a strong dose-response effect with the intensity of the ICPC plans, which is already evident at levels of moderate intensity. A well-ICPC approach can be very effective-beginning at low levels of intensity of care-in reducing the percentage of patients spending many days or dying in hospital.
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Affiliation(s)
| | - Maria Rolfini
- Health and Social Care, Emilia Romagna Region, Italy
| | - Eliana Ferroni
- Epidemiological Department of the Veneto Region, Padova, Italy
| | | | - Nicola Gennaro
- Epidemiological Department of the Veneto Region, Padova, Italy
| | - Elena Schievano
- Epidemiological Department of the Veneto Region, Padova, Italy
| | | | | | | | | | | | | | - Ugo Fedeli
- Epidemiological Department of the Veneto Region, Padova, Italy
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31
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Finotello C, Forzato C, Gasparini A, Mammi S, Navarini L, Schievano E. NMR quantification of 16-O-methylcafestol and kahweol in Coffea canephora var. robusta beans from different geographical origins. Food Control 2017. [DOI: 10.1016/j.foodcont.2016.12.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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32
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Fedeli U, Schievano E. Increase in Parkinson's disease-related mortality among males in Northern Italy. Parkinsonism Relat Disord 2017; 40:47-50. [PMID: 28416129 DOI: 10.1016/j.parkreldis.2017.04.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 03/20/2017] [Accepted: 04/09/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND According to standard mortality statistics based on the underlying cause of death (UCOD), mortality from Parkinson's disease (PD) is increasing in most European countries. However, mortality trends are better investigated taking into account all the diseases reported in the death certificate (multiple causes of death approach, MCOD). METHODS All deaths of residents in the Veneto Region (Northern Italy) aged≥45 years with any mention of PD were extracted from 2008 to 2015. The Annual Percent Change (APC) in age-standardized mortality rates was computed both for PD as the UCOD, and by MCOD. The association with common chronic comorbidities and acute complications was investigated by log-binomial regression. The frequency of the mention of PD in death certificates was investigated through linkage with an archive of patients with a previous clinical diagnosis of the disease. RESULTS PD was reported in 2.1% of all deaths, rising from 1.9% in 2008 to 2.4% in 2015. Among males, age-standardized rates increased over time both in analyses based on the UCOD (APC +4.1%; Confidence Interval +1.5%,+6.7%), and on MCOD (APC +2.2%; +0.2,+4.2%). Among females time trends were not significant. Mention of PD was associated with that of dementia/Alzheimer and acute infectious diseases. Among known PD patients, the disease was reported only in 60.2% of death certificates. CONCLUSIONS Mortality associated to PD is steeply increasing among males in Northern Italy; further investigations on time trends for PD, both through all available electronic health archives and clinical studies, should be set as a priority for epidemiological research.
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Affiliation(s)
- Ugo Fedeli
- Epidemiological Department, Veneto Region, Italy.
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Fedeli U, Piccinni P, Schievano E, Saugo M, Pellizzer G. Growing burden of sepsis-related mortality in northeastern Italy: a multiple causes of death analysis. BMC Infect Dis 2016; 16:330. [PMID: 27412337 PMCID: PMC4944523 DOI: 10.1186/s12879-016-1664-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 06/27/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Few population-based data are available on mortality due to sepsis. The aim of the study was to estimate sepsis-related mortality rates and to assess the associated comorbidities. METHODS From multiple causes of death data (MCOD) of the Veneto Region (northeastern Italy), all deaths with sepsis mentioned anywhere in the death certificate were retrieved for the period 2008-2013. Among these deaths the prevalence of common chronic comorbidities was investigated, as well as the distribution of the underlying cause of death (UCOD), the single disease selected from all condition mentioned in the certificate and usually tabulated in mortality statistics. Age-standardized mortality rates were computed for sepsis selected as the UCOD, and for sepsis mentioned anywhere in the certificate. RESULTS Overall 16,906 sepsis-related deaths were tracked. Sepsis was mentioned in 6.3 % of all regional deaths, increasing from 4.9 in 2008 to 7.7 % in 2013. Sepsis was the UCOD in 0.6 % of total deaths in 2008, and in 1.6 % in 2013. Age-standardized mortality rates increased by 45 % for all sepsis-related deaths, and by 140 % for sepsis as the UCOD. Sepsis was often reported in the presence of chronic comorbidities, especially neoplasms, diabetes, circulatory diseases, and dementia. Respiratory tract and intra-abdominal infections were the most frequently associated sites of infection. CONCLUSIONS MCOD analyses provide an estimate of the burden of sepsis-related mortality. MCOD data suggest an increasing importance attributed to sepsis by certifying physicians, but also a real increase in mortality rates, thus confirming trends reported in some other countries by analyses of hospital discharge records.
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Affiliation(s)
- Ugo Fedeli
- />Epidemiological Department, Passaggio Gaudenzio 1, Padova (PD), 35131 Veneto Region Italy
| | - Pasquale Piccinni
- />Anesthesiology and Intensive Care, Eretenia Hospital, Viale Eretenio 12, 36100 Vicenza, Italy
| | - Elena Schievano
- />Epidemiological Department, Passaggio Gaudenzio 1, Padova (PD), 35131 Veneto Region Italy
| | - Mario Saugo
- />Epidemiological Department, Passaggio Gaudenzio 1, Padova (PD), 35131 Veneto Region Italy
| | - Giampietro Pellizzer
- />Infectious Disease Unit, San Bortolo Hospital, Viale Rodolfi 37, 36100 Vicenza, Italy
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Fedeli U, Schievano E. Mortality Waves Related to Hepatitis C Virus Infection: Multiple Causes of Death Data From the United States and Northern Italy Compared. Clin Infect Dis 2016; 63:849-50. [PMID: 27329234 DOI: 10.1093/cid/ciw421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 06/06/2016] [Indexed: 12/29/2022] Open
Affiliation(s)
- Ugo Fedeli
- Epidemiological Department, Veneto Region, Padua, Italy
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Fedeli U, Schievano E, Pellizzer G. Increasing numbers of hospitalizations and deaths with mention of Clostridium difficile infection, north-eastern Italy, 2008–2013. Clin Microbiol Infect 2015; 21:e63-4. [DOI: 10.1016/j.cmi.2015.05.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 05/29/2015] [Indexed: 10/23/2022]
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Zorzi M, Fedeli U, Schievano E, Bovo E, Guzzinati S, Baracco S, Fedato C, Saugo M, Dei Tos AP. Impact on colorectal cancer mortality of screening programmes based on the faecal immunochemical test. Gut 2015; 64:784-90. [PMID: 25179811 DOI: 10.1136/gutjnl-2014-307508] [Citation(s) in RCA: 198] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 08/12/2014] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Colorectal cancer (CRC) screening programmes based on the guaiac faecal occult blood test (gFOBT) reduce CRC-specific mortality. Several studies have shown higher sensitivity with the faecal immunochemical test (FIT) compared with gFOBT. We carried out an ecological study to evaluate the impact of FIT-based screening programmes on CRC mortality. DESIGN In the Veneto Region (Italy), biennial FIT-based screening programmes that invited 50-69-year-old residents were introduced in different areas between 2002 and 2009. We compared CRC mortality rates from 1995 to 2011 between the areas where screening started in 2002-2004 (early screening areas (ESA)) and areas that introduced the screening in 2008-2009 (late screening areas (LSA)) using Poisson regression models. We also compared available data on CRC incidence rates (1995-2007) and surgical resection rates (2001-2012). RESULTS Before the introduction of screening, CRC mortality and incidence rates in the two areas were similar. Compared with 1995-2000, 2006-2011 mortality rates were 22% lower in the ESA than in the LSA (rate ratio (RR)=0.78; 95% CI 0.68 to 0.89). The reduction was larger in women (RR=0.64; CI 0.51 to 0.80) than in men (RR=0.87; CI 0.73 to 1.04). In the ESA, incidence and surgery rates peaked during the introduction of the screening programme and then returned to the baseline (2006-2007 incidence) or dropped below initial values (surgery after 2007). CONCLUSIONS FIT-based screening programmes were associated with a significant reduction in CRC mortality. This effect took place much earlier than reported by gFOBT-based trials and observational studies.
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Affiliation(s)
- Manuel Zorzi
- Veneto Tumour Registry, Veneto Region, Padua, Italy
| | - Ugo Fedeli
- SER-Epidemiological Department, Veneto Region, Padua, Italy
| | | | | | | | | | | | - Mario Saugo
- SER-Epidemiological Department, Veneto Region, Padua, Italy
| | - Angelo Paolo Dei Tos
- Veneto Tumour Registry, Veneto Region, Padua, Italy Department of Pathology, Santa Maria di Ca' Foncello Hospital, Treviso, Italy
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Fedeli U, Schievano E, Saugo M, Rodeghiero F. Mortality from myelodysplastic syndromes: a multiple causes of death approach. Am J Hematol 2014; 89:450-1. [PMID: 24425597 DOI: 10.1002/ajh.23671] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 01/10/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Ugo Fedeli
- SER - Department of Epidemiological; Veneto Region; Padova Italy
| | - Elena Schievano
- SER - Department of Epidemiological; Veneto Region; Padova Italy
| | - Mario Saugo
- SER - Department of Epidemiological; Veneto Region; Padova Italy
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Schievano E, D'Ambrosio M, Mazzaretto I, Ferrarini R, Magno F, Mammi S, Favaro G. Identification of wine aroma precursors in Moscato Giallo grape juice: A nuclear magnetic resonance and liquid chromatography–mass spectrometry tandem study. Talanta 2013; 116:841-51. [DOI: 10.1016/j.talanta.2013.07.049] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 07/15/2013] [Accepted: 07/24/2013] [Indexed: 11/27/2022]
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Pelizzo MR, Rubello D, Bernardi C, Gemo G, Bertazza L, Schievano E, Fedeli U. Thyroid surgical practices shaping thyroid cancer incidence in North-Eastern Italy. Biomed Pharmacother 2013; 68:39-43. [PMID: 24184200 DOI: 10.1016/j.biopha.2013.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 10/02/2013] [Indexed: 11/27/2022] Open
Abstract
AIM To investigate the effects of changing surgical practices on thyroid cancer incidence in the Veneto Region (North-Eastern Italy). METHODS Hospital discharge records of the period 2000-2010 were analyzed to detect trends in thyroid surgery rates by type of surgery and diagnosis. The association between surgery rates for benign and malignant diseases across the 21 Local Health Units (LHUs) was assessed by Poisson regression. In a second step, clinical and pathological charts of the year 2010 were retrieved from the larger regional surgical center. The proportions of total and incidental papillary thyroid micro carcinoma (PTMC) were compared with historical data. Factors influencing an incidental diagnosis of PTMC were analyzed by logistic regression. RESULTS Among 26,000 procedures performed in the Region, there was an increase with time in the proportion of total thyroidectomies (from 67% to 78%) and surgeries with a diagnosis of thyroid cancer (from 17% to 28%). Cancer surgery rates across LHUs resulted associated to surgery rates for benign diseases (P<0.001). In the largest regional center, the proportion of PTMC increased from 35% to 56%, of whom almost 60% were incidental cases. The probability of finding an incidental PTMC was higher in total thyroidectomies than in other procedures (odds ratio=1.84, 95% confidence interval 1.08-3.14). CONCLUSION Data from the Veneto Region suggest that the increase in PTMC is due to several factors: increased preoperative diagnosis, total gland removal, extensive histological examination. Moreover, geographical variations in cancer incidence were associated to surgery rates for benign diseases.
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Affiliation(s)
- Maria Rosa Pelizzo
- Department of Special Surgical Pathology, University of Padova, Padova, Italy
| | | | - Chiara Bernardi
- Department of Special Surgical Pathology, University of Padova, Padova, Italy
| | - Giancarlo Gemo
- Department of Special Surgical Pathology, University of Padova, Padova, Italy
| | - Loris Bertazza
- Department of Special Surgical Pathology, University of Padova, Padova, Italy
| | - Elena Schievano
- SER-Epidemiological Department, Veneto Region, Padova, Italy
| | - Ugo Fedeli
- SER-Epidemiological Department, Veneto Region, Padova, Italy
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Fedeli U, Schievano E, Lisiero M, Avossa F, Mastrangelo G, Saugo M. Descriptive epidemiology of chronic liver disease in northeastern Italy: an analysis of multiple causes of death. Popul Health Metr 2013; 11:20. [PMID: 24112320 PMCID: PMC3852117 DOI: 10.1186/1478-7954-11-20] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 10/08/2013] [Indexed: 01/12/2023] Open
Abstract
Background The analysis of multiple causes of death data has been applied in the United States to examine the population burden of chronic liver disease (CLD) and to assess time trends of alcohol-related and hepatitis C virus (HCV)-related CLD mortality. The aim of this study was to assess the mortality for CLD by etiology in the Veneto Region (northeastern Italy). Methods Using the 2008–2010 regional archive of mortality, all causes registered on death certificates were extracted and different descriptive epidemiological measures were computed for HCV-related, alcohol-related, and overall CLD-related mortality. Results The crude mortality rate of all CLD was close to 40 per 100,000 residents. In middle ages (35 to 74 years) CLD was mentioned in about 10% and 6% of all deaths in males and females, respectively. Etiology was unspecified in about half of CLD deaths. In females and males, respectively, HCV was mentioned in 44% and 21% and alcohol in 11% and 26% of overall CLD deaths. A bimodal distribution with age was observed for HCV-related proportional mortality among females, reflecting the available seroprevalence data. Conclusions Multiple causes of death analyses can provide useful insights into the burden of CLD mortality according to etiology among different population subgroups.
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Affiliation(s)
- Ugo Fedeli
- SER - Epidemiological Department, Veneto Region, Passaggio Gaudenzio 1-35131 Padova (PD), Italy.
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Abstract
BACKGROUND Contrasting findings on trends and determinants of operative mortality after surgery for esophageal and gastric cancer have been reported from population-based studies. METHODS Discharge records of residents in the Veneto Region (northeastern Italy) with a diagnosis of esophageal or gastric cancer and intervention codes for esophagectomy or gastrectomy were extracted for the years 2000-2009. In-hospital, 30-day, 90-day, and perioperative (30-day + in-hospital) mortality were computed. The influence of patient and hospital variables on in-hospital mortality was assessed through multilevel models. RESULTS Overall, 6,500 resections were performed in the period of 2000-2009, with a 10 % decline in the second half of the study period. In-hospital mortality was 4.6 % (5.3 % in 2000-2004 and 3.8 % in 2005-2009) and was higher for extended total gastrectomy and total esophagectomy. In 2005-2009 mortality declined for all resection types except extended total gastrectomy (8.0 %). For esophageal procedures, 30-day mortality was lower than in-hospital or perioperative mortality. A protective effect of procedural volume was found for esophageal but not for gastric resections; among gastric procedures, mortality was higher in male patients and in extended total gastrectomy patients. CONCLUSIONS Analyses of discharge records allowed investigation at a population level of time trends (downward mainly for esophageal resections) and determinants of perioperative mortality (hospital volume, gender, and procedure type).
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Affiliation(s)
- Ugo Fedeli
- SER-Epidemiological Department, Veneto Region, Passaggio Gaudenzio 1, 35131 Padova, Italy.
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Fedeli U, Schievano E, Buonfrate D, Pellizzer G, Spolaore P. Increasing incidence and mortality of infective endocarditis: a population-based study through a record-linkage system. BMC Infect Dis 2011; 11:48. [PMID: 21345185 PMCID: PMC3051911 DOI: 10.1186/1471-2334-11-48] [Citation(s) in RCA: 126] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Accepted: 02/23/2011] [Indexed: 11/10/2022] Open
Abstract
Background Few population-based studies provide epidemiological data on infective endocarditis (IE). Aim of the study is to analyze incidence and outcomes of IE in the Veneto Region (North-Eastern Italy). Methods Residents with a first hospitalization for IE in 2000-2008 were extracted from discharge data and linked to mortality records to estimate 365-days survival. Etiology was retrieved in subsets of this cohort by discharge codes and by linkage to a microbiological database. Risk factors for mortality were assessed through logistic regression. Results 1,863 subjects were hospitalized for IE, with a corresponding crude rate of 4.4 per 100,000 person-years, increasing from 4.1 in 2000-2002 to 4.9 in 2006-2008 (p = 0.003). Median age was 68 years; 39% of subjects were hospitalized in the three preceding months. 23% of patients underwent a cardiac valve procedure in the index admission or in the following year. Inhospital mortality was 14% (19% including hospital transfers); 90-days and 365-days mortality rose through the study years. Mortality increased with age and the Charlson comorbidity index, in subjects with previous hospitalizations for heart failure, and (in the subcohort with microbiological data) in IE due to Staphylococci (40% of IE). Conclusions The study demonstrates an increasing incidence and mortality for IE over the last decade. Analyses of electronic archives provide a region-wide picture of IE, overcoming referral biases affecting single clinic or multicentric studies, and therefore represent a first fundamental step to detect critical issues related to IE.
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Affiliation(s)
- Ugo Fedeli
- SER - Epidemiological Department, Veneto Region, Italy.
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Fedeli U, Novara G, Galassi C, Ficarra V, Schievano E, Gilardetti M, Muto G, Bertetto O, Ciccone G, Spolaore P. Population-based analyses of radical cystectomy and urinary diversion for bladder cancer in northern Italy. BJU Int 2011; 108:E266-71. [PMID: 21320273 DOI: 10.1111/j.1464-410x.2011.10095.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE •To provide updated figures on urinary diversion, length of stay and mortality after cystectomy in two regions of northern Italy. PATIENTS AND METHODS •Discharge records of patients undergoing cystectomy for bladder cancer in 2000-2008 were extracted from the regional archives of hospital discharges. •Data on partial vs radical cystectomy and type of urinary diversion were obtained from intervention codes. •The influence of demographic characteristics, year of intervention, presence of comorbidities and hospital cystectomy volume on the adoption of a continent diversion and on in-hospital mortality was assessed through multilevel models. RESULTS •The crude cystectomy rate was close to 10 per 100,000. •The share of partial cystectomies declined from 5.5% in 2000-2002 to 3.0% in 2006-2008. •A continent diversion was adopted in 35% of radical cystectomies, with higher rates in young male patients treated in high-volume hospitals. •Median length of stay declined from 20 days in 2000-2002 to 18 in 2006-2008; in-hospital mortality decreased from 3.2% to 2.2%. CONCLUSION •This first population-based report on cystectomies for bladder cancer from continental Europe evidences a limited role of partial cystectomy, a high proportion of continent diversion and a decreasing trend of length of stay and in-hospital mortality.
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Affiliation(s)
- Ugo Fedeli
- SER-Epidemiological Department, Veneto Region, University of Padua, Italy
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Abstract
A series of peptide-peptoid hybrids, containing N-substituted glycines, were synthesized based on the H-Aib-Val-Aib-Glu-Ile-Gln-Leu-Nle-His-Gln-Har-NH(2) (Har = Homoarginine) as the parent parathyroid hormone (1-11) analog. The compounds were pharmacologically characterized in their agonistic activity at the parathyroid hormone 1 receptor.
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Affiliation(s)
- A Caporale
- Department of Chemical Sciences, Institute of Biomolecular Chemistry, CNR, University of Padova, Padova, Italy.
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Brocco S, Zamboni M, Fantin F, Marchesan M, Schievano E, Zambon F, Bozzano C, Di Francesco V, Vassanelli C, Spolaore P. Quality of care in congestive heart failure in the elderly: epidemiological evidence of a gap between guidelines and clinical practice. Aging Clin Exp Res 2010; 22:243-8. [PMID: 20634648 DOI: 10.1007/bf03324803] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND AIMS This study aimed at evaluating the quality of care in elderly patients hospitalized for heart failure, compared with that received by subjects of younger age. METHODS A cross-sectional retrospective study was performed on hospitalized subjects for heart failure in the Veneto Region (4.5 million inhabitants), located in North-East Italy, for the year 2004. Through consultation of clinical charts, performance of echocardiography, and prescription of ACE-inhibitors and beta-blockers were evaluated in each patient. Multivariate statistical analysis was used to test the association between age and the end-points of interest: prescription of ACE-inhibitors or beta- blockers and performance of echocardiography. RESULTS The percentage of patients with prescriptions for ACE-inhibitors decreased with age, from 75% for patients under 65 years, to 62% for subjects over 84 years (p=0.02). A similar, but more marked, finding was observed for prescriptions of beta- blockers (56% in subjects aged <65 yrs vs 16% in those aged >84 yrs) (p<0.001). Evaluation of echocardiography was performed in 61% of subjects under 65 and in 22% in those over 84 (p<0.001). After statistical adjustment, age remained a significant predictor of prescription for beta-blockers and performance of echocardiography, but no longer for prescription of ACE-inhibitors. CONCLUSIONS Among the elderly, age was a negative predictor of beta-blocker prescription and echocardiographic evaluation, but did not affect prescriptions for ACE-inhibitors.
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Abstract
A rapid and quantitative (1)H nuclear magnetic resonance (NMR) method was developed to analyze histamine in cheeses. The procedure is simple because the acid extract is analyzed directly, without any need for further filtration, derivatization, or other manipulation. This NMR method was demonstrated to be specific by 2D total correlation spectroscopy (TOCSY) and heteronuclear multiple-quantum coherence (HMQC) experiments and reliable in terms of linearity, accuracy, recovery, repeatability, and limits of detection (LOD). Good precision, with relative standard deviation (RSD) <4%, recovery of 100%, and a range of 0.6-1 mg/kg for the LOD were obtained. The NMR method was successfully applied to different types of cheese, ranging from soft to hard. No interference from free amino acids, proteins, and other natural components was detected. The NMR method could be transferred to other kinds of food.
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Affiliation(s)
- E Schievano
- Department of Chemical Sciences, University of Padova and Institute of Biomolecular Chemistry, National Research Council (CNR), Via Marzolo 1, Padova 35131, Italy.
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Zambon F, Fedeli U, Marchesan M, Schievano E, Ferro A, Spolaore P. Seat belt use among rear passengers: validity of self-reported versus observational measures. BMC Public Health 2008; 8:233. [PMID: 18613955 PMCID: PMC2483976 DOI: 10.1186/1471-2458-8-233] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2007] [Accepted: 07/09/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The effects of seat belt laws and public education campaigns on seat belt use are assessed on the basis of observational or self-reported data on seat belt use. Previous studies focusing on front seat occupants have shown that self-reports indicate a greater seat belt usage than observational findings. Whether this over-reporting in self reports applies to rear seat belt usage, and to what extent, have yet to be investigated. We aimed to evaluate the over-reporting factor for rear seat passengers and whether this varies by gender and under different compulsory seat belt use conditions. METHODS The study was conducted in the Veneto Region, an area in the North-East of Italy with a population of 4.7 million. The prevalence of seat belt use among rear seat passengers was determined by means of a cross-sectional self-report survey and an observational study. Both investigations were performed in two time periods: in 2003, when rear seat belt use was not enforced by primary legislation, and in 2005, after rear seat belt use had become compulsory (June 2003). Overall, 8138 observations and 7902 interviews were recorded. Gender differences in the prevalence of rear seat belt use were examined using the chi-square test. The over-reporting factor, defined as the ratio of the self-reported to the observed prevalence of rear seat belt use, was calculated by gender before and after the rear seat belt legislation came into effect. RESULTS Among rear seat passengers, self-reported rates were always higher than the observational findings, with an overall over-reporting factor of 1.4. We registered no statistically significant changes over time in the over-reporting factor, nor any major differences between genders. CONCLUSION Self-reported seat belt usage by rear passengers represents an efficient alternative to observational studies for tracking changes in actual behavior, although the reported figures need to be adjusted using an appropriate over-reporting factor in order to gain an idea of genuine seat belt use.
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Affiliation(s)
- Francesco Zambon
- Regional Center for Epidemiology, Veneto Region, Via Ospedale 18, 31033 Castelfranco Veneto, Italy
| | - Ugo Fedeli
- Regional Center for Epidemiology, Veneto Region, Via Ospedale 18, 31033 Castelfranco Veneto, Italy
| | - Maria Marchesan
- Regional Center for Epidemiology, Veneto Region, Via Ospedale 18, 31033 Castelfranco Veneto, Italy
| | - Elena Schievano
- Regional Center for Epidemiology, Veneto Region, Via Ospedale 18, 31033 Castelfranco Veneto, Italy
| | - Antonio Ferro
- Regional Department for Prevention, Public Health Section, Rio Novo 3493, 30123 Venezia, Italy
| | - Paolo Spolaore
- Regional Center for Epidemiology, Veneto Region, Via Ospedale 18, 31033 Castelfranco Veneto, Italy
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Pellizzer G, Mantoan P, Timillero L, Allegranzi B, Fedeli U, Schievano E, Benedetti P, Saia M, Sax H, Spolaore P. Prevalence and Risk Factors for Nosocomial Infections in Hospitals of the Veneto Region, North-Eastern Italy. Infection 2008; 36:112-9. [DOI: 10.1007/s15010-007-7092-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Accepted: 08/15/2007] [Indexed: 11/28/2022]
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Fedeli U, Alba N, Schievano E, Visentin C, Rosato R, Zorzi M, Ruscitti G, Spolaore P. Diffusion of good practices of care and decline of the association with case volume: the example of breast conserving surgery. BMC Health Serv Res 2007; 7:167. [PMID: 17945000 PMCID: PMC2121646 DOI: 10.1186/1472-6963-7-167] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2007] [Accepted: 10/18/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several previous studies conducted on cancer registry data and hospital discharge records (HDR) have found an association between hospital volume and the recourse to breast conserving surgery (BCS) for breast cancer. The aim of the current study is to depict concurrent time trends in the recourse to BCS and its association with hospital volume. METHODS Admissions of breast cancer patients for BCS or mastectomy in the period 2000-2004 were identified from the discharge database of the Veneto Region (Italy). The role of procedural volume (low < 50, medium 50-100, high > 100 breast cancer surgeries/year), and of individual risk factors obtainable from HDR was assessed through a hierarchical log-binomial regression. RESULTS Overall, the recourse to BCS was higher in medium (risk ratio = 1.12, 95% confidence interval 1.07-1.18) and high-volume (1.09, 1.03-1.14) compared to low-volume hospitals. The proportion of patients treated in low-volume hospitals dropped from 22% to 12%, with a concurrent increase in the activity of medium-volume providers. The increase over time in breast conservation (globally from 56% to 67%) was steeper in the categories of low- and medium-volume hospitals with respect to high caseload. CONCLUSION The growth in the recourse to BCS was accompanied by a decline of the association with hospital volume; larger centers probably acted as early adopters of breast conservation strategies that subsequently spread to smaller providers.
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Affiliation(s)
- Ugo Fedeli
- SER-Epidemiological Department, Veneto Region, Via Ospedale 18-31033 Castelfranco Veneto (TV), Italy.
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Brocco S, Visentin C, Fedeli U, Schievano E, Avogaro A, Andretta M, Avossa F, Spolaore P. Monitoring the occurrence of diabetes mellitus and its major complications: the combined use of different administrative databases. Cardiovasc Diabetol 2007; 6:5. [PMID: 17302977 PMCID: PMC1804263 DOI: 10.1186/1475-2840-6-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2006] [Accepted: 02/15/2007] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE Diabetes mellitus is a growing public health problem, for which efficient and timely surveillance is a key policy. Administrative databases offer relevant opportunities for this purpose. We aim to monitor the incidence of diabetes and its major complications using administrative data. STUDY DESIGN AND METHODS We study a population of about 850,000 inhabitants in the Veneto Region (Italy) from the end of year 2001 to the end of year 2004. We use four administrative databases with record linkage. Databases of drug prescriptions and of exemptions from medical charge were linked to identify diabetic subjects; hospital discharge records and mortality data were used for the assessment of macrovascular and renal complications and vital status. RESULTS We identified 30,230 and 34,620 diabetic subjects at the start and at the end of the study respectively. The row prevalence increased from 38.3/1000 (95% CI 37.2-39.5) to 43.2/1000 (95% CI 42.3-44) for males and from 34.7/1000 (95% CI 33.9-35.5) to 38.1/1000 (95% CI 37.4-39) for females. The mean row incidence is 5.3/1000 (95% CI 5-5.6) person years for males and 4.8/1000 (95% CI 4.4-5.2) person years for females. The rate of hospitalisations for cardiovascular or kidney diseases is greatly increased in diabetic people with respect to non diabetics for both genders. The mortality relative risk is particularly important in younger age classes: diabetic males and females aged 45-64 years present relative risk for death of 1.7 (95% CI 1.58-1.88) and 2.6 (95% CI 2.29-2.97) respectively. CONCLUSION This study provides a feasible and efficient method to determine and monitor the incidence and prevalence of diabetes and the occurrence of its complications along with indexes of morbidity and mortality.
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Affiliation(s)
| | | | - Ugo Fedeli
- Epidemiological Department, Veneto Region, Italy
| | | | - Angelo Avogaro
- Department of clinical and experimental medicine, University of Padua, Italy
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