Biomedical subjects

Carlo A Perucci

Publications and source records attributed to Carlo A Perucci.

At least 19 recordsLinked to original sources

PubMed2007

Socioeconomic status, particulate air pollution, and daily mortality: differential exposure or differential susceptibility.

BACKGROUND: Short-term increases in particulate air pollution are linked with increased daily mortality and morbidity. Socioeconomic status (SES) is a determinant of overall health. We investigated whether social class is an effect modifier of the PM(10) (particulate matter with diameter <10 micron)-daily mortality association, and possible mechanisms for this effect modification. METHODS: Area-based traffic emissions, income, and SES were available for each resident in Rome. All natural deaths (83,253 subjects) occurring in Rome among city residents (aged 35+ years) during the period 1998-2001 were identified. For each deceased individual, all the previous hospitalizations within 2 years before death were available via a record linkage procedure. PM(10) daily data were available from two urban monitoring sites. A case-crossover analysis was utilized in which control days were selected according to the time stratified approach (same day of the week during the same month). Conditional logistic regression was used. RESULTS: Due to the social class distribution in the city, exposure to traffic emissions was higher among those with higher area-based income and SES. Meanwhile, people of lower social class had suffered to a larger extent from chronic diseases before death than more affluent residents, especially diabetes mellitus, hypertension, heart failure, and chronic obstructive pulmonary diseases. Overall, PM(10) (lag 0-1) was strongly associated with mortality (1.1% increase, 95%CI = 0.7-1.6%, per 10 microg/m(3)). The effect was more pronounced among persons with lower income and SES (1.9% and 1.4% per 10 microg/m(3), respectively) compared to those in the upper income and SES levels (0.0% and 0.1%, respectively). CONCLUSIONS: The results confirm previous suggestions of a stronger effect of particulate air pollution among people in low social class. Given the uneven geographical distributions of social deprivation and traffic emissions in Rome, the most likely explanation is a differential burden of chronic health conditions conferring a greater susceptibility to less advantaged people.

Adult↗

PubMed2006

The influence of socioeconomic status on utilization and outcomes of elective total hip replacement: a multicity population-based longitudinal study.

OBJECTIVE: In countries with universal health coverage, socioeconomic status is not expected to influence access to effective treatment and its prognosis. We tested whether socioeconomic status affects the rates of elective total hip replacement and whether it plays a role in early and late outcomes. DESIGN: Multicity population-based longitudinal study. SETTING AND PARTICIPANTS: From Hospital Registries of four Italian cities (Rome, Milan, Turin, and Bologna), we identified 6140 residents aged 65+ years undergoing elective total hip replacement in 1997-2000. MAIN OUTCOME MEASURES: An area-based (census block) income index was used for each individual. Poisson regression yielded rate ratios (RR) of population occurrence by income level. Logistic regression estimated odds ratios (OR) of selected outcomes within 90 days. Cox proportional hazard models evaluated effects of income on rates of revision of total hip replacement and mortality up to 31 December 2004. Analyses were adjusted for age, gender, city of residence, and coexisting medical conditions. RESULTS: Low-income people were less likely than high-income counterparts to undergo total hip replacement [RR = 0.87, 95% confidence interval (CI) 0.81-0.95]; the effect was stronger among those aged 75+ years (RR = 0.76, 95% CI = 0.66-0.86). Low income was associated with higher risk of acute adverse medical events (P trend = 0.05) and of general infections and decubitus ulcer (P trend = 0.02) within 90 days. The effects were even higher among those aged 75+ years. No effects were found either for orthopaedic complications within 90 days or for revision and mortality. CONCLUSIONS: Total hip replacement is underutilized among elderly deprived individuals. Disadvantaged patients seem more vulnerable to acute adverse medical events after surgery. The evidence of unmet need and poor prognosis of low social class people has important implications for health care policy.

Aged↗

PubMed2006

Socioeconomic differentials in premature mortality in Rome: changes from 1990 to 2001.

BACKGROUND: While socioeconomic inequalities in mortality have widened in many countries, evidence of social differentials is scarce in Southern Europe. We studied temporal changes in premature mortality across socioeconomic groups in Rome between 1990 and 2001. METHODS: We analysed all 126,511 death certificates of residents of Rome aged 0-74 years registered between 1990-2001. A 4-level census block index based on the 1991 census was used as an indicator of socioeconomic position (SEP). Using routine mortality data, standardised mortality rates (per 100,000 inhabitants) were calculated by SEP and gender for four time periods. Rate ratios were used to compare mortality by gender and age. RESULTS: Overall premature mortality decreased in both genders and in all socioeconomic groups; the change was greater in the highest socio-economic group. In both men and women, inequalities in mortality strengthened during the 1990s and appeared to stabilise at the end of the 20th century. However, for 60-74 year old women the gap continued to widen. CONCLUSION: Socioeconomic inequalities in health in Rome are still present at the beginning of the 21st century. Strategies to monitor the impact of SEP on mortality over time in different populations should be implemented to direct health policies.

Adolescent↗

PubMed2006

Risk adjustment for inter-hospital comparison of primary cesarean section rates: need, validity and parsimony.

BACKGROUND: Cesarean section rates is often used as an indicator of quality of care in maternity hospitals. The assumption is that lower rates reflect in developed countries more appropriate clinical practice and general better performances. Hospitals are thus often ranked on the basis of caesarean section rates. The aim of this study is to assess whether the adjustment for clinical and sociodemographic variables of the mother and the fetus is necessary for inter-hospital comparisons of cesarean section (c-section) rates and to assess whether a risk adjustment model based on a limited number of variables could be identified and used. METHODS: Discharge abstracts of labouring women without prior cesarean were linked with abstracts of newborns discharged from 29 hospitals of the Emilia-Romagna Region (Italy) from 2003 to 2004. Adjusted ORs of cesarean by hospital were estimated by using two logistic regression models: 1) a full model including the potential confounders selected by a backward procedure; 2) a parsimonious model including only actual confounders identified by the "change-in-estimate" procedure. Hospital rankings, based on ORs were examined. RESULTS: 24 risk factors for c-section were included in the full model and 7 (marital status, maternal age, infant weight, fetopelvic disproportion, eclampsia or pre-eclampsia, placenta previa/abruptio placentae, malposition/malpresentation) in the parsimonious model. Hospital ranking using the adjusted ORs from both models was different from that obtained using the crude ORs. The correlation between the rankings of the two models was 0.92. The crude ORs were smaller than ORs adjusted by both models, with the parsimonious ones producing more precise estimates. CONCLUSION: Risk adjustment is necessary to compare hospital c-section rates, it shows differences in rankings and highlights inappropriateness of some hospitals. By adjusting for only actual confounders valid and more precise estimates could be obtained.

Adult↗

PubMed2006

Comparison of different methods in analyzing short-term air pollution effects in a cohort study of susceptible individuals.

BACKGROUND: Short-term fluctuations of ambient air pollution have been associated with exacerbation of cardiovascular disease. A multi-city study was designed to assess the probability of recurrent hospitalization in a cohort of incident myocardial infarction survivors in five European cities. The objective of this paper is to discuss the methods for analyzing short-term health effects in a cohort study based on a case-series. METHODS: Three methods were considered for the analyses of the cohort data: Poisson regression approach, case-crossover analyses and extended Cox regression analyses. The major challenge of these analyses is to appropriately consider changes within the cohort over time due to changes in the underlying risk following a myocardial infarction, slow time trends in risk factors within the population, dynamic cohort size and seasonal variation. RESULTS: Poisson regression analyses, case-crossover analyses and Extended Cox regression analyses gave similar results. Application of smoothing methods showed the capability to adequately model the complex time trends. CONCLUSION: From a practical point of view, Poisson regression analyses are less time-consuming, and therefore might be used for confounder selection and most of the analyses. However, replication of the results with Cox models is desirable to assure that the results are independent of the analytical approach used. In addition, extended Cox regression analyses would allow a joint estimation of long-term and short-term health effects of time-varying exposures.

Journal Article↗

PubMed2006

Prognostic factors and determinants of fatal outcome due to bacterial meningitis in the Lazio region of Italy, 1996-2000.

OBJECTIVES: To estimate case fatality rates (CFR) of bacterial meningitis and analyze factors associated with mortality due to bacterial meningitis in the Italian region of Lazio. METHODS: Patients reported with bacterial meningitis during the period 1996-2000, who died within 30 days from hospitalization (cases), were compared with survivors (controls) for factors related to healthcare. Age, gender, residence, bacterial agent, co-morbidities, and signs of disease severity were also analyzed in the final model. Healthcare factors were analyzed using current surveillance databases. RESULTS: Disease severity (OR=8.84; 95% CI=3.35-23.34) and age >44 years (OR=4.59; 95% CI=2.01-10.48) were the risk factors most strongly associated with death, while treatment in an infectious diseases ward was a protective factor, although modified by patient residence and by co-morbidities. CONCLUSIONS: This protective effect was possibly due to differences in treatment protocols between the infectious diseases ward and other wards. The protective effect was found to be stronger for residents of Rome, suggesting delayed access to infectious diseases wards for non-residents. The difference in risk of dying from meningitis at younger ages than that found in other studies should be further evaluated, using information on bacteria serogroups and antibiotic susceptibility.

Age Factors↗

PubMed2006

Indicators of breast cancer severity and appropriateness of surgery based on hospital administrative data in the Lazio Region, Italy.

BACKGROUND: Administrative data can serve as an easily available source for epidemiological and evaluation studies. The aim of this study is to evaluate the use of hospital administrative data to determine breast cancer severity and the appropriateness of surgical treatment. METHODS: the study population consisted of 398 patients randomly selected from a cohort of women hospitalized for first-time breast cancer surgery in the Lazio Region, Italy. Tumor severity was defined in three different ways: 1) tumor size; 2) clinical stage (TNM); 3) severity indicator based on HIS data (SI). Sensitivity, specificity, and positive predictive value (PPV) of the severity indicator in evaluating appropriateness of surgery were calculated. The accuracy of HIS data was measured using Kappa statistic. RESULTS: Most of 387 cases were classified as T1 and T2 (tumor size), more than 70% were in stage I or II and the SI classified 60% of cases in medium-low category. Variation from guidelines indications identified under and over treatments. The accuracy of the SI to predict under-treatment was relatively good (58% of all procedures classified as under-treatment using pT where also classified as such using SI), and even greater predicting over-treatment (88.2% of all procedures classified as over treatment using pT where also classified as such using SI). Agreement between clinical chart and hospital discharge reports was K = 0.35. CONCLUSION: Our findings suggest that administrative data need to be used with caution when evaluating surgical appropriateness, mainly because of the limited ability of SI to predict tumor size and the questionable quality of HIS data as observed in other studies.

Adult↗

PubMed2006

An outbreak of aseptic meningitis due to echovirus 30 associated with attending school and swimming in pools.

OBJECTIVES: To identify the risk factors of an outbreak of meningitis associated with echovirus 30-infection that occurred in Rome, Italy, in late 1997 among children from two different schools. METHODS: A case-control study was carried out. A case was defined as a child from either of the two schools, A or B, who presented meningitis-like (fever, headache and vomiting), diarrhea, or respiratory tract symptoms. All asymptomatic students were included in the analysis as controls. RESULTS: Among 446 pupils (80%) who answered the questionnaire, 68 met the case definition. Twenty pupils developed a meningitis-like illness. Echovirus 30 was isolated from cerebrospinal fluid (CSF) in four and from stools in six. Forty-eight pupils reported other symptoms. The attack rate was 10.8% in school A and 0.8% in school B for meningitis-like illness; it was 12% and 10%, respectively, for other enterovirus-like illnesses. The risk of meningitis-like illness was higher among children attending school A (crude OR = 14.9; 95% CI = 4.3-52.1), among children using any public pool (OR = 3.8; 95% CI = 1.5-9.9) and those using an outside swimming pool X (OR=13.4; 95% CI=2.7-65.8 versus no swimming pool and OR = 8.3; 95% CI = 1.1-62.6 versus other pools). The epidemic curve appears to suggest a person-to-person transmission. CONCLUSIONS: The epidemic occurred by person-to-person transmission in a number of classrooms and at swimming pool X.

Case-Control Studies↗

PubMed2006

Heroin maintenance treatment for chronic heroin-dependent individuals: a Cochrane systematic review of effectiveness.

The provision of prescribed heroin to chronic heroin-dependent individuals failing other treatments has been supported during the last 70 years on the ground that the first goal of interventions on drug users is to keep them in treatment to protect them from criminal activities and to promote social integration. To assess heroin prescription effectiveness, we conducted a Cochrane systematic review of all relevant randomized controlled trials. We searched MEDLINE, EMBASE, CINAHL, and the Cochrane Library and contacted leading researchers for ongoing studies. We found 19 eligible studies, of which 4 met our inclusion criteria (577 patients). In 1 study, patients in the heroin arm remained in treatment longer than those in the methadone arm (n = 96, RR = 2.82, 95% CI = 1.70-4.68); in 2 studies, there was no difference; and in 1 study, patients given heroin left the study earlier than those given methadone (n = 235, RR = 0.79, 95% CI = 0.68-0.90). Heroin was more effective than methadone in refraining people from using street heroin in 2 studies (n = 96, RR = 1.10, 95% CI = 0.79-1.53; n = 51, RR = 0.33, 95% CI = 0.15-0.72). In 1 study, heroin reduced the risk of being charged (RR = 0.32, 95% CI = 0.14-0.78); 2 studies showed no difference, and another 2 studies adopted a multidomain outcome enclosing criminal offense and social functioning and found improvements with heroin + methadone over methadone only. It is unclear if heroin attracts people in treatment; those in treatment use less street heroin and are likely to have less criminal activities. This review systematizes and compares studies showing some inconsistencies between their aims, their adopted outcomes, and their conclusions drawn from results.

Chronic Disease↗

PubMed2006

Characteristics of early transient, persistent, and late onset wheezers at 9 to 11 years of age.

STUDY OBJECTIVE: To investigate the early determinants and characteristics of different phenotypes of wheeze in children on the basis of questionnaire data, lung function, and prick tests. DESIGN: Cross-sectional survey. Setting. Rome and Fiumicino municipalities in Lazio region, Italy, within the ISAAC phase II project. SUBJECTS: Sample of 2107 9-11 year old schoolchildren (response rate 83.5%). RESULTS: We divided children into four mutually exclusive groups according to onset of wheeze: 154 early transient (birth to age 2), 51 persistent (birth to age 2 and current), 66 late onset (current only), and 1,446 control subjects (no early or current wheeze). Logistic regression models have shown that a family history of asthma and allergies is strongly associated with persistent and late onset wheezing; exposure to parental smoking--both during pregnancy and during the child's first year of life--is related to persistent wheezing; all children with wheezing show a significantly greater risk to have current respiratory symptoms other than wheeze compared with control subjects; current allergic rhinoconjunctivitis symptoms and atopy are related with both persistent and late onset wheeze. Multiple linear regression models show that forced expiratory rates at 25% to 75% of vital capacity (FEF25-75) and the ratio between forced expiratory volume in 1 second and forced vital capacity (FEV1/FVC) are significantly lower both in early transient (-305 mL/s, -1.7%) and persistent (-298 mL/s, -3.2%) wheezers; FEV1/FVC is significantly reduced in late onset wheezers too (-2.0%). CONCLUSIONS: The strength of the association of family history and exposure to parental smoking varies with the three wheezing phenotypes. Moreover, early, persistent and late onset wheezers have different clinical characteristics in terms of their respiratory health and atopic status.

Age Factors↗

PubMed2006

Vulnerability to heat-related mortality: a multicity, population-based, case-crossover analysis.

BACKGROUND: Although studies have documented increased mortality during heat waves, little information is available on the subgroups most susceptible to these effects. We evaluated the effects of summertime high temperature on daily mortality among population subgroups defined by demographic characteristics, socioeconomic status, and episodes of hospitalization for various conditions during the preceding 2 years. METHODS: We studied a total of 205,019 residents of 4 Italian cities (Bologna, Milan, Rome, and Turin) age 35 or older who died during 1997-2003. The case-crossover design was applied to evaluate the association between mean apparent temperature (same and previous day) and all-cause mortality. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) of dying at 30 degrees C (apparent temperature) relative to 20 degrees C were estimated accounting for time, population changes, and air pollution. RESULTS: We found an overall OR of 1.34 (CI = 1.27-1.42) at 30 degrees C relative to 20 degrees C. The odds ratio increased with age and was higher among women (OR = 1.45; 1.37-1.52) and among widows and widowers (1.50; 1.33-1.69). Low area-based income modestly increased the effect. Among the preexisting medical conditions investigated, effect modification was detected for previous psychiatric disorders (1.69; 1.39-2.07), depression (1.72; 1.24-2.39), heart conduction disorders (1.77; 1.38-2.27), and circulatory disorders of the brain (1.47; 1.34-1.62). Temperature-related mortality was higher among people residing in nursing homes, and a large effect was also detected for hospitalized subjects. CONCLUSIONS: Subsets of the population that are particularly vulnerable to high summer temperatures include the elderly, women, widows and widowers, those with selected medical conditions, and those staying in nursing homes and healthcare facilities.

Adult↗

PubMed2006

Associations of area based deprivation status and individual educational attainment with incidence, treatment, and prognosis of first coronary event in Rome, Italy.

BACKGROUND: Socioeconomic gradients in the occurrence of myocardial infarction are well known, but few studies have examined socioeconomic disparities in post-infarction outcomes. The objective of this study was to explore relations of socioeconomic status with the incidence, treatment, and outcome of first coronary event in Rome, Italy, during the period 1998-2000, examining effect modification by gender. METHODS: Subjects were Rome residents aged 35-84 years who died from first acute coronary event before reaching the hospital (n=3470) or were hospitalised for first acute myocardial infarction (n=8467). Area based deprivation status and patients' educational attainment were the exposure variables. The outcomes were: incidence of coronary event; recanalisation at the index hospitalisation and fatality within 28 days of hospitalisation; cardiac readmissions and fatality between 28 days and one year of index hospitalisation. RESULTS: Incidence rates increased as area based deprivation status increased; the effect was stronger among women than among men (men RR=1.40, 95%CI:1.30, 1.50, women RR=1.78, 95%CI:1.60, 1.98, most compared with least deprived). Rates of recanalisation were significantly lower in the most deprived patients than in the least deprived (OR=0.77, 95%CI:0.59, 0.99) and in the less educated than in the highly educated (OR=0.73, 95%CI:0.58, 0.90). Associations of short term fatality with area based deprivation status and educational attainment were weak and inconsistent. However, neither deprivation status nor education was associated with one year outcomes. CONCLUSIONS: Area based deprivation status is strongly related to incidence of coronary events, and more so among women than among men. Deprivation status and educational attainment are weakly and inconsistently associated with short term fatality but seem not to influence one year prognosis of acute myocardial infarction. Deprived and less educated patients experience limited access to recanalisation procedures.

Adult↗

PubMed2006

Temperature and summer mortality: geographical and temporal variations in four Italian cities.

STUDY OBJECTIVE: To investigate geographical and temporal variations in the temperature-mortality relation. DESIGN: The relation between mortality and maximum apparent temperature (Tappmax) in 2003, 2004, and a previous reference period was explored by using segmented regression and generalised additive models. SETTING: Four Italian cities (Bologna, Milano, Roma, and Torino), included in a national network of prevention programmes and heat health watch warning systems (HHWWS) were considered. PARTICIPANTS: Daily mortality counts of the resident population dying in each city during summer (June to September). MAIN RESULTS: The impact of Tappmax on mortality differed between cities and varied in the three periods analysed. The geographical heterogeneity of the J shaped relation was seen in the reference period with Tappmax thresholds ranging from 28 degrees C in Torino to 32 degrees C in Milano and Roma. In all cities, the percentage variation in mortality was greatest in 2003. In Torino and Roma a significant increase was seen also at lower Tappmax values that are usually not associated to an increase in mortality (26-28 degrees C). In summer 2004 the exposure levels were similar to the reference period; only in Torino the effect of Tappmax on mortality remained relevant even if reduced compared with 2003, while in Bologna no statistically significant effect was seen for any temperature range. CONCLUSIONS: The observed heterogeneous reduction in the impact of temperature on mortality from 2003 to 2004 may be partly explained by the lower levels of exposure. Changes in the ability of individuals and communities to adjust to high temperatures as a consequence of the implementation of public health interventions, based on HHWWS, characterised by a diverse effectiveness, may also have played an important part.

Aged↗

PubMed2006

Methadone treatment in clinical practice in Italy: need for improvement.

BACKGROUND: Methadone at appropriate doses has been demonstrated to be the most effective means for retaining patients in treatment and suppressing heroin use. AIM: To describe the modalities of day-to-day provision of methadone maintenance treatments (MMT) in Italian public health centres and to analyze the duration of MMTs by dose and by association with psychosocial treatments. PATIENTS AND METHODS: We analyzed 8,378 subjects, 18 years of age or over, enrolled between September 1998 and March 2001 in one of 115 public treatment centres for heroin dependence in Italy. Treatment data were collected for each subject from enrolment to the end of the study period (maximum of 18 months). RESULTS: Of the total of 29,495 treatments delivered, 21.0% were methadone maintenance, and 34.4% were methadone detoxification. Fifty percent of MMTs offered had a mean dose less than or equal to 40 mg/day, and only 19% had doses higher than or equal to 60 mg/day; treatments with doses higher than 60 mg/day lasted longer than treatments with lower doses. Differences in treatment length were observed between MMTs associated with a psychosocial treatment and those offered alone, only for doses <60 mg/day. CONCLUSIONS: In Italy, MMTs are delivered at inappropriate doses in more than 80% of the cases. The increase of methadone doses to adequate levels as indicated by the literature is necessary to ensure proper and effective use of MMTs in public treatment centres for heroin users.

Cohort Studies↗

PubMed2006

Risk adjustment and outcome research. Part I.

OBJECTIVE: The increasing demand for comparative evaluation of outcomes requires the development and diffusion of epidemiologic research, the ability to correctly formulate hypotheses, to conduct analyses and to interpret the results. The purpose of this paper is to provide a detailed but easy-reading review of epidemiologic methods to compare healthcare outcomes, particularly risk-adjustment methods. METHODS: The paper is divided into three parts. Part I describes confounding in observational studies, the ways confounding is identified and controlled (propensity adjustment and risk adjustment), and the methods for constructing the severity measures in risk-adjustment procedures. CONCLUSIONS: It is becoming increasingly important for policy makers and planners to identify which factors may improve or worsen the effectiveness of treatments and services and to compare the performances of providers. Politicians, managers, epidemiologists, and clinicians should make their decisions based on the validity and precision of study results, by using the best scientific knowledge available. The statistical methods described in this review cannot measure 'reality' as it 'truly' is, but can produce 'images' of it, defining limits and uncertainties in terms of validity and precision. Studies that use credible risk-adjustment strategies are more likely to yield reliable and applicable findings.

Confounding Factors, Epidemiologic↗

PubMed2005

Drug-related mortality and its impact on adult mortality in eight European countries.

OBJECTIVE: To estimate the mortality rates from drug-related deaths and other causes among problem drug users and population attributable risk of death due to opiate use in eight study sites in Europe. METHODS: Opiate users were recruited from drug treatment centres during the period 1990-1998 and deaths followed up through national or local mortality registries. Gender-specific overall mortality rate, proportion of deaths by cause (drug-related, HIV, other), standardized mortality ratios (SMRs), and the attributable risk fraction (ARF) were estimated. RESULTS: Crude mortality rates varied from 1 per 100 person-years in the Dublin and London cohorts to 3.8 per 100 person-years in Barcelona. The highest drug-related mortality rate was 10 per 1,000 person-years in Barcelona; the rates were approximately 7 per 1,000 person-years in Denmark, London, Rome, and Vienna, and <3.5 per 1,000 person-years for the others cohorts. The mortality rate for AIDS was <2 per 1,000 person-years in all the cohorts except Lisbon, Rome, and Barcelona, for which it was approximately 6 per 1,000 person-years. The highest SMR among males was 21.1 in Barcelona, and among females the highest SMRs were 53.7 and 37.7 in Barcelona and Rome, respectively. In Denmark the ARF was 5%, whereas it was >10% in all other study sites and 24% in Barcelona. CONCLUSION: Cohort mortality studies, especially in combination with estimates of prevalence, provide useful insights into the impact of opiate use on mortality across European countries and emphasize how preventing overall and drug-related deaths among opiate users can significantly improve the health of the population.

Adolescent↗

PubMed2005

A case-crossover analysis of out-of-hospital coronary deaths and air pollution in Rome, Italy.

RATIONALE: Out-of-hospital coronary heart disease death is a major public health problem, but the association with air pollution is not well understood. OBJECTIVES: We evaluated the association between daily ambient air pollution levels (particle number concentration [PNC]--a proxy for ultrafine particles [diameter < 0.1 microm], mass of particles with diameter less than 10 microm [PM10]; CO, NO2, and O3) and the occurrence of fatal, nonhospitalized coronary events. METHODS: Subjects were 5,144 out-of-hospital fatalities (410-414, International Classification of Diseases-9; 1998-2000) who had been residents of Rome. Hospitalizations during the 3 yr before death were considered to identify comorbidities (e.g., diabetes, hypertension, heart failure, dysrhythmia, chronic obstructive pulmonary disease). Statistical analyses were performed using a case-crossover design. MEASUREMENTS AND MAIN RESULTS: The association with out-of-hospital coronary deaths was statistically significant for PNC, PM10, and CO. Air pollution on the day of death had the strongest effect (e.g., 7.6% increase [95% confidence interval, 2.0-13.6%]) for an interquartile range of PNC, 27,790 particles/cm3. The 65-74- and 75+-yr age groups were at higher risk than the 35-64-yr age group, and there was a suggestion of effect modification for people with hypertension and chronic obstructive pulmonary disease. CONCLUSIONS: Air pollutants originating from combustion processes, including ultrafine particles, are related to fatal, nonhospitalized coronary events. The effect is stronger among people over 65 years of age, but is not limited to a group with a specific comorbidity.

Aged↗

PubMed2005

Income inequality and mortality in Italy.

BACKGROUND: The relationship between income inequality and health remains controversial in terms of whether or not it exists and, if so, its extent and the mechanisms involved. This study examines the relationship between income inequality, as indicated by the Gini coefficient, and mortality in Italy. METHODS: Cross-sectional ecological study on the 57,138,489 inhabitants living in the 95 provinces existing in Italy in 1994. Multivariate weighted regression analysis of total and age-specific mortality, income inequality, gender, and interaction between income inequality and median income or geographical area. RESULTS: A positive association between income inequality and total mortality was observed for both genders in provinces with a low per capita income and in Southern and Central Italy. The effect was present for infants and for persons over 24 years of age; it was marked for the elderly, particularly women. A negative association with mortality was observed for males living in the North-west. Interactions between income inequality and median income, and between income inequality and geographical area were found. CONCLUSION: In Italy, the relationship between income inequality and health is mixed and not universal, in so far as a positive association was observed only in provinces with lower absolute income. Elderly persons living in Southern Italy represent the population subgroup most vulnerable to unequal income distribution. Income inequality can, in part, explain the historically higher mortality among women in Southern Italy compared to women in the North. These results indicate that income inequality affects the health of population subgroups differentially.

Adolescent↗