Asthma in the elderly: mortality rate and associated risk factors for mortality.

BACKGROUND: There is a distinct lack of information on the prognosis of asthma in the elderly. METHODS: In order to compare mortality rates of elderly people with and without asthma and to identify mortality risk factors in those with asthma, 1,233 ambulatory patients aged > or = 65 years with a diagnosis of asthma (n = 210) or chronic nonrespiratory conditions (n = 1,023) were enrolled in a multicentric study. Patients underwent baseline spirometry and multidimensional assessment and were then followed up for a mean of 57.9 months (SD 16.9). We compared mortality rates in the two groups and identified predictors of death using multivariable survival analysis. RESULTS: The 5-year mortality rate in people with asthma was 24.3%, compared to 16.3% in control subjects (p < 0.01), but asthma per se did not explain the excess risk of death. The main causes of death among people with and without asthma were cardiovascular diseases (36.4% and 21.3%, respectively), nonneoplastic lung diseases (28.8% vs 5.4%), and neoplasms (7.6% vs 22.6%). In people without asthma, death was associated with age, gender, smoking, cardiovascular diseases, worse performance on a 6-min walking test, cognitive impairment, depression, and worse respiratory function. In people with asthma, only the association between death and age, smoking, and depression was confirmed. At variance with control subjects, in asthmatics we found an inverse correlation between being overweight and death (hazard ratio [HR], 0.35; 95% confidence interval [CI], 0.13 to 0.94) and a trend toward a higher mortality rate in people with a body mass index < 22 kg/m(2) (HR, 2.21; 95% CI, 0.94 to 5.18). CONCLUSIONS: Asthma in the elderly was associated with higher mortality rate, although this condition was not an independent risk factor. Causes of death and factors associated with death were somewhat different between people with and without asthma.

Mortality study of employees in a factory of recovery and refining of catalytic converters in Rome, Italy.

The study objective is to describe cause specific mortality of employees in a plant engaged in production, recovery and refining of catalytic converters located in Rome. Previous epidemiological studies conducted in similar plants are not available. A total of 828 workers (642 males and 186 females) were followed up between 1956 and 31-12-2003. Cause specific standardized mortality ratio (SMR) and 90% confidence intervals (CI) were computed using regional rates for comparison. Among males hired between 1956 and 1993, followed up until 31/12/2003, mortality for all causes (SMR 0,8; 90% CI 0,7-1,0; 85 observed) and all neoplasms (SMR 0,6; 90% CI 0,42-0,87; 20 observed) is below expected; an increase is present for liver cirrhosis (SMR 2,74; 90% CI 1,47-5,1; 7 observed) and brain cancer (SMR 5,24; 90% CI 2,3-11,90; 4 observed). The present investigation complies with the proposed scientific standards for occupational cohort studies. The study was not prompted by well defined a priori hypotheses but it is included in a process intended to typify a potentially polluted site; the absence of a priori hypotheses and of previous epidemiological evidence, prevent from a causal interpretation of the increased mortality from liver cirrhosis and brain cancer. The implementation of cohort studies in industrial sites where industrial activities similar to the one here examined are present, are highly recommended.

[Social inequalities in survival of people with AIDS]. / Differenze sociali nella sopravvivenza delle persone con AIDS.

OBJECTIVE: As a result of the introduction of new highly active antiretroviral therapy (HAART) in industrialized countries, social inequalities in survival of people with AIDS were observed. The aim of this study was to evaluate the presence of these inequalities in a cohort of persons with diagnosis of AIDS in a period of wider diffusion of the therapy. DESIGN AND SETTING: Longitudinal study of 1,368 resident of Rome, age between 18 and 59 years, diagnosed with AIDS between 1996 and 2000. MAIN OUTCOME MEASURES: Survival at 31.12.2002 after diagnosis of AIDS was analysed with respect to variables indicating socioeconomic status (SES) and income (IR) calculated for census tract of residence. We calculated hazard ratios (HR) of death using the Cox regression model and adjusting for gender, age, risk factor, period of diagnosis, CD4 cell count at diagnosis, AIDS defining disease and hospital of diagnosis. RESULTS: The analysis of survival has not evidenced difference of survival for different levels of SES and IR. For males only, there was an increase in mortality for persons of second level (HR=1.68; 95%CI 1.04-2.71) and fourth level (HR=1.85; 95% CI 1.15-2.96) of IR when compared with the first level CONCLUSION: In this study, conducted in the context of wider diffusion of HAART, the social differentials in survival with AIDS found in previous studies were not confirmed.

[Preliminary study of cause-specific mortality of a population exposed to 50 Hz magnetic fields, in a district of Rome municipality]. / Studio preliminare di mortalità per causa di una popolazione con esposizione residenziale a campi magnetici a 50 Hz, in un quartiere del comune di Roma.

OBJECTIVE: To investigate cause-specific mortality in a population exposed to high levels of 50 Hz magnetic fields, in a district of Rome. DESIGN: A cohort of 357 subjects that are resident in an area of about 100 meters on the two sides of a 60 kV power line was studied. Exposure to 50 Hz magnetic fields was evaluated by spot and long-term measurements and by adopting a model based on current load, characteristics of the line and distance of dwellings from conductors. The mortality experience of the cohort was observed from January 1st, 1980 through December 31st, 2003. Analysis took into account duration of residence and latency. Separate analyses were performed for three subcohorts characterized by different distances from the line and different estimated and measured field levels. MAIN OUTCOMES: Cause-specific standardized mortality ratios (SMRs) were computed comparing the observed number of deaths with the corresponding expected figures derived from the Latium Region mortality rates. This was done both in the overall cohort and in the subcohorts. RESULTS: All-causes mortality of the cohort did not differ from expected values (SMR 0.99; 95% CI 0.73-1.35; 40 observed). All cancers mortality showed a non-significant increase (SMR 1.34; 95% CI 0.82-2.18; 16 observed), that reached statistical significance in the analyses limited to subjects with more than 30 years of residence (SMR 2.09; 95% CI 1.05-4.19; 8 observed). Mortality from lymphohaematopoietic malignancies was increased, based on two cases of leukemia. All cancers mortality was highest in the subcohort closest to the power line and exposed to highest levels of magnetic fields. An increased risk for digestive tract neoplasms (SMR 3.57; 95% CI 1.49-8.58; 5 observed) was observed, which was mainly caused by pancreatic cancer. DISCUSSION AND CONCLUSION: Some increase in mortality of the overall cohort and especially of the highly exposed sub cohort was detected, notwithstanding the low power of the study. Other studies are currently on-going in the same area: a cross-sectional investigation on health status, an analysis of hospital discharge cards, a project for estimating individual exposure levels and a research in veterinary epidemiology. It is recommended to replicate the present study in areas presenting similar exposure patterns, in order to be able to pool data with the aim of estimating risk associated with the exposure levels of interest.

[Fatality rates of bacterial meningitis from current health databases suggest a different case definition. Results of a follow-up study of bacterial meningitis in Lazio Region, Italy, 1996-2000]. / La stima della letalità per meningite batterica mediante l'uso di database correnti può sottintendere una diversa definizione di caso. Risultati di uno studio di follow-up sulle meningiti batteriche nel Lazio, 1996-2000.

OBJECTIVES: To describe mortality and case fatality rate due to bacterial meningitis in the Lazio Region from 1996 to 2000, and to compare these estimates with those from Cause-of-death Registry (CDR) and Hospital Discharge Registry (HDR). METHODS: A follow-up study of mortality was conducted through Registry Offices for bacterial meningitis cases reported to surveillance in 1996-2000 among residents in the Lazio Region. Death due to bacterial meningitis was defined as a patient who died during a hospitalization for meningitis or who died within 30 days after hospitalization and whose underlying cause of death was bacterial meningitis (ICD-9: 036.0, 036.1, 036.2,320.0, 320.1, 320.2, 320.3, 320.7, 320.8, 320.9, 027.0). Case fatality rates estimated from follow-up study were compared with estimates from CDR and HDR of the same period. RESULTS: 525 bacterial meningitis cases were reported among residents in the whole period; 98 deaths were detected with a case fatality rate (CFR) of 18.7% (CI 95% 15.4-22.5); estimates were higher in patients 64+ year old (44.6%; CI 95% 33.7-55.9) and in meningitis due to Streptococcus pneumoniae (27.5%; CI 95% 20.3-35.6) or Listeria (32.0%; CI 95% 14.9-53.5). The CFR was 10.1% according to the CDR and 10.9% according to the HDR. CONCLUSIONS: CFRs differ according to the database used. Differences may be partially due to a selective lower sensitivity in reporting deceased cases, but the most important factor seems to be the case definition used in follow-up study and other sources of data.

[Estimates of pleural mesothelioma incidence in the Lazio region (Italy), 1997-2000]. / Stime di incidenza del mesotelioma pleurico nel Lazio, 1997-2000.

BACKGROUND: Malignant mesothelioma is indicative of past exposure to asbestos. In recent years an increase of incidence and mortality from malignant mesothelioma has been observed. Recent legislation in Italy requires nation-wide registration of asbestos-related pathologies. We conducted a preparatory study for systematic recording of cases of malignant pleural mesothelioma in the Lazio region. OBJECTIVES: To register new diagnoses of malignant mesothelioma, to estimate the incidence in the Lazio region, and to evaluate possible survey instruments. METHODS: We conducted a systematic study of hospital admissions in the region with diagnosis of cancer of the pleura (ICD-IX 163) in the period 1997-2000. Clinical information and results of diagnostic tests were requested for 530 patients from the hospitals involved. Using the capture-recapture method, it was possible to estimate the accuracy of the data we compiled using hospital admissions as the data source (76.8%, 95% C.I.=76.4-77.3). RESULTS: After careful review of clinical documentation, the diagnosis of malignant mesothelioma of the pleura was confirmed in 31.6% of cases (156 cases diagnosed). The percentage of confirmed cases has risen over the years (from 21% in 1997 to 45.1% in 2000) and it was higher in large public hospitals than in other types of health care facilities. On the basis of 156 confirmed cases of mesothelioma (116 males and 40 females), we estimated the annual incidence of the disease in the Lazio region as 1.73 new cases per 100,000 inhabitants among men and 0.47 new cases per 100,000 inhabitants among women. CONCLUSIONS: The results show that the incidence of mesothelioma in the region is consistent with national data, falling in the middle of the range for all Italian regions. However, some areas emerge (for example, Colleferro, Civitavecchia, Tarquinia, Ferentino, Gaeta, Aprilia, Pomezia) that have particularly high rates, probably in relation to past occupational asbestos exposure. The role of diffuse environmental exposure in Rome may warrant further investigation.