Effects of deprivation and age on staging of breast, colon, rectum and prostate cancer in Umbria region, Italy: a multilevel approach.

BACKGROUND: Early diagnosis of breast, colon, rectum and prostate cancers improves health outcomes. Low socioeconomic status (SES) is related to advanced stages at diagnosis; inequalities could explain differences in outcomes by age. The influence of SES, age and residence area on staging was explored in the Umbrian population. METHODS: 2001-2010 cases were geo-coded by census tract of residence. Stage distribution or Gleason score were analyzed by multilevel multinomial logistic regression with age and SES as the fixed effects and census tract as the random-effect. RESULTS: For breast and colorectal cancers, the screening age class was advantaged. For breast, age effect was modulated by deprivation and census tract. In the elderly, the richest were advantaged, the poorest disadvantaged; issues emerged for the young. For colon, age effect is modulated by census tract in early stages and deprivation in late stages. The elderly were disadvantaged; the young and the deprived had more stages IV. About rectum, age effect was modulated by deprivation in the late stages. The elderly were disadvantaged; the young and the deprived presented more stages IV. For prostate, age effect was modulated by deprivation and census tract. The intermediate age class was advantaged, the elderly disadvantaged. CONCLUSION: Age was not always the determinant of a delayed staging when SES was considered. For breast and colorectal cancers, issues of delayed diagnosis emerged in the young. If the care center was near the residence, the census tract modified the stage at diagnosis. These results are useful to reduce SES barriers by specific programs adapted to the age of the patient and area of residence.

Deindustrialisation, demographic decline, aging, economic crisis and social involution in a metropolitan area analysed by applying Socio-Economic and Health Deprivation Indices.

AIMS: Genoa is a city hit by a strong economic, demographic and social involution. The changes in the demographic and socio-economic (SE) situation were analysed and the capacity of two Socio-Economic and Health Deprivation Indices (SEHDI) in describing the evolutions of the recent period were verified. MATERIAL AND METHODS: The data about the evolution of demographic and SE situation in Genoa came from publications of Statistics Offices of Genoa Municipality and Liguria Region and from published analyses of Bank of Italy. The two SEHDIs, referring to 2001 and 2011 population, were computed at census tract level by linear regression, factor and clusters analyses and had been already validated and published. RESULTS: Wide transformations in aging and population composition by age groups and gender occurred in Genoa between 1951 and 2016. Internal (from other Italian regions) and external (from other countries) migrations concurred to change the profile of Genoese population. These changes followed the industrial history of city and its deindustrialization occurred since 2001. A progressive SE involution, worsened by the Italian and international crises, carried out the recent impoverishment of the city. Between 2001 and 2011 the population at medium-high deprivation increased and the SEHDIs 2001 and 2011 contributed to describe the population distribution by deprivation groups, either geographically, and by groups of citizenships (Italians and Foreigners). The first identified in 2001 some aspects of a well-off society regarding education, labour market and characteristics of the family and housing structure. The second depicted in 2011 an impoverished society in aging, lack of family support and of property of the main house, diminishing of educational level. DISCUSSION: Genoa city demonstrated an its own specific decline. Starting from the deindustrialization, a worsening of welfare, independently from the national and international economic troubles, was evident. The aging and the changed equilibria among age groups testified the growing difficulties of society in keeping up with the deep social and economic changes. The results demonstrated that specific deprivation indices aid to better define the populations under analysis, because they identify the subpopulations that could have the maximum benefit from investments of resources targeted to the correction of inequalities.

Application of Socio-Economic and Health Deprivation Indices to study the relationships between socio-economic status and disease onset and outcome in a metropolitan area subjected to aging, demographic fall and socio-economic crisis.

AIMS: Genoa is a city affected by a deep economic, demographic and social involution. The association between disease onset and outcome and socioeconomic status (SES) was assessed in the mortality by cause in two periods, using indices referred to the distribution of deprivation in the population defined in a ten-years span (2001 to 2011). MATERIAL AND METHODS: Two Socio-Economic and Health Deprivation Indices (SEHDIs), computed at census tract level (2001 and 2011 Censuses), were applied to analyse the SMRs by cause, age (0-64 and 65+ years) and gender of the five normalised groups of deprivation individuated in the two population distribution. The associations between SES and onset of disease was described in the mortality 2008-11 using the index referred to 2001 population. The second index, referred to 2011 population, described the associations between SES and disease outcomes in the mortality 2009-13. Two ANOVAs evaluated the statistical significance (p < 0.05) of differences in death distribution among groups. RESULTS: The population at medium-high deprivation increased in Genoa between 2001 and 2011. The mortality by age and gender showed different trends. Not significant trends (NS) in both periods regarded only the younger (respiratory diseases in both sexes, prostate cancer, diabetes in women). Linearly positives (L↑) trends in both periods were observed only in men (all cancers and lung cancers, overall mortality and cardiovascular diseases in younger, diabetes in older). Not linear trends (NL) in both periods interested both sexes for flu and pneumonia, women for lung cancer, old women for overall mortality and respiratory diseases, old men for colorectal cancers. Instead, L↑ trends in the final phases of disease interest all cancers in the elderly (NS trend at the disease onset), all cancers and breast cancer in young women, diabetes and colorectal cancers in young men (NL trends at the disease onset). On the contrary, L↑ trends at the disease onset and NL trends in the final phases regarded cardiovascular diseases in elderly, overall mortality, respiratory diseases and prostate cancer in old men, diabetes and colorectal cancers in old women. Finally, NL trends at the disease onset regarded colorectal cancers in young women (NS trend in the final phases) and breast cancer in the older (linearly negative trend, L↓, in the final phases). DISCUSSION: Deprivation trends confirmed the literature about populations shifting towards poverty. Aging-linked social risks were revealed, reflecting the weakening of social-health care, which worsened in elderly if alone. Serious problems in younger singles or in the single-parent families arose. Cardiovascular diseases, all cancers and colorectal cancers trends confirmed the advantage of less deprived when diseases are preventable and curable. Prostate and breast cancers trends reflected the rising incidence and increasing problems in care. The need of corrective interventions in social and health policies was emerging, aimed to support in a targeted way a population in an alarming condition of socio-economic deterioration.

Development of a cross-cultural deprivation index in five European countries.

BACKGROUND: Despite a concerted policy effort in Europe, social inequalities in health are a persistent problem. Developing a standardised measure of socioeconomic level across Europe will improve the understanding of the underlying mechanisms and causes of inequalities. This will facilitate developing, implementing and assessing new and more effective policies, and will improve the comparability and reproducibility of health inequality studies among countries. This paper presents the extension of the European Deprivation Index (EDI), a standardised measure first developed in France, to four other European countries-Italy, Portugal, Spain and England, using available 2001 and 1999 national census data. METHODS AND RESULTS: The method previously tested and validated to construct the French EDI was used: first, an individual indicator for relative deprivation was constructed, defined by the minimal number of unmet fundamental needs associated with both objective (income) poverty and subjective poverty. Second, variables available at both individual (European survey) and aggregate (census) levels were identified. Third, an ecological deprivation index was constructed by selecting the set of weighted variables from the second step that best correlated with the individual deprivation indicator. CONCLUSIONS: For each country, the EDI is a weighted combination of aggregated variables from the national census that are most highly correlated with a country-specific individual deprivation indicator. This tool will improve both the historical and international comparability of studies, our understanding of the mechanisms underlying social inequalities in health and implementation of intervention to tackle social inequalities in health.

Age-related mortality trends in Italy from 1901 to 2008.

We stratified the Italian population according to age and gender in order to evaluate mortality trends over more than one century. Data covering the 1901-2008 period were used to study the yearly variations in mortality. Fluctuations in age-adjusted mortality curves were analyzed by Join Point Regression Models, identifying Join Points and Annual Percent Changes. A consistent decline in all-cause mortality occurred across the whole period, the most striking variations being observed in the 0-49 years population. In 1901, other and undefined diseases were the main causes of death, followed by infectious, digestive, and respiratory diseases in the 0-49 years population and by respiratory, cardiovascular, and cerebrovascular diseases in the ≥ 50 years population groups. In 2008 the main causes of death were accidents (males) and tumors (females) in the 0-49 age class, tumors in the 50-69 age class (both genders), and tumors (males) and cardiovascular diseases (females) in the elderly. The results highlight the interplay between age and gender in affecting mortality trends and reflect the dramatic progress in nutritional, lifestyle, socioeconomic, medical, and hygienic conditions.

Italian regional health system structure and expected cancer survival.

BACKGROUND AND AIMS: Few studies deal with the association of socioeconomic and health system resource variables with cancer survival at the Italian regional level, where the greatest number of decisions about social and health policies and resource allocations are taken. The present study aimed to describe the causal relationships between socioeconomic and health system resource factors and regional cancer survival and to compute the expected cancer survival at provincial, regional and area levels. METHODS AND STUDY DESIGN: Age-standardized relative survival at 5 years from diagnosis of cases incident in 1995-1998 and followed up to 2004 were derived by gender for 11 sites from the Italian Association of Cancer Registries data bank. The socioeconomic and health system resource variables, describing at a regional level the macro-economy, demography, labor market, and health resources for 1995-2005, came from the Health for All database. A principal components factor analysis was applied to the socioeconomic and health system resource variables. For every site, linear regression models were computed considering the relative survival at 5 years as a dependent variable and the principal components factor analysis factors as independent variables. RESULTS: The factors described the socioeconomic and health-related features of the regional systems and were causally related to the characteristics of the patient taken in charge. The models built by the factors allowed computation of the expected relative survival at 5 years with very good concordance with those observed at regional, macro-regional and national levels. In the regions without any cancer registry, survival was coherent with that of neighboring regions with similar socioeconomic and health system resources characteristics. CONCLUSIONS: The models highlighted the causal correlations between socioeconomic and health system resources and cancer survival, suggesting that they could be good evaluation tools for the efficiency of the resources allocation and use.

Cancer rehabilitation services: an Italian population-based cohort study.

AIMS AND BACKGROUND: In Italy more than 55% of cancer patients live for more than 5 years after diagnosis, sometimes with several cancer-related sequelae. For this reason rehabilitation must offer not only physical interventions but also psychological, clinical, social and nutritional support. The CAREMORE pilot study was designed to assess whether cancer registries could serve to collect information on rehabilitation services, to describe and quantify the services provided by the National Health Service, and to examine the allocation of rehabilitation services to cancer patients. METHODS AND STUDY DESIGN: This was a pilot population-based cohort study. A sample of 1200 patients was identified from the databases of the Varese, Genoa, Reggio Emilia, Sassari and Ragusa cancer registries, all diagnosed in 2002 and followed for 5 years. For 4 cancer sites a list of rehabilitation items to be collected was drafted by a joint community of researchers and voluntary associations, with variables regarding rehabilitation data and follow-up. Data were analyzed by groups of patients, vital status, sex, and age. RESULTS: This pilot study suggested it is useful to collect information on several rehabilitation services: disability benefits, home care, aids and other support; it was not possible to collect reliable information on nutritional and psychological rehabilitation. In all, 36% of the sample applied for disability benefits, but with important differences between cancer sites. Eleven percent of the sample obtained home care, with no substantial differences between cancer sites, and 16% received at least one aid, with percentages varying from 27% for rectal cancer to 8% for lymphoma patients. CONCLUSIONS: The pilot study indicated that cancer registries could collect information on rehabilitation services. In the future it would be interesting to expand the roles of these registries to factors that influence quality of life, taking into account the possibility of collecting more information by actually interviewing patients.

Survival after cancer in Italian persons with AIDS, 1986-2005: a population-based estimation.

BACKGROUND: Cancer survival in persons with AIDS (PWA) after introduction of antiretroviral therapies remains poorly characterized. The aim is to provide population-based estimates of cancer survival, overall and for the most important cancer types in PWA, and a comparison with persons without AIDS (non-PWA) affected by the same cancer. METHODS: PWA with cancer at AIDS diagnosis or thereafter were individually matched with non-PWA by type of cancer, sex, age, year of diagnosis, area of living, and, for lymphomas, histological subtype. Five-year observed survival and hazard ratios (HRs) of death in PWA versus non-PWA with 95% confidence intervals (CIs) were estimated. RESULTS: We included 2262 Italian PWA and 4602 non-PWA with cancer diagnosed during 1986-2005. Between 1986 and 1995, and 1996 and 2005, 5-year survival for all cancers in PWA improved from 12% to 41% and the corresponding HR versus non-PWA decreased from 5.1 (95% CI: 4.3 to 6.1) to 2.9 (95% CI: 2.6 to 3.3). During 1996-2005, HRs were 2.0 (95% CI: 1.4 to 2.9) for Kaposi sarcoma, 3.4 (95% CI: 2.9 to 4.1) for non-Hodgkin lymphoma, and 2.4 (95% CI: 1.4 to 4.0) for cervical cancer. HRs were 2.5 (95% CI: 2.1 to 3.1) for all non-AIDS-defining cancers, 5.9 (95% CI: 3.1 to 11.2) for Hodgkin lymphoma, and 7.3 (95% CI: 2.8 to 19.2) for nonmelanoma skin cancer. A ≤3-fold survival difference was found for cancers of the stomach, liver, anus, lung, brain, and the most aggressive lymphoma subtypes. CONCLUSIONS: The persisting, although narrowing, gap in cancer survival between PWA and non-PWA indicates the necessity of enhancing therapeutic approaches, so that PWA can be provided the same chances of survival observed in the general population, and improving cancer prevention and screening.

Estimates of cancer burden in Liguria.

AIMS AND BACKGROUND: The regional health care system of Liguria caters for a resident population which is among the oldest in Europe. One population-based cancer registry is present in the region, providing incidence and survival data for the Genoa province (covering 55% of the regional population). This paper will estimate the incidence, prevalence and mortality in the Liguria region for cancers of the lung, breast, prostate, colon-rectum, stomach and uterine cervix and melanoma of the skin in 1970-2015. METHODS: The estimated figures were obtained by applying the MIAMOD method. Starting from mortality and survival data, incidence and prevalence were derived using a statistical back-calculation approach. Survival was modeled on the basis of published data from the Italian cancer registries. The MIAMOD method was applied also to estimate the colorectal cancer incidence, mortality and prevalence rates in the Ligurian provinces in the period 1988-2015. RESULTS: In 2012 about 1,500 new cases of breast cancer were expected in Ligurian women. The estimates for the other cancer sites were considerably lower, ranging from 839 (colon-rectum) to 54 (cervix). In men about 1,400 new cases were estimated for prostate cancer, while the incidence for the other sites ranged from 1,118 (colon-rectum) to 208 (skin melanoma). The breast cancer prevalence rate was more than 10 times the incidence rate in women, and the lung cancer prevalence rate was more than double the incidence rate in both sexes. Mortality rates were highest for lung cancer in men and breast cancer in women; the lowest rates were estimated for melanoma and cancer of the uterine cervix. CONCLUSION: In Liguria a large portion of the health expenditure has been devoted to diagnostic and therapeutic resources. This may have contributed to the reduction of mortality rates and to the improvement of cancer survival. This phenomenon, added to population aging, will inflate the cancer prevalence. One of the major challenges for the Liguria region is to face the increasing demand for oncology services.

Useful indicators to interpret the cancer burden in Italy.

INTRODUCTION: In the last decades the demographics of most Western countries have undergone a deep transformation, which has caused a steady increase in degenerative chronic diseases and has made maintaining health and social support by the welfare system difficult. This paper aims to present a set of indicators pertaining to the health status of the Italian population and to the national economic and social systems, as an aid to a better interpretation of the cancer burden impact and of its future tendencies. MATERIAL AND METHODS: All indicators were derived from the ISTAT Health for All database. They were presented by region or macro area, globally or by gender, considering the most recent regional distribution and their time trends. The following features of the Italian population were chosen: percent of people aged over 65 years; life expectancy at birth; birth rate; crude and age-standardized overall mortality rates; dependency ratio; percent of single persons; percent of people with no more than a junior high school diploma; percent of people attaining at least the short first university degree; percent of people employed in the service and tertiary sectors; unemployment rate; incidence of poverty; total health expenditure (THE) as an absolute value and as percent of GDP; percent of public THE; percent of out-of-pocket THE of households; percent of smokers; proportion of overweight and obese people aged ≥18 years. RESULTS: Italy presented an unbalanced demographic situation with an increasingly old population, a decreasing middle-aged age group, a low birth rate, high crude overall mortality rates, and decreasing standardized overall mortality rates. The Italian population is characterized by a constant increase in the dependency ratio and in the percentage of people living alone, together with increasing expenses for health care, both at the public and households levels. Smoking has reduced its impact in men but not yet in women. The increasing proportion of overweight and obese people may explain the convergence in time of the mortality rates of the different Italian macro areas. DISCUSSION AND CONCLUSION: The Italian situation seems to be not well fitted to face the expected growing cancer burden. Along with the aging of the population, the corresponding lowering of the national GDP due to the persisting global economic crisis will lead the public sector and families to reduce health expenditure, while the number of people affected by cancer is bound to increase. Moreover, the social support provided by family members and the advantages of the Mediterranean dietary habits are declining. The strategies for facing the challenging evolution of the future should focus on successful primary prevention and a wider application of evidence-based medicine to optimize the choice of diagnostic and therapeutic procedures offered to citizens.

Colorectal cancer survival in the USA and Europe: a CONCORD high-resolution study.

OBJECTIVES: To assess the extent to which stage at diagnosis and adherence to treatment guidelines may explain the persistent differences in colorectal cancer survival between the USA and Europe. DESIGN: A high-resolution study using detailed clinical data on Dukes' stage, diagnostic procedures, treatment and follow-up, collected directly from medical records by trained abstractors under a single protocol, with standardised quality control and central statistical analysis. SETTING AND PARTICIPANTS: 21 population-based registries in seven US states and nine European countries provided data for random samples comprising 12 523 adults (15-99 years) diagnosed with colorectal cancer during 1996-1998. OUTCOME MEASURES: Logistic regression models were used to compare adherence to 'standard care' in the USA and Europe. Net survival and excess risk of death were estimated with flexible parametric models. RESULTS: The proportion of Dukes' A and B tumours was similar in the USA and Europe, while that of Dukes' C was more frequent in the USA (38% vs 21%) and of Dukes' D more frequent in Europe (22% vs 10%). Resection with curative intent was more frequent in the USA (85% vs 75%). Elderly patients (75-99 years) were 70-90% less likely to receive radiotherapy and chemotherapy. Age-standardised 5-year net survival was similar in the USA (58%) and Northern and Western Europe (54-56%) and lowest in Eastern Europe (42%). The mean excess hazard up to 5 years after diagnosis was highest in Eastern Europe, especially among elderly patients and those with Dukes' D tumours. CONCLUSIONS: The wide differences in colorectal cancer survival between Europe and the USA in the late 1990s are probably attributable to earlier stage and more extensive use of surgery and adjuvant treatment in the USA. Elderly patients with colorectal cancer received surgery, chemotherapy or radiotherapy less often than younger patients, despite evidence that they could also have benefited.

Yearly variations of demographic indices and mortality data in Italy from 1901 to 2008 as related to the caloric intake.

The aim of the present study was to evaluate, by Join Point regression method, the yearly variations in demographic indices and mortality data in Italy from 1901 to 2008, as related to the caloric intake. The relationships between mortality and caloric intake were studied by time series. The results showed that, from 1901 to 2008, the Italian population grew from 32.5 to 59.6 millions; the live births rates decreased from 31.8 to 10.1‰ (males) and from 33.3 to 9.0‰ (females); the infant mortality rates fell from 184.1 to 3.7‰ (males) and from 149.4 to 3.2‰ (females); males and females gained 35.7 and 40.6 years in life expectancy at birth, respectively. In 1901 the 61% of deaths occurred in the youngest, whereas in 2008 the elderly accounted for the 80%. In 1901, in terms of age-adjusted data, other and undefined causes overcame the specific causes of death, whose rank was: respiratory, digestive, infectious, cardiovascular, cerebrovascular, cancers, accidents, endocrine, and nervous system diseases. In 2008, undefined causes ranked 3rd (males) and 4th (females), while cancers became the leading cause of death, followed by cardiovascular, cerebrovascular, accidental, respiratory, endocrine, digestive, nervous system, and infectious diseases. The caloric intake showed a negative correlation with all-cause mortality, infant mortality, and mortality for a number of specific causes. These patterns reflect the progress in average nutritional status, lifestyle quality, socioeconomic level, and hygienic conditions.

Incidence and mortality trends for four major cancers in the elderly and middle-aged adults: an international comparison.

BACKGROUND: Time trends comparisons by age are important to understand the specific needs of elderly cancer patients and to improve clinical procedures. The aim is to compare 1998-2005 cancer incidence and mortality trends in Italy and the US for both sexes and for two age groups, namely 50-69 year old and 70+ year old. METHODS: Cancer incidence and mortality data came from 22 Cancer Registries (CRs) of the Italian association of cancer registries (AIRTUM), while the US incidence records were provided by 13 SEER CRs and the mortality statistics provided by the WHO Database. Trends were analysed by the Joinpoint Regression Program in order to obtain Annual Percent Changes and Joinpoints. RESULTS: Colorectal cancer incidence trends were favourable in the US for both sexes and in both age groups, whilst the rates increased in Italian elderly individuals and mortality rates fell markedly only in the US. For lung cancer, incidence and mortality decreased in men but increased in women in the two geographical areas. Breast cancer incidence and mortality declined both in Italy and the US for younger women, but the trends were less favourable in the Italian elderly individuals. The increase of prostate incidence slowed down and mortality diminished for every age group in the US, whilst in Italy only in the younger group. CONCLUSIONS: For major cancers, the Italian elderly experienced less favourable trends than the middle-aged patients whereas, in the US, the trends were similar for both age groups and favourable also for the elderly.

Socio-economic inequalities: a review of methodological issues and the relationships with cancer survival.

During the past few decades, many studies on socio-economic factors and health outcomes have been developed using various methodologies with differing approaches. A bibliographic research in MEDLINE/PubMed and SCOPUS was carried out for the period 2000-2011 to describe the influence of socio-economic status (SES) on cancer survival, in particular with reference to the outcome of European research results and the results of some cases of other Western studies. This review is divided into two sections: the first describing the different approaches of the study on individuals and populations of the concept of "social class" as well as methods used to measure the association between deprivation and health (i.e. ecological level studies, deprivation indexes, etc.); and the second discussing the association between socio-economic factors and cancer survival, describing the roles of various determinants of differences in survival, such as clinical and pathological prognostic factors, together with consideration of diagnosis and treatment and some patients' characteristics.

Breast cancer survival in the US and Europe: a CONCORD high-resolution study.

Breast cancer survival is reportedly higher in the US than in Europe. The first worldwide study (CONCORD) found wide international differences in age-standardized survival. The aim of this study is to explain these survival differences. Population-based data on stage at diagnosis, diagnostic procedures, treatment and follow-up were collected for about 20,000 women diagnosed with breast cancer aged 15-99 years during 1996-98 in 7 US states and 12 European countries. Age-standardized net survival and the excess hazard of death up to 5 years after diagnosis were estimated by jurisdiction (registry, country, European region), age and stage with flexible parametric models. Breast cancers were generally less advanced in the US than in Europe. Stage also varied less between US states than between European jurisdictions. Early, node-negative tumors were more frequent in the US (39%) than in Europe (32%), while locally advanced tumors were twice as frequent in Europe (8%), and metastatic tumors of similar frequency (5-6%). Net survival in Northern, Western and Southern Europe (81-84%) was similar to that in the US (84%), but lower in Eastern Europe (69%). For the first 3 years after diagnosis the mean excess hazard was higher in Eastern Europe than elsewhere: the difference was most marked for women aged 70-99 years, and mainly confined to women with locally advanced or metastatic tumors. Differences in breast cancer survival between Europe and the US in the late 1990s were mainly explained by lower survival in Eastern Europe, where low healthcare expenditure may have constrained the quality of treatment.

A method for differentiating cancer prevalence according to health status, exemplified using a population-based sample of Italian colorectal cancer cases.

UNLABELLED: Cancer prevalence is the proportion of a population diagnosed with cancer. We present a method for differentiating prevalence into the proportions expected to survive without relapse, die of cancer within a year, and die of cancer within 10 years or survive with relapse at the end of the 10th year. MATERIAL AND METHODS: The method was applied to samples of colorectal cancer cases, randomly extracted from four Italian cancer registries (CRs). The CRs collected data on treatments, local relapses, distant relapses, and causes of death: 1) over the entire follow-up to 31 December 2007 for 601 cases diagnosed in 2002 (cohort approach); 2) over a single year (2007) for five cohorts of cases defined by year of diagnosis (from 1997 to 2001), alive at 1 January 2007 (total 298 cases). The cohorts were combined into a fictitious cohort with 10 years survival experience. For each year j after diagnosis the health status of cases alive at the beginning of j was estimated at the end of the 10th year. From these estimates the 10-year colorectal cancer prevalence was differentiated. RESULTS: We estimated: 74.7% alive without relapse or not undergoing treatment at the end of 10 years; 8.1% had died of colorectal cancer within a year; 11.4% had died of colorectal cancer 1-10 years after diagnosis or had relapsed or were undergoing treatment at the end of the 10th year; and 5.8% had died of other causes. CONCLUSIONS: We have introduced a new method for estimating the healthcare and rehabilitation demands of cancer survivors based on CR data plus treatment and relapse data specifically collected for samples of cases archived by CRs.

Use of SERTS (Socio-Economic, health Resources and Technologic Supplies) models to estimate cancer survival at provincial geographical level.

AIM: The main aim of this work is to compute expected cancer survival for Italian provinces by Socio-Economic and health Resources and Technologic Supplies (SERTS) models, based on demographic, socioeconomic variables and information describing the health care system (SEH). METHODS: Five-year age-standardised relative survival rates by gender for 11 cancer sites and all cancers combined of patients diagnosed in 1995-1999, were obtained from the Italian Association of Cancer Registries (CRs) database. The SEH variables describe at provincial level macro-economy, demography, labour market, health resources in 1995-2005. A principal components factor analysis was applied to the SEH variables to control their strong mutual correlation. For every considered cancer site, linear regression models were estimated considering the 5-RS% as dependent variable and the principal components factors of the SEH variables as independent variables. RESULTS: The model composition was correlated to the characteristics of take in charge of patients. SEH factors were correlated with the observed survival for all cancer combined and colon-rectum in both sexes, prostate, kidney and non Hodgkin's lymphomas in men, breast, corpus uteri and melanoma in women (R(2) from 40% to 85%). In the provinces without any CR the survival was very similar with that of neighbouring provinces with analogous social, economic and health characteristics. CONCLUSIONS: The SERTS models allowed us to interpret the survival outcome of oncologic patients with respect to the role of the socio-economic and health related system characteristics, stressing how the peculiarities of the take in charge at the province level could address the decisions regarding the allocation of resources.

[Building of a local deprivation index to measure the health status in the Liguria Region]. / Costruzione di un indice di deprivazione per misurare lo stato di salute in Liguria.

AIMS: During the last twenty years, in the most of the European nations, studies on how measuring socioeconomic differences related to inequities in take in charge of patients, health care and outcomes have been developed. The aim of this paper is the computation of a Liguria Region Deprivation Index (IDR), able to describe the peculiar health characteristics of the Liguria population, economically and socially quite homogeneous, on the basis of the socioeconomic (SE) differences related to health outcomes according to the differences in general mortality. DESIGN: All the population and households variables from the 2001 Italian Census have been considered at municipal level and, for Genoa and Savona, at lower administrative area level, selecting only the ones significantly correlated to the general mortality by Pearson correlation. The Standard Mortality Ratios (SMR on 2001 standard Liguria population) for Overall Mortality by gender and age groups (0-64 years and 65+ years) have been used as dependent variables. In order to build the RDI and classify the areas on the basis of increasing socioeconomic deprivation, a multivariate methodology have been used by means of principal component factor analysis of the previous selected variables and k-means clustering of the geographical areas; then these results have been compared with the SMR by analysis of variance. Finally, the RDI has been applied to the SMR of some groups of principal causes of death (all tumours and cardiovascular, respiratory and digestive system diseases), in order to differentiate the population by health outcomes. RESULTS: Two factors have been identified: an economic-educational factor and a socio-familiar one. The first factor describes the educational level and occupation, while the second one the marital status, the family dimension and the house peculiarities. The clustering procedure has allowed to identify five groups of geographical areas, distributed by the increasing of the SE deprivation. The most problematic areas are located in the countryside or in some spot places of the seaside, far from the health care centres and with difficult access by travel connection. The association between RDI and overall mortality SMRs confirms the relationship between deprivation and mortality increases, according to a statistically significant linear trend. Similar relationships have been observed for cardiovascular and digestive system diseases, while no associations have been found for respiratory illness and overall cancers. CONCLUSIONS: The RDI is able to give information on the health differences in the population, by differentiating the mortality trend on the basis of specific situations of richness and social hardship. It is useful not only for disentangling by economic condition, but also by the resources of the social and familiar support to cope with the illness situations. So, the relationship between deprivation and mortality, according to a statistically significant linear trend, shows how groups of Liguria people suffer by a lack of familiar resources, which strongly reduces the possibility of a quick take in charge and the adhesion to the more adequate therapeutic procedure, till to fatal results. In this way, areas of aimed actions can be defined by the local decision-makers, in order to optimize the health resources allocation and to reduce inequities.

Cancer prevalence in Italy: an analysis of geographic variability.

PURPOSE: Statistics on cancer prevalence are scanty. The objectives of this study were to describe the cancer prevalence in Italy and to explore determinants of geographic heterogeneity. METHODS: The study included data from 23 population-based cancer registries, including one-third of the Italian population. Five-year cancer prevalence was observed, and complete prevalence (i.e., all patients living after a cancer diagnosis) was estimated through sex-, age-, cancer site-, and observation period length-specific completeness indices by means of regression models. RESULTS: In 2006, 3.8 % of men and 4.6 % of women in Italy were alive after a cancer diagnosis, with a 5-year prevalence of 1.9 % and 1.7 % in men and women, respectively. A relevant geographic variability emerged for all major cancer sites. When compared to national pooled estimates, crude cancer prevalence proportions were 10 % higher in the north and 30 % lower in the south of Italy. However, these variations were consistently reduced after age adjustment and, in both sexes, largely overlapped those of incidence rates, with correlations >0.90 between variations of prevalence and incidence for all cancer sites and areas. CONCLUSIONS: Magnitude of the cancer prevalence and the geographic heterogeneity herein outlined in Italy will help in meeting the needs of specific population of survivor patients.

Changes in the incidence of thyroid cancer between 1991 and 2005 in Italy: a geographical analysis.

BACKGROUND: The incidence of thyroid cancer (TC) has been increasing over the last 30 years in several countries, with some of the worldwide highest TC incidence rates (IRs) reported in Italy. The objectives of this study were to evaluate by histological subtypes the geographical heterogeneity of the incidence of TC in Italy and to analyze recent time trends for papillary thyroid carcinoma (PTC) in different cancer registries (CRs). METHODS: The study included cases of TC (<85 years of age) reported to 25 Italian CRs between 1991 and 2005. Age-standardized IRs were computed for all histological subtypes of TC according to CRs. Estimated annual percent change and joinpoint regression analysis were used for analysis of PTC. RESULTS: In women, IRs of PTC ranged between 3.5/100,000 in Latina and 8.5/100,000 in Sassari for the period 1991-1995 (a 2.4-fold difference) and between 7.3/100,000 in Alto Adige and 37.5/100,000 in Ferrara for 2001-2005 (a 5.1-fold difference). In men, IRs ranged between 0.7/100,000 in Latina and 3.4/100,000 in Sassari for the period 1991-1995 (a 4.9-fold difference) and between 2.0/100,000 (Alto Adige, Trento) and 10.6/100,000 in Ferrara for 2001-2005 (a 5.3-fold difference). In both sexes, IRs significantly higher than the pooled estimates emerged for the most recent period in the majority of CRs located within the Po River plain and in Latina, but they were lower in the Alpine belt. For women, CRs reported higher IRs than pool estimates showed, between 1991 to 2005, a significantly more marked annual percent change (+12%) than other CRs (+7%). For men the corresponding estimates were +11% and +8%. CONCLUSIONS: The distribution of PTC does not lend support to a role of environmental radiation exposure due to the Chernobyl fallout, iodine deficiency, or (volcanic) soils. Between 1991 and 2005, wide geographic variations in the incidence of PTC and heterogeneous upward trends emerged, suggesting that the heterogeneity was a relatively recent phenomenon; this appeared to be mainly explained by variations, at a local level, in medical surveillance.