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BACKGROUND: Every year in Italy, influenza affects about 4 million people. Almost 5% of them are hospitalised. During peak illness, enormous pressure is placed on healthcare and economic systems. This study aims to quantify the clinical and economic burden of severe influenza during 5 epidemic seasons (2014-2019) from administrative claims data. METHODS: Patients hospitalized with a diagnosis of influenza between October 2014, and April 2019, were analyzed. Clinical characteristics and administrative information were retrieved from health-related Administrative Databases (ADs) of 4 Italian Local Health Units (LHUs). The date of first admission was set as the Index Date (ID). A follow-up period of six months after ID was considered to account for complications and re-hospitalizations, while a lookback period (2 years before ID) was set to assess the prevalence of underlying comorbidities. RESULTS: Out of 2,333 patients with severe influenza, 44.1% were adults ≥ 65, and 25.6% young individuals aged 0-17. 46.8% had comorbidities (i.e., were at risk), mainly cardiovascular and metabolic diseases (45.3%), and chronic conditions (24.7%). The highest hospitalization rates were among the elderly (≥ 75) and the young individuals (0-17), and were 37.6 and 19.5/100,000 inhabitants/year, respectively. The average hospital stay was 8 days (IQR: 14 - 4). It was higher for older individuals (≥ 65 years, 11 days, [17 - 6]) and for those with comorbidities (9 days, [16 - 6]), p-value < 0.001. Similarly, mortality was higher in elderly and those at risk (p-value < 0.001). Respiratory complications occurred in 12.7% of patients, and cardiovascular disorders in 5.9%. Total influenza-related costs were 9.7 million with hospitalization accounting for 95% of them. 47.3% of hospitalization costs were associated with individuals ≥ 65 and 52.9% with patients at risk. The average hospitalisation cost per patient was 4,007. CONCLUSIONS: This retrospective study showed that during the 2014-2019 influenza seasons in Italy, individuals of extreme ages and those with pre-existing medical conditions, were more likely to be hospitalized with severe influenza. Together with complications and ageing, they worsen patient's outcome and may lead to a prolonged hospitalization, thus increasing healthcare utilization and costs. Our data generate real-world evidence on the burden of influenza, useful to inform public health decision-making.
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Hospitalização , Influenza Humana , Humanos , Itália/epidemiologia , Influenza Humana/epidemiologia , Influenza Humana/economia , Influenza Humana/mortalidade , Idoso , Masculino , Feminino , Estudos Retrospectivos , Adolescente , Pessoa de Meia-Idade , Criança , Adulto , Pré-Escolar , Hospitalização/estatística & dados numéricos , Hospitalização/economia , Lactente , Adulto Jovem , Recém-Nascido , Idoso de 80 Anos ou mais , Estações do Ano , Comorbidade , Efeitos Psicossociais da Doença , Bases de Dados FactuaisRESUMO
BACKGROUND: People who reach old age enjoying good physical and mental health can be defined as (health) "superheroes", given their relatively low impact on healthcare expenditure and the desirable model they represent. AIM: To evaluate prevalence and possible determinants of being "physical superheroes" (i.e., free from the ten major chronic conditions, plus obesity), "mental superheroes" (i.e., free from major mental symptoms), and "superheroes" (i.e., both mental and physical superheroes). METHODS: A telephone-based cross-sectional study (LOST in Lombardia) was conducted in November 2020 (i.e., during the COVID-19 pandemic) on a representative sample of 4,400 adults aged ≥ 65 years from Lombardy region, northern Italy. All participants provided both current data and data referring to one year before. RESULTS: Mental and physical superheroes were 59.0% and 17.6%, respectively. Superheroes were 12.8% overall, 15.1% among men, and 11.1% among women; 20.2% among individuals aged 65-69 years, 11.3% among 70-74, 10.0% among 75-79, and 8.3% among ≥ 80 years. Multivariable analysis showed that female sex, higher age, disadvantaged socio-economic status, and physical inactivity (p for trend < 0.001) were inversely related to being superheroes. People not smoking (adjusted odds ratio, aOR = 1.40), alcohol abstainers (aOR = 1.30), and those free from feelings of hopelessness (aOR = 5.92) more frequently met the definition of superheroes. During COVID-19 pandemic, the proportion of superheroes decreased by 16.3%. CONCLUSIONS: Differences in the older adults' health status are largely attributable to their lifestyles but are also likely due to gender, educational, and socio-economic disparities, which should be properly addressed by public health policies.
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COVID-19 , Pandemias , Masculino , Humanos , Feminino , Idoso , Fatores de Risco , Estudos Transversais , Obesidade/epidemiologia , COVID-19/epidemiologiaRESUMO
BACKGROUND: Few studies have focused on changes in health and social services access due to the COVID-19 pandemic. We aimed to describe changes in the use of selected health and social home services due to the pandemic and to investigate potential associated factors, including socio-demographic characteristics, number of chronic diseases and mental health indicators, among older Italian individuals. METHODS: We analysed data from the LOST in Lombardia cross-sectional study conducted in November 2020 on a large representative sample of 4400 individuals aged ⩾65 years. To identify potential factors associated with the increased use of three selected health and social home services, we estimated odds ratios (OR) and confidence intervals (CI) using multivariable logistic regression models. RESULTS: Compared to the year before, 5.0% of older adults increased help from domestic workers (vs. 6.9% reducing) during the pandemic, 4.4% increased help from non-familiar caregivers (vs. 1.3% decreasing) and 4.7% increased medical home visits (vs. 1.0% decreasing). An increase in the use of these services was more frequent among participants with co-morbidities (p for trend <0.001), especially with diabetes (for caregivers: OR=12.2, 95% CI 6.0-24.8), and worse mental health (for caregivers and for those with a GAD-2 score ⩾3 vs. <3: OR=10.6, 95% CI 5.8-19.4). Conversely, people living in more crowded households less frequently increased health and social services use during the pandemic. CONCLUSIONS: Our results should inform targeted interventions for the identified vulnerable groups to close the gap in health and social inequities.
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BACKGROUND: The COVID-19 pandemic and associated lockdown measures posed an unprecedented challenge to the crucial role of grandparenting in family-oriented cultures, such as Italy. Reduced contact with grandchildren during this period potentially threatened grandparents' mental health and well-being. METHODS: We analysed data from the LOckdown and lifeSTyles in Lombardia cross-sectional study conducted in November 2020. The study included a representative sample of 4400 older adults from Lombardy, Italy, of which 1289 provided childcare to their grandchildren. RESULTS: A decrease in self-reported grandparenting was associated with an increased likelihood of experiencing depressive symptoms among grandparents (OR 1.50, 95% CI 1.01-2.24). Conversely, an increase in grandparenting was linked to poorer sleep quality (OR 11.67, 95% CI 5.88-23.17) and reduced sleep quantity (OR 2.53, 95% CI 1.45-4.41). CONCLUSIONS: Despite the barriers posed by the pandemic, grandparenting played a beneficial role in maintaining the mental health and well-being of older adults. However, it is crucial to recognise specific vulnerabilities, such as gender, feelings of hopelessness and overcrowding, which can have detrimental effects during and beyond emergency situations. Careful attention to these factors is essential for developing targeted support systems and interventions aimed at safeguarding the mental health of older adults and enhancing their resilience in crises.
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Avós , Saúde Mental , Humanos , Idoso , Avós/psicologia , Pandemias , Estudos Transversais , FamíliaRESUMO
BACKGROUND: We aimed to assess the prevalence of depressive and anxiety symptoms, hopelessness and insomnia in the older adults before and during the COVID-19 pandemic identifying subgroups at higher risk of mental distress. METHODS: Within the Lost in Lombardy project, a web-based cross-sectional study was conducted on a representative sample of 4400 older adults aged 65 years or more from the Lombardy region recruited between November 17th and 30th 2020. RESULTS: The prevalence of depressive symptoms increased by +112 % during the pandemic, anxiety symptoms by +136 %, insufficient sleep by +12 %, unsatisfactory sleep by +15 %. Feelings of hopelessness were more frequent among women compared to men and increased with increasing age. A worsening in each of the four specific mental health outcomes was more frequently observed in women (OR = 1.50, depression; OR = 1.31, anxiety; OR = 1.57, sleep quality; OR = 1.38, sleep quantity), in subjects who decreased their physical activity during the pandemic (OR = 1.64, depression; OR = 1.48, anxiety; OR = 2.05, sleep quality; OR = 1.28, sleep quantity), and with increasing number of pre-existing chronic diseases. The use of at least one psychotropic drug - mostly antidepressants/anxiolytics - increased by +26 % compared to pre-pandemic. LIMITATIONS: Pre-pandemic symptoms were retrospectively reported during the Covid pandemic. Potential information and recall bias should not be ruled out. CONCLUSIONS: If confirmed by future longitudinal studies, our findings could support evidence-based health and welfare policies on responding to this pandemic and on how to promote mental health and wellbeing, should future waves of infection emerge.
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COVID-19 , Saúde Mental , Masculino , Feminino , Humanos , Idoso , Pandemias , COVID-19/epidemiologia , Estudos Transversais , Estudos Retrospectivos , Ansiedade/epidemiologia , Itália/epidemiologia , Depressão/epidemiologiaRESUMO
BACKGROUND: The role of statins among patients with established cardiovascular diseases (CVDs) who are hospitalized with COVID-19 is still debated. This study aimed at assessing whether the prior use of statins was associated with a less severe COVID-19 prognosis. METHODS: Subjects with CVDs infected with SARS-CoV-2 and hospitalized between 20 February 2020 and 31 December 2020 were selected. These were classified into two mutually exclusive groups: statins-users and non-users of lipid-lowering therapies (non-LLT users). The relationship between statins exposure and the risk of Mechanical Ventilation (MV), Intensive Care Unit (ICU) access and death were evaluated by using logistic and Cox regressions models. RESULTS: Of 1127 selected patients, 571 were statins-users whereas 556 were non-LLT users. The previous use of statins was not associated with a variation in the risk of need of MV (Odds Ratio [OR]: 1.00; 95% Confidence Intervals [CI]: 0.38-2.67), ICU access (OR: 0.54; 95% CI: 0.22-1.32) and mortality at 14 days (Hazard Ratio [HR]: 0.42; 95% CI: 0.16-1.10). However, a decreased risk of mortality at 30 days (HR: 0.39; 95% CI: 0.18-0.85) was observed in statins-users compared with non-LLT users. CONCLUSIONS: These findings support the clinical advice for patients CVDs to continue their treatment with statins during SARS-CoV-2 infection.
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OBJECTIVES: Previous studies ruled out the benefits of azithromycin for treatment of patients with COVID-19 who are hospitalized. However, the effects of azithromycin for treatment of patients with positive SARS-CoV-2 test results in the community remains a matter of debate. This study aimed to assess whether azithromycin, when used in subjects with positive test results for SARS-CoV-2, is associated with a reduced risk of hospitalization, in-hospital COVID-19 outcomes, and death. METHODS: Two study cohorts were selected. Cohort A included subjects with positive test results for SARS-CoV-2 between February 20, 2020 and December 10, 2020; cohort B included subjects infected with SARS-CoV-2 and hospitalized between February 20, 2020 and December 31, 2020. We compared the risk of hospitalization, intensive care unit access, need for mechanical ventilation, and death in azithromycin users versus nonusers. A clustered Fine-Gray analysis was employed to assess the risk of hospitalization; logistic and Cox regressions were performed to assess the risk of intensive care unit access, mechanical ventilation, and death. RESULTS: In cohort A, among 4861 azithromycin users and 4861 propensity-matched nonusers, azithromycin use was associated with higher risk of hospitalization (hazard ratio [HR] 1.59, 95% confidence interval [CI] 1.45-1.75) compared with nonuse. In cohort B, among 997 subjects selected in both groups, azithromycin use was not significantly associated with intensive care unit access (odds ratio [OR] 1.22, 95% CI 0.93-1.56), mechanical ventilation (OR 1.30, 95% CI 0.99-1.70), 14-day mortality (HR0.88, 95% CI 0.74-1.05), or 30-day mortality (HR 0.89, 95% CI 0.77-1.03). CONCLUSION: Our findings confirm the lack of benefits of azithromycin treatment among community patients infected with SARS-CoV-2, raising concern on potential risks associated with its inappropriate use.
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Tratamento Farmacológico da COVID-19 , Humanos , Azitromicina/efeitos adversos , SARS-CoV-2 , Hospitalização , Respiração ArtificialRESUMO
The COVID-19 pandemic disproportionally affected older people in terms of clinical outcomes and care provision. We aimed to investigate older adults' changes in access to care during the pandemic and their determinants. We used data from a cross-sectional study (LOST in Lombardia) conducted in autumn 2020 on a representative sample of 4400 older adults from the most populated region in Italy. Lifestyles, mental health, and access to healthcare services before and during the pandemic were collected. To identify factors associated with care delays, reduction in emergency department (ED) access, and hospitalisations, we estimated prevalence ratios (PR) and 95% confidence intervals (CI) using multivariable log-binomial regression models. During the pandemic, compared to the year before, 21.5% of the study population increased telephone contacts with the general practitioner (GP) and 9.6% increased self-pay visits, while 22.4% decreased GP visits, 12.3% decreased outpatient visits, 9.1% decreased diagnostic exams, 7.5% decreased ED access, and 6% decreased hospitalisations. The prevalence of care delays due to patient's decision (overall 23.8%) was higher among men (PR 1.16, 95% CI 1.05-1.29), subjects aged 75 years or more (PR 1.12, 95% CI 1.00-1.25), and those with a higher economic status (p for trend < 0.001). Participants with comorbidities more frequently cancelled visits and reduced ED access or hospitalisations, while individuals with worsened mental health status reported a higher prevalence of care delays and ED access reductions. Access to care decreased in selected sub-groups of older adults during the pandemic with likely negative impacts on mortality and morbidity in the short and long run.
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COVID-19 , Idoso , COVID-19/epidemiologia , Controle de Doenças Transmissíveis , Estudos Transversais , Serviço Hospitalar de Emergência , Acessibilidade aos Serviços de Saúde , Humanos , Estilo de Vida , Masculino , PandemiasRESUMO
Healthcare delivery reorganization during the COVID-19 emergency may have had a significant impact on access to care for older adults with chronic conditions. We investigated such impact among all adults with chronic conditions aged ≥ 65 years, identified through the electronic health databases of two local health agencies-ATS Brianza and ATS Bergamo-from the Lombardy region, Italy. We considered hospitalizations for 2020 compared to the average 2017-2019 and quantified differences using rate ratios (RRs). Overall, in 2017-2019 there were a mean of 374,855 older adults with ≥ 1 chronic condition per year in the two ATS and 405,371 in 2020. Hospitalizations significantly decreased from 84,624 (225.8/1000) in 2017-2019 to 78,345 (193.3/1000) in 2020 (RR 0.86). Declines were reported in individuals with many chronic conditions and for most Major Diagnostic Categories, except for diseases of the respiratory system. The strongest reductions were observed in hospitalizations for individuals with active tumours, particularly for surgical ones. Hospitalization rates increased in individuals with diabetes, likely due to COVID-19-related diseases. Although determinants of the decrease in demand and supply for care among chronic older adults are to be further explored, this raises awareness on their impacts on chronic patients' health in the medium and long run.
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COVID-19 , Idoso , COVID-19/epidemiologia , Doença Crônica , Bases de Dados Factuais , Atenção à Saúde , Hospitalização , HumanosRESUMO
Most COVID-19 fatalities have occurred among older adults; however, evidence regarding the determinants of SARS-CoV-2 infection in this population is limited. Telephone interviews were conducted in November 2020 with a representative sample of 4400 Italians aged ≥65 years from the Lombardy region. We determined the prevalence of a history of SARS-CoV-2 infection. Through unconditional multiple logistic regression models, we estimated the odds ratios (ORs) of infection and the corresponding 95% confidence intervals (CIs). We further evaluated whether infection was related to a reduction in mental wellbeing. Of the participants, 4.9% reported a previous infection. No significant relationship between sex and infection was observed. Prior infection was less frequently reported in subjects aged ≥70 (OR = 0.55; 95% CI: 0.41-0.74) compared to 65-69 years, with no trend after 70 years of age. Those with at least one chronic condition reported a lower infection rate compared to healthy subjects (OR = 0.68; 95% CI: 0.49-0.93). Participants who lived alone more frequently reported infection than those who cohabited (OR = 2.33; 95% CI: 1.29-4.20). Prior infection was related to increased depressive symptoms (OR = 1.57; 95% CI: 1.17-2.10). This representative study of people aged ≥65 years suggests that in Italy, the oldest subjects and chronic patients less frequently exposed themselves to SARS-CoV-2 infection.
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AIMS: Restrictions imposed to prevent SARS-CoV-2 transmission should be weighed against consequences on vulnerable groups' health. Lifestyles and disease management of older people with diabetes might have been differentially impacted compared to non-chronic individuals. METHODS: A cross-sectional study (LOST in Lombardia) was conducted on a representative full sample of 4 400 older adults (17th-30th November 2020), collecting data on lifestyles, mental health and access to care before and during the pandemic. RESULTS: We compared 947 (51.9%) people with diabetes and 879 (48.1%) healthy subjects reporting no chronic conditions. People with diabetes reported more frequently increased physical activity (odds ratio, OR 2.65, 95% confidence internals, CI 1.69-4.13), drinks/week reduction (OR 6.27, 95%CI 3.59-10.95), increased consumption of fruit (OR 2.06, 95%CI 1.62-2.63), vegetables (OR 1.41, 95%CI 1.10-1.82), fish (OR 2.51, 95%CI 1.74-3.64) and olive oil (OR 3.54, 95%CI 2.30-5.46). People with diabetes increased telephone contacts with general practitioners (OR 3.70, 95%CI 2.83-4.83), hospitalisations (OR 9.01, 95%CI 3.96-20.51), visits and surgeries cancellations (OR 3.37, 95%CI 2.58-4.42) and treatment interruptions (OR 1.95, 95%CI 1.33-2.86). CONCLUSIONS: Pandemic adverse effects occurred but are heterogenous in a population with chronic diseases, who seized the opportunity to improve health behaviours, despite health system difficulties guaranteeing routine care, within and beyond COVID-19.
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COVID-19 , Diabetes Mellitus , COVID-19/epidemiologia , Estudos Transversais , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/terapia , Humanos , Azeite de Oliva , Pandemias/prevenção & controle , SARS-CoV-2RESUMO
BACKGROUND: Evidence showed that mental health problems have risen markedly during COVID-19. It is unclear if part of the mental sufferings relates to the climate of uncertainty and confusion originated from rough communication by health officials and politicians. Here, we test the impact of unanticipated policy announcements of lockdown policies on mental health of the older population. METHODS: We used a representative telephone-based survey of 4400 people aged 65 years or older in Italy's Lombardy region to compare information on self-reported symptoms of anxiety, depression and poor-quality sleep of subjects interviewed on the days of the policy announcement with that of subjects interviewed on other days. We used regression models adjusting for potential socio-demographic confounders as well study design with inverse probability weighting. RESULTS: On days when policymakers announced to extend the lockdown, mental health deteriorated on average by 5.5 percentage points [95% confidence interval (CI): 1.1-9.8] for self-reported anxiety symptoms and 5.1 percentage points (95% CI: 2.7-7.4) for self-reported depressive symptoms. The effect of the announcement to shorten the lockdown is more moderate but statistically significant. These associations were short term in duration; after just 1 day, self-reported mental health and sleep quality return to levels better than pre-announcement until a new policy change. CONCLUSIONS: Our research shows that lockdown policy announcements are associated with short-term worsening in mental distress, highlighting the importance of appropriate communication strategies and political determinations in crisis times.
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COVID-19 , Distúrbios do Início e da Manutenção do Sono , Ansiedade/epidemiologia , Transtornos de Ansiedade/epidemiologia , COVID-19/epidemiologia , COVID-19/prevenção & controle , Controle de Doenças Transmissíveis , Depressão/epidemiologia , Humanos , Itália/epidemiologia , Saúde MentalRESUMO
Background: Although a direct relationship between tinnitus or hearing difficulties and COVID-19 has been suggested, current literature provides inconsistent results, and no research has been undertaken in older adults. Methods: In November 2020, we conducted the LOST in Lombardia survey, a telephone-based cross-sectional study on a sample of 4,400 individuals representative of the general population aged ≥65 years from Lombardy region, Northern Italy. Individuals with diagnosed tinnitus and/or hearing loss were asked whether their conditions had improved or deteriorated in 2020 compared to 2019. Results: Overall, 8.1% of older adults reported a diagnosis of tinnitus and 10.5% of hearing loss. In 2020 compared to 2019, among individuals with tinnitus, those with increasing severity (5.0%) were similar to those decreasing it (5.3%). Among individuals with hearing loss, more people reported an increase (13.6%) than a decrease (3.2%) in their disease severity. No individual with a diagnosis in 2020 of tinnitus (n = 6) or hearing loss (n = 13) had COVID-19. The incidence of tinnitus was lower in 2020 (rate: 14.8 per 10,000 person-years) than in previous years (rate in 1990-2019: 36.0 per 10,000 person-years; p = 0.026). There was no change in the incidence of hearing loss (p = 0.134). Conclusions: In this large representative sample of older adults, on average neither COVID-19 confinement nor SARS-CoV-2 infection appeared to increase the severity or incidence of tinnitus. The increased severity of hearing difficulties may totally or partially be explained by physiologic deterioration of the condition, or by a misperception due to the use of face-masks.
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BACKGROUND & AIMS: COVID-19 containment measures significantly impacted lifestyle of the general population, including physical activity. Although the older adults are particularly susceptible to the potential consequences of sedentary lifestyle and inactivity, few studies investigated pandemic effects in this segment of the population. We aimed to evaluate COVID-19 pandemic effects on weight gain and physical activity in the Italian older adults, and assess the impact of possible changes in physical activity on mental health wellbeing. METHODS: In November 2020, a cross-sectional survey was conducted on a representative sample of 4400 older adults (aged 65 or more) from the Lombardy region, Northern Italy. Changes in body mass index (BMI) and physical activity were assessed, compared to the previous year. Using unconditional multiple logistic models, we estimated the odds ratios (OR) and the corresponding 95% confidence intervals (CI) of a decrease in physical activity during COVID-19 pandemic and we evaluated if decreased physical activity was a determinant of a worsening in psychological wellbeing. RESULTS: Neither weight gain nor increase in obesity prevalence occurred during the pandemic. Mean time spent in physical activity significantly decreased, with 43.8% of participants reporting a decrease of 1 h/week or more during COVID-19 pandemic. A decreased physical activity was determinant of a worsening of selected mental health outcomes, such as: sleep quality (OR = 2.45; 95% CI: 1.91-3.15) and quantity (OR = 1.54; 95% CI: 1.18-2.02), anxiety (OR = 1.31; 95% CI: 1.14-1.52) and depressive symptoms (OR = 1.61; 95% CI: 1.38-1.88). CONCLUSION: During the COVID-19 pandemic, while no major changes in BMI were observed, physical activity significantly declined in the older adults. In this population, the lack of physical activity might have contributed to the observed worsening in mental health. During emergency periods, encouraging physical activity might be effective also to preserve psychological wellbeing.
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COVID-19 , Idoso , COVID-19/epidemiologia , Estudos Transversais , Exercício Físico , Humanos , Pandemias , Aumento de PesoRESUMO
Little is known on potential socioeconomic and gender disparities in dietary changes during the COVID-19 pandemic. We conducted a telephone-based survey during fall 2020 on 4400 participants representative of the population aged 65-99 years living in Lombardy, Italy. Changes in a Mediterranean lifestyle were assessed retrospectively by scoring modifications in the consumption of nine food groups and five diet-related behaviours compared to 2019. A Mediterranean COVID-19 Pandemic Score (MedCovid-19 Score) was computed, reflecting changes during pandemic, with increasing values indicating improvements in line with a Mediterranean lifestyle. Predictors of favourable dietary changes (MedCovid-19 Score ≥ 1) were education (odds ratio [OR] = 1.52; 95% confidence interval 1.19-1.95 for postgraduate vs. lower), wealth (OR = 1.52; 1.14-2.02 for high vs. low) and skilled manual occupations (OR = 1.57; 1.28-1.92 vs. white collars). Women were more likely than men to move away from a Mediterranean lifestyle (OR = 1.86; 1.58-2.21). In conclusions, changes towards a Mediterranean lifestyle were disproportionately distributed across gender and socioeconomic strata.
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COVID-19 , Dieta Mediterrânea , Idoso , COVID-19/epidemiologia , Escolaridade , Feminino , Humanos , Itália/epidemiologia , Estilo de Vida , Masculino , Pandemias , Estudos Retrospectivos , Fatores SocioeconômicosRESUMO
Psoriasis has been linked with several comorbidities and increased all-cause mortality compared with the general population. Data are still limited concerning mortality especially from Southern European countries. Between January 2012 and December 2018, we conducted a retrospective cohort study on psoriasis patients and population controls in Northern Italy. Through record linkage of health-care databases, psoriasis cases were identified, and their morbidity and mortality were compared with the general population. The Charlson index was used as an index of comorbidities. Standardized mortality ratios (SMR) were estimated for overall psoriasis cases and for patients with mild vs moderate-to-severe disease, separately. We identified 12,693 psoriasis patients (mean age: 60.8 ± 16.3 years). They had a significantly higher Charlson index compared with the general population (p < 0.001). In spite of the higher rate of comorbidities, age-specific SMR was not increased in the psoriasis population as a whole (1.04 (95% CI 0.89-1.20)) or in people with mild psoriasis. However, a 40% higher than the expected risk of all-cause mortality was documented in individuals with moderate-to-severe psoriasis (SMR: 1.41; 95% CI 1.12-1.75). Notably, an excess mortality in these patients occurred as early as age 40-49 years. The proportion of deaths from malignancies and cardiovascular diseases was remarkably high. Our results support the notion that psoriasis severity influences mortality and indicate that patients with psoriasis, especially those with severe disease, should receive appropriate screening and health education.
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Causas de Morte , Psoríase/diagnóstico , Adulto , Idoso , Comorbidade , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Educação em Saúde , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Psoríase/epidemiologia , Estudos Retrospectivos , Índice de Gravidade de DoençaRESUMO
OBJECTIVES: The study aimed to determine the prevalence of rheumatoid factor (RF) and anti-citrullinated peptides (ACPA), to estimate the association with hepatitis B (HBV) or C (HCV) virus infections and the 15-year risk of developing RA in a large cohort from a Northern Italian region. METHODS: In 1998, 15,907 subjects between the ages of 18 and 75 were randomly selected 1:4 for HBV and HCV testing; more recently, we tested a subgroup of sera for RF (n=2196) and ACPA (n=2525). Administrative databases were searched after 15 years for incident RA diagnoses occurring between 1998 and 2013. RESULTS: RF was positive in 8.1% of cases with 10% of RF-positive subjects having HBsAg (p=0.004) and 9% anti-HCV. ACPA were detected in 4.8% of subjects with 5% of the ACPA-positive subjects having HBsAg and 5.9% anti-HCV. Older subjects had higher positivity rates for both RF and ACPA. HBsAg and anti-HCV were detected in 5.5% and 4.3% of sera, respectively. Over 15 years, 10 RA cases were recorded (9 women, median age at diagnosis 52 years) with RF previously positive in 2/10 and ACPA in 5/10 cases. RF and ACPA were associated with relative risks for developing RA of 5.7 (adjusted for HBsAg status; 95% CI 1.2-26.3) and 13.2 (95% CI 3.8-46.3), respectively. CONCLUSIONS: Our data in a large cohort from an unselected general population confirm a higher risk of RA development associated with ACPA compared to RF. HBV exposure correlates with RF but not with ACPA positivity.
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Artrite Reumatoide , Hepatite B , Adolescente , Adulto , Idoso , Anticorpos Antiproteína Citrulinada , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/epidemiologia , Autoanticorpos , Estudos de Coortes , Feminino , Hepatite B/diagnóstico , Hepatite B/epidemiologia , Humanos , Pessoa de Meia-Idade , Peptídeos Cíclicos , Fator Reumatoide , Adulto JovemRESUMO
The aim of this article is to give a better understanding of the dynamics of the SARS-CoV-2 pandemic in the Bergamo province (Italy), one of the most hit areas of the world, between February and April 2020. A new compartmental model, called SIAT3HE, was designed and fitted on accurate data about the pandemic provided by ATS Bergamo, the health protection agency of the Bergamo province. Our results show that SARS-CoV-2 reached Bergamo in January and infected 318,000 people, the 28.8% of the province population. The 43.1% of the infected individuals stayed asymptomatic. As 6,028 people died due to COVID-19 till April 30th, the infection fatality ratio of SARS-CoV-2 in the Bergamo province was 1.9%. These results are in very good agreement with available information: the number of infections is consistent with the results of recent serological surveys and the number of deaths due to COVID-19 is close to the excess mortality of the considered period.
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BACKGROUND: The real impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on overall mortality remains uncertain as surveillance reports have attributed a limited number of deaths to novel coronavirus disease 2019 (COVID-19) during the outbreak. The aim of this study was to assess the excess mortality during the COVID-19 outbreak in highly impacted areas of northern Italy. METHODS: We analysed data on deaths that occurred in the first 4â months of 2020 provided by the health protection agencies (HPAs) of Bergamo and Brescia (Lombardy), building a time-series of daily number of deaths and predicting the daily standardised mortality ratio (SMR) and cumulative number of excess deaths through a Poisson generalised additive model of the observed counts in 2020, using 2019 data as a reference. RESULTS: We estimated that there were 5740 (95% credible set (CS) 5552-5936) excess deaths in the HPA of Bergamo and 3703 (95% CS 3535-3877) in Brescia, corresponding to a 2.55-fold (95% CS 2.50-2.61) and 1.93 (95% CS 1.89-1.98) increase in the number of deaths. The excess death wave started a few days later in Brescia, but the daily estimated SMR peaked at the end of March in both HPAs, roughly 2â weeks after the introduction of lockdown measures, with significantly higher estimates in Bergamo (9.4, 95% CI 9.1-9.7). CONCLUSION: Excess mortality was significantly higher than that officially attributed to COVID-19, disclosing its hidden burden likely due to indirect effects on the health system. Time-series analyses highlighted the impact of lockdown restrictions, with a lower excess mortality in the HPA where there was a smaller delay between the epidemic outbreak and their enforcement.