2,971 publications from this institution
A steady decrease in COPD mortality was observed in most of countries for men, whilst a different trend was observed in women in several countries. These trends are largely explained by changes in smoking habits, with an additional contribution of air pollution and occupational exposures. Despite past and ongoing tobacco control initiatives, this condition still remains a leading cause of death, in particular in countries with lower socio-demographic indices.
In 1980, the ratio of home birth to public hospital perinatal and neonatal mortality rates decreased from Northern to Southern Italy, being inversely related to the proportion of home deliveries and probably reflecting the effect of planned versus unplanned home births. The post neonatal mortality rate in Southern Italy was about four times as high in children born at home (9.5/1,000 live births) than in those delivered in public hospitals (2.6/1,000 live births), probably reflecting differences in the socioeconomic status according to the birthplace selection in various regions.
A method of graphic representation of time factors in cancer mortality is presented, based on different tonalities of grey applied to the surface of the matrix defined by various age-specific rates. It is illustrated using mortality data from cancers of the mouth or pharynx, oesophagus, larynx and lung in Italian and Swiss males. Progressively more complex regression surface equations are defined, on the basis of two independent variables (age and cohort) and a dependent one (each age-specific rate). General patterns of trends were thus identified, showing important similarities in cohort and period effects, but also noticeable differences in time-related factors in mortality from various neoplasms of the upper digestive and respiratory tract. For instance, there were declines in mortality from cancers of the mouth or pharynx in the oldest age groups, whereas rates were appreciably upwards at younger and middle age, particularly in Italy. Likewise, cancers of the oesophagus and, chiefly, of the larynx were substantially increasing, on a cohort basis, in oldest Italian males. Temporal pattern for laryngeal cancer in Italy was similar to that of lung cancer, thus suggesting that (cigarette) smoking has a greater impact on this cancer site as compared with alcohol. However, it is difficult to explain, on this basis alone, the totally diverging pattern for cancer of the larynx (downwards) and of the lung (upwards) observed among older Swiss males. These examples indicate that trend surface models are a useful summary guide to illustrate and understand the general patterns of age, period and cohort effects in cancer mortality.
Editor—A Danish study of 156 subjects with upper digestive tract cancers showed that wine drinkers may be at a lower risk than drinkers with a similar intake of beer or spirits.1 Wine is the most common alcoholic beverage in Italy, accounting for over 80% of alcohol intake.2 We investigated the separate and combined effect of wine drinking in a large dataset.3 Data were collected between 1984 and 1993 in Greater Milan and the province of Pordenone, Northern Italy, on 547 histologically confirmed incident cases of cancer of the oral cavity and pharynx (466 men, 81 women; age 22-74 (median 57)) and 412 cases of cancer of the oesophagus (345 men, 67 women; age 26-74 (median 60)). Controls were 2375 subjects (1797 men, 578 women; age 25-74 (median 56)) admitted to the same network of hospitals with acute non-neoplastic conditions unrelated to alcohol or tobacco consumption. Of these, 570 were admitted for trauma, 593 for non-traumatic orthopaedic conditions, 475 for acute surgical diseases, 428 for eye diseases, and 309 for miscellaneous other illnesses. Trained interviewers questioned cases and controls, using a structured questionnaire; questions on the days per week that each type of alcoholic beverage (wine, beer, and spirits) was consumed and the average number of drinks per day were included. The table gives the distribution of cases of oral and pharyngeal and oesophageal cancer and of the comparison group according to consumption of various alcoholic beverages. When non-drinkers and moderate drinkers (<3 drinks a day) were used as the comparison group, the odds ratios of oral and pharyngeal cancer were 4.95 for very heavy (⩾10 drinks per day) wine drinkers and 4.13 for very heavy wine, beer, and spirit drinkers. Corresponding findings for oesophageal cancer were 7.53 and 5.52. The odds ratios for beer or spirit drinkers only were 0.9 (95% confidence interval 0.3 to 2.4) for cancers of the oral cavity (7 cases, 47 controls) and 1.5 (0.6 to 3.9) for oesophageal cancer (7 cases, 47 controls). These results were consistent across separate diagnostic conditions in controls. This pattern of risk according to type of alcoholic beverage is different from that reported in the Danish study.1 Taken together, these data lead us to conclude that ethanol is the main component of alcoholic beverages that determines the risk of cancer and that the most frequently consumed beverage in each area tends to be the one with the highest risk.4,5 Wine consumption is clearly strongly related to cancers of the upper digestive tract in individuals and populations with heavy consumption.
Trends in death certification rates from male breast cancer over the period 1955-89 were analysed for 25 European countries (excluding the Soviet Union and a few small countries) on the basis of official data from the World Health Organization database. In the late 1980's, about 550-600 deaths per year from male breast cancer were certified in these countries. The variation was relatively limited, most age-standardized (world standard) rates being within the range of 1.5 to 3.0 per million. The highest rates were in France, Hungary, Austria and Scotland. No clear pattern of trend was observed over the last few decades, but mortality rates in the late 1980's tended to be, for most countries, lower than those registered 3 decades earlier. Comparison was possible for 18 countries, and for 11 (including the largest ones, i.e. France, Germany, Italy and England and Wales), male breast cancer rates in 1985-89 were lower than in 1955-59. The pattern was similar when only truncated (from 35 to 64 years) mortality rates were considered and, for the largest countries, upon accurate inspection of age-specific rates. In conclusion, therefore, this overview of male breast cancer trends in Europe precludes any generalized increase in mortality from the disease over recent decades and, hence, weighs against the introduction and presence of any important new cause of this rare disease.
In spite of mixed trends, suicide remains a significant public health problem worldwide.
The mortality experience of a cohort of chrysotile miners employed since 1946 in Balangero, northern Italy was updated to the end of 1987 giving a total of 427 deaths out of 27,010 man-years at risk. A substantial excess mortality for all causes (standardised mortality ratio (SMR) = 149) was found, mainly because of high rates for some alcohol related deaths (hepatic cirrhosis, accidents). For mortality from cancer, however, the number of observed deaths (82) was close to that expected (76.2). The SMR was raised for oral cancer (SMR 231 based on six deaths), cancer of the larynx (SMR 267 based on eight deaths), and pleura (SMR 667 based on two deaths), although the excess only reached statistical significance for cancer of the larynx. Rates were not increased for lung, stomach, or any other type of cancer. No consistent association was seen with duration or cumulative dust exposure (fibre-years) for oral cancer, but the greatest risks for laryngeal and pleural cancer were in the highest category of duration and degree of exposure to fibres. Although part of the excess mortality from laryngeal cancer is probably attributable to high alcohol consumption in this group of workers, the data suggest that exposure to chrysotile asbestos (or to the fibre balangeroite that accounts for 0.2-0.5% of total mass in the mine) is associated with some, however moderate, excess risk of laryngeal cancer and pleural mesothelioma. The absence of excess mortality from lung cancer in this cohort is difficult to interpret.
