Impact of the AIDS epidemic on mortality of young women in Italy

We have previously shown a substantial rise in total mortality for Italian men aged 20–39 years, mainly for those aged 25–34 years, in 1990 compared with 1985, although in the absence of appreciable changes in women [1]. This was attributed to the impact of the AIDS epidemic on male mortality. Although the spread of AIDS has occurred a few years later in women than in men, upward trends in AIDS incidence and mortality have been seen in the last decade in European and Northern American women, including Italian women [2–5]. These increases in AIDS and AIDS-related mortality have been reflected in total mortality trends in younger women over the last few years. Table 1 gives age- specific total mortality rates in Italian men and women aged 20–39 years between 1985 and 1994. For men aged 20–24 and 25–29 years, total mortality peaked in 1990, with rates for 1994 over 10% lower than those for 1990. However, steady upward trends were still present in the early 1990s in men aged 30–34 and 35–39 years, whose respective total mortality rates were 68 and 16% higher in 1994 compared with 1985. For women, total mortality was lower in 1994 than in 1985 at ages of 20–24 and 35–39 years. However, in the same period, rates increased by 19% at age 25–29 years and 28% at age 30–34 years (i.e., age groups where 64% of female AIDS cases had occurred [5]). Most of the increases were observed during the last few years, confirming that the AIDS epidemic was still spreading in Italian women up to the early 1990s [2–5].Table 1: . Age-specific total mortality in Italian men and women aged 20–39 years, 1985–1994.In 1994, deaths attributed specifically to AIDS accounted for 24 (3.9%) out of 611 of all deaths in women aged 20–24 years, 250 (24.4%) out of 1025 of those aged 25–29 years, 342 (25.7%) out of 1333 of those aged 30–34 years, and 161 (11.1%) out of 1448 of those aged 35–39 years. It is also worth bearing in mind that misclassification of cause of death and high competing risks (e.g., overdose, suicide, infections, and neoplasms), particularly amongst injecting drug users, lead to underestimates of AIDS-specific mortality. Finally, trends in AIDS mortality should be viewed against the recent decreases in death rates from motor vehicle accidents and cardiovascular diseases in young Italian men and women [6–8], suggesting that the real impact of the AIDS epidemic has probably been even larger than indicated by inspection of total mortality rates.