Studio ecologico sulla mortalita dei residenti a Manfredonia dal 1970 al 2013.

OBJECTIVES: to evaluate the health status of the residents in the
Manfredonia municipality (Apulia Region, Southern Italy) in the
period 1970-2013.
DESIGN: ecological study on general and cause-specific mortality by
gender, age-class, calendar period, and birth cohort.
SETTINGS AND PARTICIPANTS: demographic and mortality data
came from the Italian National Institute of Statistics (Istat); 55 causes
of death were analysed. All analyses were specific for gender and
calendar period.
OUTCOMES: Direct standardized mortality rates (TSD) (European
standard population), indirect standardized mortality ratios
(SMR%) (regional and provincial reference rates for each calendar
period considered), with 90% confidence intervals (90%CI).
RESULTS: health status (general mortality) of the residents in Manfredonia
improved. Between the periods 1970-1974 and 2012-2013,
direct age-standardized rates x10,000 decreased from 92 to 52 among
men, and from 70 to 39 among women. However, from 1970 (first
year for which data are available) Manfredonia progressively lost
its advantage over the regional average (men: from -20% to -10%;
women: from -20% to +1.5%). This loss of advantage is most evident
for cardiovascular diseases. No differences from the reference populations
(regional and provincial) emerged for malignant tumours. In the
last period analysed (2006-2011), mortality for myocardial infarction Regiwas
higher than the regional average (men: +35%; women: +54%).
SMR% for lung cancer showed and increasing trend among men, in
particular with regard to the provincial reference. In the period 2006-
2011 we observed 22 death per year vs. 19 expected (SMR%: 117.2;
90%CI: 101.1-135.2). Among women, SMRs% were above the provincial
reference on the last calendar periods (2012-2013: 7 deaths/
year vs. 4.2 expected; SMR%: 116.4; 90%CI 97.0-260.7).
CONCLUSIONS: mortality among the residents in Manfredonia
showed a smaller improvement than the regional and provincial reference
populations. The advantage observed in the Sixties was gradually
lost in recent years. This trend was evident since the late Seventies.
Since 2000, mortality for myocardial infarction was above
the regional and provincial references. The literature documents an
increased cardiovascular mortality at short-medium latency period
in populations suffering from both natural and man-made catastrophes.
Mortality for lung cancer showed an increase with respect to
the reference populations (vs. the province standard, in particular)
since the year 2000, which is consistent with the latency period
from the exposure to arsenic in the Seventies.