Years of Life Lost Due to Premature Mortality in Italy

• Published in: European journal of epidemiology 2003-01, Vol.18 (6), p.513-521
• Main Authors: Mariotti, Sergio, D'Errigo, Paola, Mastroeni, Simona, Freeman, Karen
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age; Age Distribution; Alzheimers disease; Analysis. Health state; Biological and medical sciences; Breast cancer; Cardiovascular diseases; Cause of Death; Child; Cost of Illness; Death; Diabetes; Disabilities; Discounting; Epidemiology; Female; General aspects; Humans; International Classification of Diseases; Italy - epidemiology; Lung cancer; Male; Medical sciences; Middle Aged; Models, Statistical; Mortality; Public health. Hygiene; Public health. Hygiene-occupational medicine; Quality of life; Quality-Adjusted Life Years; Studies; Traffic accidents
• ISSN: 0393-2990; 1573-7284
• DOI: 10.1023/a:1024635401206

Background: The assessment of the burden of disease (BOD) is necessary for sensibly allocating limited health-related resources. No such assessment is available currently for Italy. Methods: Global burden of disease (GBD) methods were used to analyse in detail the years of life lost (YLLs) component of BOD for the most important diseases contributing to premature mortality in Italy in 1998. YLLs were computed with and without age-weighting and discounting. YLLs were also analysed by gender, for Italy vs. the Euro-A region (a group of 26 European countries) defined in the 2000 update of the GBD Study, and for northern, central and southern Italy, the three traditionally demarcated regions of the country. Results: The use of YLLs yields a ranking of diseases by their relative contribution to mortality burden which differs from a ranking based purely on death counts. Although males contributed 58.5% and females 41.5% of the total mortality burden in terms of YLLs, using death counts the percentages for males and females were similar (50.6% M, 49.4% F). The leading cause of mortality burden, both in terms of YLLs and death counts, was ischaemic heart disease, followed by stroke and lung cancer. Several other conditions, however, had rankings that varied depending on the measure used. While cardiovascular diseases accounted for 31.7% and 'all cancers' for 34.1% of YLLs, they were responsible, respectively, for 44.7 and 27.9% of death counts. The results for Italy generally corresponded with those obtained in GBD 2000 for EURO-A, but the proportion of the total mortality burden explained by the four leading causes is higher in Italy. For within Italy comparisons, there was a decreasing trend from north to south for 'all cancers' and for several specific cancers. Conversely, a consistent increase in YLL rates from north to south was observed for stroke and hypertensive disease. Conclusions: This analysis of Italy's mortality burden represents the first phase in identifying Italy's total BOD. Simply establishing death counts and rates is no longer sufficient for a full understanding of a country's health status.