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Francesco Forastiere

Publications and source records attributed to Francesco Forastiere.

At least 19 recordsLinked to original sources
PubMed2007

Methodological issues regarding confounding and exposure misclassification in epidemiological studies of occupational exposures.

BACKGROUND: Confounding and exposure misclassification are issues that concern epidemiologists because of their potential to bias results of studies and complicate interpretations. In occupational epidemiology both are routinely raised to argue that an observed result is either a false positive or a false negative finding. Although it is important to consider the potential for limitations of epidemiologic investigations, judgment regarding their importance should be based on their actual likelihood of occurrence. METHODS: This paper is based on our experience in epidemiologic analyses and a brief review of the literature regarding confounding and exposure misclassification. RESULTS: Examples of substantial confounding are rare in occupational epidemiology. In fact, even for studies of occupational exposures and lung cancer, tobacco-adjusted relative risks rarely differ appreciably from the unadjusted estimates. This is surprising because it seems the perfect situation for confounding to occur. Yet, despite the lack of evidence that confounding is a common problem, nearly every epidemiologic paper includes a lengthy discussion on uncontrolled or residual confounding. On the other hand, exposure misclassification probably occurs in all studies. The only question is, how much? The direction and magnitude of nondifferential exposure misclassification (the type most likely to occur in cohort studies) on estimates of relative risks can be largely predicted given knowledge on the degree of misclassification, that is, relatively small amounts of misclassification can bias relative risks substantially towards the null. The literature, however, is full of discussions implying that misclassification of exposure is an explanation for a positive finding. CONCLUSIONS: These comments are not to suggest that all potential limitations for epidemiologic studies should not be considered and evaluated. We do believe, however, that the likelihood of occurrence and the direction and magnitude of the effect should be more carefully and realistically considered when making judgments about study design or data interpretation.

Age Factors↗
PubMed2007

Socioeconomic status, particulate air pollution, and daily mortality: differential exposure or differential susceptibility.

BACKGROUND: Short-term increases in particulate air pollution are linked with increased daily mortality and morbidity. Socioeconomic status (SES) is a determinant of overall health. We investigated whether social class is an effect modifier of the PM(10) (particulate matter with diameter <10 micron)-daily mortality association, and possible mechanisms for this effect modification. METHODS: Area-based traffic emissions, income, and SES were available for each resident in Rome. All natural deaths (83,253 subjects) occurring in Rome among city residents (aged 35+ years) during the period 1998-2001 were identified. For each deceased individual, all the previous hospitalizations within 2 years before death were available via a record linkage procedure. PM(10) daily data were available from two urban monitoring sites. A case-crossover analysis was utilized in which control days were selected according to the time stratified approach (same day of the week during the same month). Conditional logistic regression was used. RESULTS: Due to the social class distribution in the city, exposure to traffic emissions was higher among those with higher area-based income and SES. Meanwhile, people of lower social class had suffered to a larger extent from chronic diseases before death than more affluent residents, especially diabetes mellitus, hypertension, heart failure, and chronic obstructive pulmonary diseases. Overall, PM(10) (lag 0-1) was strongly associated with mortality (1.1% increase, 95%CI = 0.7-1.6%, per 10 microg/m(3)). The effect was more pronounced among persons with lower income and SES (1.9% and 1.4% per 10 microg/m(3), respectively) compared to those in the upper income and SES levels (0.0% and 0.1%, respectively). CONCLUSIONS: The results confirm previous suggestions of a stronger effect of particulate air pollution among people in low social class. Given the uneven geographical distributions of social deprivation and traffic emissions in Rome, the most likely explanation is a differential burden of chronic health conditions conferring a greater susceptibility to less advantaged people.

Adult↗
PubMed2006

The influence of socioeconomic status on utilization and outcomes of elective total hip replacement: a multicity population-based longitudinal study.

OBJECTIVE: In countries with universal health coverage, socioeconomic status is not expected to influence access to effective treatment and its prognosis. We tested whether socioeconomic status affects the rates of elective total hip replacement and whether it plays a role in early and late outcomes. DESIGN: Multicity population-based longitudinal study. SETTING AND PARTICIPANTS: From Hospital Registries of four Italian cities (Rome, Milan, Turin, and Bologna), we identified 6140 residents aged 65+ years undergoing elective total hip replacement in 1997-2000. MAIN OUTCOME MEASURES: An area-based (census block) income index was used for each individual. Poisson regression yielded rate ratios (RR) of population occurrence by income level. Logistic regression estimated odds ratios (OR) of selected outcomes within 90 days. Cox proportional hazard models evaluated effects of income on rates of revision of total hip replacement and mortality up to 31 December 2004. Analyses were adjusted for age, gender, city of residence, and coexisting medical conditions. RESULTS: Low-income people were less likely than high-income counterparts to undergo total hip replacement [RR = 0.87, 95% confidence interval (CI) 0.81-0.95]; the effect was stronger among those aged 75+ years (RR = 0.76, 95% CI = 0.66-0.86). Low income was associated with higher risk of acute adverse medical events (P trend = 0.05) and of general infections and decubitus ulcer (P trend = 0.02) within 90 days. The effects were even higher among those aged 75+ years. No effects were found either for orthopaedic complications within 90 days or for revision and mortality. CONCLUSIONS: Total hip replacement is underutilized among elderly deprived individuals. Disadvantaged patients seem more vulnerable to acute adverse medical events after surgery. The evidence of unmet need and poor prognosis of low social class people has important implications for health care policy.

Aged↗
PubMed2006

Socioeconomic differentials in premature mortality in Rome: changes from 1990 to 2001.

BACKGROUND: While socioeconomic inequalities in mortality have widened in many countries, evidence of social differentials is scarce in Southern Europe. We studied temporal changes in premature mortality across socioeconomic groups in Rome between 1990 and 2001. METHODS: We analysed all 126,511 death certificates of residents of Rome aged 0-74 years registered between 1990-2001. A 4-level census block index based on the 1991 census was used as an indicator of socioeconomic position (SEP). Using routine mortality data, standardised mortality rates (per 100,000 inhabitants) were calculated by SEP and gender for four time periods. Rate ratios were used to compare mortality by gender and age. RESULTS: Overall premature mortality decreased in both genders and in all socioeconomic groups; the change was greater in the highest socio-economic group. In both men and women, inequalities in mortality strengthened during the 1990s and appeared to stabilise at the end of the 20th century. However, for 60-74 year old women the gap continued to widen. CONCLUSION: Socioeconomic inequalities in health in Rome are still present at the beginning of the 21st century. Strategies to monitor the impact of SEP on mortality over time in different populations should be implemented to direct health policies.

Adolescent↗
PubMed2006

Parental smoking and lung function: misclassification due to background exposure to passive smoking.

We evaluated the role played by background exposure (i.e. exposure to Environmental Tobacco Smoke, ETS, from sources other than parental smoking) when evaluating the effect of parental smoking on lung function of adolescents. We performed a cross-sectional survey (937 adolescents) in the Lazio Region. Data were collected by a questionnaire, lung function tests and urinary cotinine to creatinine ratios (CCR) were measured. We found that 62.1% of subjects were exposed to current parental smoke. Among the 355 adolescents not exposed to parental smoke, a total of 92 (25.9%) had CCR levels greater than the median value of the distribution (17.3 ng/mg). Subjects with smoking parents had higher FVC and significant lower FEV(1)/FVC ratios than subjects without smoking parents. When "Background" ETS exposure was removed from the unexposed group by separately studying those without parental exposure but with CCR>17.3, results showed a reduction in lung function due to parental smoking which is greater compared to the previous model. Our study adds further evidence regarding the detrimental effect of ETS on lung function of adolescents. Negative results on the effect of parental smoking on lung function should be revisited if background exposure has not been considered in the analysis.

Adolescent↗
PubMed2006

Maternal complications and procedures in pregnancy and at birth and wheezing phenotypes in children.

RATIONALE: There is increasing interest in the potential influence of fetal and early life conditions on childhood wheezing. OBJECTIVES: To investigate the associations between maternal complications and procedures in pregnancy and at birth and the risk of various wheezing phenotypes in young children. METHODS: We studied 15,609 children, aged 6-7 yr, enrolled in a population-based study. Standardized questionnaires were completed by the children's mothers. RESULTS: Of the children, 9.5% (1,478) had transient early wheezing, 5.4% (884) had persistent wheezing, and 6.1% (948) had late-onset wheezing. Maternal hypertension or preeclampsia was associated with an increased risk of all three wheezing phenotypes (for transient early wheezing: odds ratio [OR], 1.40; 95% confidence interval [95% CI], 1.08-1.82; for persistent wheezing: OR, 1.59; 95% CI, 1.15-2.19; and for late-onset wheezing: OR, 1.47; 95% CI, 1.06-2.01). Use of antibiotics for urinary tract infections was associated with transient early wheezing (OR, 1.52; 95% CI, 1.16-2.00), whereas antibiotic administration at delivery was associated with both transient early wheezing (OR, 1.21; 95% CI, 1.01-1.46) and persistent wheezing (OR, 1.39; 95% CI, 1.10-1.75). Children who had a mother with diabetes were also more likely to have persistent wheezing (OR, 1.72; 95% CI, 0.99-3.00). Neither amniocentesis/chorionic villus sampling, nor weight gain in pregnancy, nor cesarean section was associated with the subsequent development of wheezing. Maternal asthma or atopy was not an effect modifier of the associations found. CONCLUSIONS: Some maternal complications during pregnancy and at delivery may increase the risk of developing different phenotypes of wheezing in childhood.

Child↗
PubMed2006

Comparison of different methods in analyzing short-term air pollution effects in a cohort study of susceptible individuals.

BACKGROUND: Short-term fluctuations of ambient air pollution have been associated with exacerbation of cardiovascular disease. A multi-city study was designed to assess the probability of recurrent hospitalization in a cohort of incident myocardial infarction survivors in five European cities. The objective of this paper is to discuss the methods for analyzing short-term health effects in a cohort study based on a case-series. METHODS: Three methods were considered for the analyses of the cohort data: Poisson regression approach, case-crossover analyses and extended Cox regression analyses. The major challenge of these analyses is to appropriately consider changes within the cohort over time due to changes in the underlying risk following a myocardial infarction, slow time trends in risk factors within the population, dynamic cohort size and seasonal variation. RESULTS: Poisson regression analyses, case-crossover analyses and Extended Cox regression analyses gave similar results. Application of smoothing methods showed the capability to adequately model the complex time trends. CONCLUSION: From a practical point of view, Poisson regression analyses are less time-consuming, and therefore might be used for confounder selection and most of the analyses. However, replication of the results with Cox models is desirable to assure that the results are independent of the analytical approach used. In addition, extended Cox regression analyses would allow a joint estimation of long-term and short-term health effects of time-varying exposures.

Journal Article↗
PubMed2006

Respiratory symptoms/diseases and environmental tobacco smoke (ETS) in never smoker Italian women.

AIM: To study the relationship between respiratory/allergic disorders and chronic environmental tobacco smoke (ETS) exposure to husband or at workplace among non-smoking women of a general population in Italy. METHODS: Analyses regard 2195 married or employed women. Information was collected through a self-administered questionnaire. ETS exposure was validated by salivary cotinine. RESULTS: Exposure both to husband and at work resulted a significant risk factor for current dyspnoea (odds ratio (OR) 1.61, 95% confidence interval (CI) 1.20-2.16), any shortness of breath at rest (OR 2.81, 95% CI 1.83-4.30), recent wheeze (OR 1.71, 95% CI 1.04-2.82), recent attacks of shortness of breath with wheeze (OR 1.85, 95% CI 1.05-3.26), asthma diagnosis/symptoms (OR 1.50, 95% CI 1.09-2.08), diagnosis of asthma or bronchitis/emphysema (obstructive lung diseases (OLD)) (OR 2.24, 95% CI 1.40-3.58), current cough/phlegm (OR 1.52, 95% CI 1.07-2.15), and rhino-conjunctivitis (OR 1.48, 95% CI 1.13-1.94). Exposure only at work yielded higher adjusted odds ratios for all health conditions, except for rhino-conjunctivitis. Overall, about 24% of shortness of breath at rest, 16% of dyspnoea, 17% of rhino-conjunctivitis, 12% of OLD, and 10% of asthma diagnosis/symptoms are attributable to the effect of exposures to both husband and at work. Twelve percent of shortness of breath at rest and 10% of rhino-conjunctivitis cases might be avoided by eliminating exposure only at work and only to husband, respectively. CONCLUSIONS: Lifetime ETS exposure, especially at work, is associated with respiratory symptoms/diseases, and it accounts for a sizeable proportion of such disorders. The combined effect of both exposures is higher than the separate effects.

Adolescent↗
PubMed2006

Air pollution and lung function among susceptible adult subjects: a panel study.

BACKGROUND: Adverse health effects at relatively low levels of ambient air pollution have consistently been reported in the last years. We conducted a time-series panel study of subjects with chronic obstructive pulmonary disease (COPD), asthma, and ischemic heart disease (IHD) to evaluate whether daily levels of air pollutants have a measurable impact on the lung function of adult subjects with pre-existing lung or heart diseases. METHODS: Twenty-nine patients with COPD, asthma, or IHD underwent repeated lung function tests by supervised spirometry in two one-month surveys. Daily samples of coarse (PM10-2.5) and fine (PM2.5) particulate matter were collected by means of dichotomous samplers, and the dust was gravimetrically analyzed. The particulate content of selected metals (cadmium, chrome, iron, nickel, lead, platinum, vanadium, and zinc) was determined by atomic absorption spectrometry. Ambient concentrations of nitrogen dioxide (NO2), carbon monoxide (CO), ozone (O3), and sulphur dioxide (SO2) were obtained from the regional air-quality monitoring network. The relationships between concentrations of air pollutants and lung function parameters were analyzed by generalized estimating equations (GEE) for panel data. RESULTS: Decrements in lung function indices (FVC and/or FEV1) associated with increasing concentrations of PM2.5, NO2 and some metals (especially zinc and iron) were observed in COPD cases. Among the asthmatics, NO2 was associated with a decrease in FEV1. No association between average ambient concentrations of any air pollutant and lung function was observed among IHD cases. CONCLUSION: This study suggests that the short-term negative impact of exposure to air pollutants on respiratory volume and flow is limited to individuals with already impaired respiratory function. The fine fraction of ambient PM seems responsible for the observed effects among COPD cases, with zinc and iron having a potential role via oxidative stress. The respiratory function of the relatively young and mild asthmatics included in this study seems to worsen when ambient levels of NO2 increase.

Adult↗
PubMed2006

Rhinitis and snoring as risk factors for hypertension in post-menopausal women.

OBJECTIVE: Several studies have suggested an association between snoring and hypertension. An association between rhinitis and hypertension has been recently indicated in men but not in women. Since menopausal status is an important determinant of blood pressure, we evaluated the relationship between rhinitis, snoring and blood pressure taking into account the modifying effect of menopausal status. DESIGN: Cross-sectional survey. SETTINGS: Four areas of Italy: the Po river Delta, Pisa (Tuscany), Viterbo (Lazio) and Rome. MAIN OUTCOME MEASURES: Data were collected by a questionnaire and a medical visit. PARTICIPANTS: One thousand five hundred and fifty-four female non-smokers. RESULTS: Systolic blood pressure (SBP) was significantly related to both occasional and habitual snoring in the overall sample. No associations were found between SBP, snoring, and rhinitis in pre-menopausal women. Both occasional and habitual snoring, but not rhinitis, were significant risk factors for increased SBP in women who stopped menstruating fewer than 11 years previously (beta=10.27 mmHg, 95% confidence interval (CI)=3.5, 17.01 and beta=9.91 mmHg, 95% CI=2.3, 17.5, respectively). However, women who had been menopausal for more than 11 years were found to have an increased SBP if they were occasional snorers (beta=8.94 mmHg 95% CI=1.2, 16.6) or habitual snorers (beta=8.01 mmHg, 95% CI=0.10, 15.9). The increase in SBP was even greater in these women when habitual snoring was associated with rhinitis (beta=11.96 mmHg, 95% CI=1.01, 22.9). CONCLUSION: We suggest that the association of snoring with rhinitis may facilitate the development of apnea during sleep, which in post-menopausal women may increase the risk of developing hypertension.

Adult↗
PubMed2006

Continued exposure to silica after diagnosis of silicosis in Brazilian gold miners.

BACKGROUND: There is a paucity of studies analyzing the effect of continued silica exposure after the onset of silicosis with regard to disease progression. The present study investigates differences in clinical and radiological presentation of silicosis among former workers with a diagnosis of silicosis, and compares workers who continued to be exposed to silica with those who stopped silica exposure after having received their diagnosis. METHODS: A sample of 83 former gold miners with a median of 21 years from the first diagnoses of silicosis, had their clinical and occupational histories taken and underwent both chest radiography (International Labor Organization standards) and spirometry. Their silica exposure was assessed and an exposure index was created. The main outcome was the radiological severity of silicosis and tuberculosis (TB). The statistical analysis was done by multiple logistic regression. RESULTS: Among the 83 miners, 44 had continued exposed to silica after being diagnosed with silicosis. Continuation of silica exposure was associated with advanced radiological images of silicosis (X-ray classification in category 3, OR = 6.42, 95% CI = 1.20-34.27), presence of coalescence and/or large opacities (OR = 3.85, CI = 1.07-13.93), and TB (OR = 4.61, 95% CI = 1.14-18.71). CONCLUSIONS: Differential survival is unlikely to explain observed differences in silicosis progression. Results reinforce the recommendation that silica exposure should be halted at an early stage whenever X-ray is suggestive of the disease.

Adult↗
PubMed2006

Characteristics of early transient, persistent, and late onset wheezers at 9 to 11 years of age.

STUDY OBJECTIVE: To investigate the early determinants and characteristics of different phenotypes of wheeze in children on the basis of questionnaire data, lung function, and prick tests. DESIGN: Cross-sectional survey. Setting. Rome and Fiumicino municipalities in Lazio region, Italy, within the ISAAC phase II project. SUBJECTS: Sample of 2107 9-11 year old schoolchildren (response rate 83.5%). RESULTS: We divided children into four mutually exclusive groups according to onset of wheeze: 154 early transient (birth to age 2), 51 persistent (birth to age 2 and current), 66 late onset (current only), and 1,446 control subjects (no early or current wheeze). Logistic regression models have shown that a family history of asthma and allergies is strongly associated with persistent and late onset wheezing; exposure to parental smoking--both during pregnancy and during the child's first year of life--is related to persistent wheezing; all children with wheezing show a significantly greater risk to have current respiratory symptoms other than wheeze compared with control subjects; current allergic rhinoconjunctivitis symptoms and atopy are related with both persistent and late onset wheeze. Multiple linear regression models show that forced expiratory rates at 25% to 75% of vital capacity (FEF25-75) and the ratio between forced expiratory volume in 1 second and forced vital capacity (FEV1/FVC) are significantly lower both in early transient (-305 mL/s, -1.7%) and persistent (-298 mL/s, -3.2%) wheezers; FEV1/FVC is significantly reduced in late onset wheezers too (-2.0%). CONCLUSIONS: The strength of the association of family history and exposure to parental smoking varies with the three wheezing phenotypes. Moreover, early, persistent and late onset wheezers have different clinical characteristics in terms of their respiratory health and atopic status.

Age Factors↗
PubMed2006

Effects of parental smoking and level of education on initiation and duration of breastfeeding.

AIM: To evaluate the effects of parental smoking and level of education on the initiation and duration of breastfeeding in a prospective cohort study on mother-infant pairs. METHODS: We studied 543 mother-infant pairs enrolled after delivery at a hospital in Rome. Information about parents' characteristics were obtained from a questionnaire administered in hospital; the outcome of the study was the infant's feeding habits in the preceding 24 h, assessed by telephone every 2 wk. The effects of parental smoking and level of education on initiation and duration of breastfeeding were evaluated through multivariate logistic regression models and time-dependent Cox models. RESULTS: After controlling for confounding factors, we found a negative effect for mothers' smoking both on breastfeeding initiation (odds ratio 2.19, 95% CI 1.05-4.55) and duration (hazard ratio 3.37, 95% CI 1.85-6.13) when at least one parent had a low level of education. CONCLUSION: Our study shows that maternal smoking, particularly when one of the parents has a low level of education, determines a negative effect on the initiation and duration of breastfeeding. Public health policy should promote educational programmes for both parents focused on quitting smoking, which could have positive effects on the initiation and duration of breastfeeding.

Adult↗
PubMed2006

Survival and prognostic variables of cutaneous melanoma observed between 1995 and 2000 at Istituto Dermopatico Dell'Immacolata (IDI-IRCCS), Rome, Italy.

INTRODUCTION: Melanoma is an increasingly common malignancy of melanocytes, with incidence rates steadily rising over the past several decades. The objective of this study was to evaluate 5-year survival and to investigate the association between melanoma mortality and clinical and histological features. METHODS: We conducted a 5-year cohort study among 1020 patients from the same geographic area (Rome) with a single primary cutaneous melanoma diagnosed between January 1995 and December 2000. Survival probability was determined by Kaplan-Meier estimates, and prognostic factors were evaluated by multivariate analysis (Cox proportional hazards model). RESULTS: Survival decreased with increasing age (P for trend <0.049) and Breslow thickness (P for trend <0.0001). In the multivariate Cox model, Breslow thickness was the only independent prognostic factor for mortality in primary melanoma patients. The risk of death among patients with melanoma increased with increasing tumour thickness 0.76-1.49 mm (relative risk (RR) 2.67, 95% confidence interval (95% CI) 0.63-11.4); 1.50-4.0 mm (RR 6.38, 95% CI 1.75-23.2), >4.0 mm (RR 34.6, 95% CI 8.23-145.7) (P for trend <0.0001). The Years of Life Lost (YLLs) for the Breslow categories < or =0.75 mm, 0.76-1.49 mm, 1.50-4.0 mm and >4.0 mm were 65.4, 153.6, 274.3 and 317.6 years, respectively. CONCLUSION: This study shows the great importance of secondary melanoma prevention and illustrates how many years of life could be saved by early diagnosis.

Adolescent↗
PubMed2006

Short-term effects of ambient particles on cardiovascular and respiratory mortality.

BACKGROUND: Particulate air pollution is associated with increased mortality. There is a need for European results from multicountry databases concerning cause-specific mortality to obtain more accurate effect estimates. METHODS: We report the estimated effects of ambient particle concentrations (black smoke and particulate matter less than 10 mum [PM10]) on cardiovascular and respiratory mortality, from 29 European cities, within the Air Pollution and Health: a European Approach (APHEA2) project. We applied a 2-stage hierarchical modeling approach assessing city-specific effects first and then overall effects. City characteristics were considered as potential effect modifiers. RESULTS: An increase in PM10 by 10 microg/m (lag 0 + 1) was associated with increases of 0.76% (95% confidence interval = 0.47 to 1.05%) in cardiovascular deaths and 0.58% (0.21 to 0.95%) in respiratory deaths. The same increase in black smoke was associated with increases of 0.62% (0.35 to 0.90%) and 0.84% (0.11 to 1.57%), respectively. CONCLUSIONS: These effect estimates are appropriate for health impact assessment and standard-setting procedures.

Air Pollutants↗
PubMed2006

Vulnerability to heat-related mortality: a multicity, population-based, case-crossover analysis.

BACKGROUND: Although studies have documented increased mortality during heat waves, little information is available on the subgroups most susceptible to these effects. We evaluated the effects of summertime high temperature on daily mortality among population subgroups defined by demographic characteristics, socioeconomic status, and episodes of hospitalization for various conditions during the preceding 2 years. METHODS: We studied a total of 205,019 residents of 4 Italian cities (Bologna, Milan, Rome, and Turin) age 35 or older who died during 1997-2003. The case-crossover design was applied to evaluate the association between mean apparent temperature (same and previous day) and all-cause mortality. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) of dying at 30 degrees C (apparent temperature) relative to 20 degrees C were estimated accounting for time, population changes, and air pollution. RESULTS: We found an overall OR of 1.34 (CI = 1.27-1.42) at 30 degrees C relative to 20 degrees C. The odds ratio increased with age and was higher among women (OR = 1.45; 1.37-1.52) and among widows and widowers (1.50; 1.33-1.69). Low area-based income modestly increased the effect. Among the preexisting medical conditions investigated, effect modification was detected for previous psychiatric disorders (1.69; 1.39-2.07), depression (1.72; 1.24-2.39), heart conduction disorders (1.77; 1.38-2.27), and circulatory disorders of the brain (1.47; 1.34-1.62). Temperature-related mortality was higher among people residing in nursing homes, and a large effect was also detected for hospitalized subjects. CONCLUSIONS: Subsets of the population that are particularly vulnerable to high summer temperatures include the elderly, women, widows and widowers, those with selected medical conditions, and those staying in nursing homes and healthcare facilities.

Adult↗
PubMed2006

Associations of area based deprivation status and individual educational attainment with incidence, treatment, and prognosis of first coronary event in Rome, Italy.

BACKGROUND: Socioeconomic gradients in the occurrence of myocardial infarction are well known, but few studies have examined socioeconomic disparities in post-infarction outcomes. The objective of this study was to explore relations of socioeconomic status with the incidence, treatment, and outcome of first coronary event in Rome, Italy, during the period 1998-2000, examining effect modification by gender. METHODS: Subjects were Rome residents aged 35-84 years who died from first acute coronary event before reaching the hospital (n=3470) or were hospitalised for first acute myocardial infarction (n=8467). Area based deprivation status and patients' educational attainment were the exposure variables. The outcomes were: incidence of coronary event; recanalisation at the index hospitalisation and fatality within 28 days of hospitalisation; cardiac readmissions and fatality between 28 days and one year of index hospitalisation. RESULTS: Incidence rates increased as area based deprivation status increased; the effect was stronger among women than among men (men RR=1.40, 95%CI:1.30, 1.50, women RR=1.78, 95%CI:1.60, 1.98, most compared with least deprived). Rates of recanalisation were significantly lower in the most deprived patients than in the least deprived (OR=0.77, 95%CI:0.59, 0.99) and in the less educated than in the highly educated (OR=0.73, 95%CI:0.58, 0.90). Associations of short term fatality with area based deprivation status and educational attainment were weak and inconsistent. However, neither deprivation status nor education was associated with one year outcomes. CONCLUSIONS: Area based deprivation status is strongly related to incidence of coronary events, and more so among women than among men. Deprivation status and educational attainment are weakly and inconsistently associated with short term fatality but seem not to influence one year prognosis of acute myocardial infarction. Deprived and less educated patients experience limited access to recanalisation procedures.

Adult↗