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  1. Article ; Online: Diabetes as a cause of death across different COVID-19 epidemic waves.

    Fedeli, Ugo / Casotto, Veronica / Schievano, Elena / Bonora, Enzo / Zoppini, Giacomo

    Diabetes research and clinical practice

    2022  Volume 190, Page(s) 109984

    Abstract: Aims: The aim of this study is to assess the role of diabetes as a cause of death through different epidemic waves of COVID-19.: Methods: The annual percentage change in age-standardized rates (APC) was estimated for diabetes as the underlying (UCOD) ...

    Abstract Aims: The aim of this study is to assess the role of diabetes as a cause of death through different epidemic waves of COVID-19.
    Methods: The annual percentage change in age-standardized rates (APC) was estimated for diabetes as the underlying (UCOD) and as multiple causes of death (MCOD) in 2008-2019. Diabetes-related deaths in 2020 were compared to the 2018-2019 average. SARIMA models were applied to monthly excess in mortality considering seasonality and long-term trends.
    Results: 2018-2019-Age-standardized mortality rates decreased, especially among females (MCOD: APC -2.49, 95%CI -3.01/-1.97%). In 2020, deaths increased by 19% (95%CI 13-25%) for UCOD, and by 27% (95%CI 24-30%) for MCOD. Diabetes and COVID-19 accounted for 74% of such excess. During the first epidemic wave, the increase in observed rates vs predicted by the model was larger in males (March +39%, April +46%) than in females (+30% and +32%). In the second wave, a huge excess of similar magnitude was observed in the two sexes; rates in December exceeded those predicted by more than 100%.
    Conclusions: The COVID-19 pandemic abruptly interrupted a long-term declining trend in mortality associated to diabetes. MCOD analyses are warranted to fully estimate the impact of epidemic waves on diabetes-related mortality.
    MeSH term(s) COVID-19/epidemiology ; Cause of Death ; Diabetes Mellitus/epidemiology ; Female ; Humans ; Male ; Mortality ; Pandemics
    Language English
    Publishing date 2022-07-06
    Publishing country Ireland
    Document type Journal Article
    ZDB-ID 632523-3
    ISSN 1872-8227 ; 0168-8227
    ISSN (online) 1872-8227
    ISSN 0168-8227
    DOI 10.1016/j.diabres.2022.109984
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    Zs.A 2047: Show issues Location:
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  2. Article ; Online: Mortality trend of ischemic heart disease (2008-2022): A retrospective analysis of epidemiological data.

    Wolf, Simon / Schievano, Elena / Amidei, Claudio Barbiellini / Kucher, Nils / Valerio, Luca / Barco, Stefano / Fedeli, Ugo

    International journal of cardiology

    2024  , Page(s) 132042

    Abstract: Background: Age-sex specific trend analyses of ischemic heart disease (IHD)-related mortality and prevalent risk factors can improve our understanding and approach to the disease.: Methods: We performed a 15-year retrospective epidemiological ... ...

    Abstract Background: Age-sex specific trend analyses of ischemic heart disease (IHD)-related mortality and prevalent risk factors can improve our understanding and approach to the disease.
    Methods: We performed a 15-year retrospective epidemiological analysis of acute and chronic IHD-related mortality and prevalent cardiovascular risk factors using administrative data from Veneto, a socio-economically homogeneous Italian region. Standard mortality statistics using the underlying cause of death (UCOD) and deaths with any mention of IHD in death certificates (MCOD) from ICD-10 codes I20-I25 was performed between 2008 and 2022.
    Results: A total of 134,327 death certificates reported IHD-related deaths, representing 18.6% of all deaths. Proportional mortality decreased from 14.6% in 2008 to 7.8% in 2022 for deaths with IHD as the UCOD and from 23.5% to 14.6% for deaths with IHD among the MCOD. A more pronounced decline of proportionate and case-specific mortality rate was seen in women. The decline in mortality over the whole study period was larger for acute (vs. chronic) IHD. The COVID-19 pandemic led to a marked increase in mortality in 2020 (+12.2%) with a subsequent further decline. IHD-related deaths displayed a typical seasonal pattern with more deaths during winter. The prevalence of cardiovascular risk factors was higher in IHD (vs. no IHD) deaths: this association appeared more pronounced in younger adults.
    Conclusions: We provided an analysis of epidemiological trends in IHD-related mortality and prevalence of risk factors. Our findings indicate a change in the pattern of cardiovascular deaths and may suggest a switch in death from acute to chronic conditions.
    Language English
    Publishing date 2024-04-12
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 779519-1
    ISSN 1874-1754 ; 0167-5273
    ISSN (online) 1874-1754
    ISSN 0167-5273
    DOI 10.1016/j.ijcard.2024.132042
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    Zs.A 1673: Show issues Location:
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  3. Article ; Online: Mortality Associated with Idiopathic Pulmonary Fibrosis in Northeastern Italy, 2008-2020: A Multiple Cause of Death Analysis.

    Marcon, Alessandro / Schievano, Elena / Fedeli, Ugo

    International journal of environmental research and public health

    2021  Volume 18, Issue 14

    Abstract: Mortality from idiopathic pulmonary fibrosis (IPF) is increasing in most European countries, but there are no data for Italy. We analysed the registry data from a region in northeastern Italy to assess the trends in IPF-related mortality during 2008-2019, ...

    Abstract Mortality from idiopathic pulmonary fibrosis (IPF) is increasing in most European countries, but there are no data for Italy. We analysed the registry data from a region in northeastern Italy to assess the trends in IPF-related mortality during 2008-2019, to compare results of underlying vs. multiple cause of death analyses, and to describe the impact of the COVID-19 epidemic in 2020. We identified IPF (ICD-10 code J84.1) among the causes of death registered in 557,932 certificates in the Veneto region. We assessed time trends in annual age-standardized mortality rates by gender and age (40-74, 75-84, and ≥85 years). IPF was the underlying cause of 1310 deaths in the 2251 certificates mentioning IPF. For all age groups combined, the age-standardized mortality rate from IPF identified as the underlying cause of death was close to the European median (males and females: 3.1 and 1.3 per 100,000/year, respectively). During 2008-2019, mortality rates increased in men aged ≥85 years (annual percent change of 6.5%, 95% CI: 2.0, 11.2%), but not among women or for the younger age groups. A 72% excess of IPF-related deaths was registered in March-April 2020 (mortality ratio 1.72, 95% CI: 1.29, 2.24). IPF mortality was increasing among older men in northeastern Italy. The burden of IPF was heavier than assessed by routine statistics, since less than two out of three IPF-related deaths were directly attributed to this condition. COVID-19 was accompanied by a remarkable increase in IPF-related mortality.
    MeSH term(s) Aged ; Aged, 80 and over ; COVID-19 ; Cause of Death ; Europe ; Female ; Humans ; Idiopathic Pulmonary Fibrosis ; Italy/epidemiology ; Male ; Mortality ; SARS-CoV-2
    Language English
    Publishing date 2021-07-06
    Publishing country Switzerland
    Document type Journal Article
    ISSN 1660-4601
    ISSN (online) 1660-4601
    DOI 10.3390/ijerph18147249
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  4. Article ; Online: Change in trends of hospitalizations and deaths with mention of

    Bellio, Stefania / Fedeli, Ugo / Schievano, Elena / Saia, Mario

    Infection control and hospital epidemiology

    2021  Volume 43, Issue 10, Page(s) 1512–1513

    MeSH term(s) Humans ; Clostridium Infections/epidemiology ; Clostridioides difficile ; Hospitalization ; Italy/epidemiology
    Language English
    Publishing date 2021-07-29
    Publishing country United States
    Document type Journal Article
    ZDB-ID 639378-0
    ISSN 1559-6834 ; 0195-9417 ; 0899-823X
    ISSN (online) 1559-6834
    ISSN 0195-9417 ; 0899-823X
    DOI 10.1017/ice.2021.317
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    Zs.A 1714: Show issues Location:
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  5. Article ; Online: Excess diabetes-related deaths: The role of comorbidities through different phases of the COVID-19 pandemic.

    Fedeli, Ugo / Amidei, Claudio Barbiellini / Casotto, Veronica / Schievano, Elena / Zoppini, Giacomo

    Nutrition, metabolism, and cardiovascular diseases : NMCD

    2023  Volume 33, Issue 9, Page(s) 1709–1715

    Abstract: Background and aims: Diabetes confers an excess risk of death to COVID-19 patients. Causes of death are now available for different phases of the pandemic, encompassing different viral variants and COVID-19 vaccination. The aims of the present study ... ...

    Abstract Background and aims: Diabetes confers an excess risk of death to COVID-19 patients. Causes of death are now available for different phases of the pandemic, encompassing different viral variants and COVID-19 vaccination. The aims of the present study were to update multiple causes of death data on diabetes-related mortality during the pandemic and to estimate the impact of common diabetic comorbidities on excess mortality.
    Methods and results: Diabetes-related deaths in 2020-2021 were compared with the 2018-2019 average; furthermore, age-standardized rates observed during the pandemic were compared with expected figures obtained from the 2008-2019 time series through generalized estimating equation models. Changes in diabetes mortality associated with specific comorbidities were also computed. Excess diabetes-related mortality was +26% in 2020 and +18% in 2021, after the initiation of the vaccination campaign. The presence of diabetes and hypertensive diseases was associated with the highest mortality increase, especially in subjects aged 40-79 years, +41% in 2020 and +30% in 2021.
    Conclusion: The increase in diabetes-related deaths exceeded that observed for all-cause mortality, and the risk was higher when diabetes was associated with hypertensive diseases. Notably, the excess mortality decreased in 2021, after the implementation of vaccination against COVID-19.
    Language English
    Publishing date 2023-05-30
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 1067704-5
    ISSN 1590-3729 ; 0939-4753
    ISSN (online) 1590-3729
    ISSN 0939-4753
    DOI 10.1016/j.numecd.2023.05.028
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    Zs.A 3149: Show issues Location:
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  6. Article ; Online: Association of multiple-sclerosis-related mortality with COVID-19 and other common infections: a multiple causes of death analysis.

    Fedeli, Ugo / Barbiellini Amidei, Claudio / Avossa, Francesco / Schievano, Elena / Kingwell, Elaine

    European journal of neurology

    2023  Volume 30, Issue 9, Page(s) 2870–2873

    Abstract: Background and purpose: People with multiple sclerosis (MS) suffer from higher infection-related mortality compared to the general population; however, sparse data are available on the increased risk of death associated with coronavirus disease 2019 ( ... ...

    Abstract Background and purpose: People with multiple sclerosis (MS) suffer from higher infection-related mortality compared to the general population; however, sparse data are available on the increased risk of death associated with coronavirus disease 2019 (COVID-19) and other common types of infections.
    Methods: All mortality records and multiple-cause-of-death data in 2010-2021 of residents in the Veneto region (northeastern Italy) were extracted. Mention of specific infections was compared between death certificates reporting MS or not. Odds ratios (OR) with 95% confidence intervals (95% CI) were estimated by conditional logistic regression matching by age, sex and calendar year. The bimonthly averages of MS-related deaths in 2010-2019 were compared with those registered during the pandemic (2020-2021).
    Results: Of 580,015 deaths through 2010-2021, MS was mentioned in 850 cases (0.15%), 59.3% women. Influenza and pneumonia were reported in 18.4% of MS-related compared to 11.0% non-MS-related deaths (OR 2.72, 95% CI 2.28-3.25). The odds of mention of urinary tract infections was significantly greater in MS-related deaths of men (OR 8.16, 95% CI 5.23-12.7) than women (OR 3.03, 95% CI 1.82-5.02). Aspiration pneumonia, pressure ulcers/skin infections and sepsis were also significantly associated with MS-related deaths. Reporting of COVID-19 as a cause of death did not significantly differ between deaths with and without mention of MS (approximately 11% of both). However, compared to 2010-2019, peaks in MS-related deaths were observed during the pandemic waves.
    Conclusions: Infections continue to play a significant role in MS-related deaths, underlying the need to improve prevention and management strategies.
    MeSH term(s) Male ; Humans ; Female ; COVID-19 ; Cause of Death ; Sclerosis ; Causality ; Multiple Sclerosis/complications
    Language English
    Publishing date 2023-06-20
    Publishing country England
    Document type Journal Article
    ZDB-ID 1280785-0
    ISSN 1468-1331 ; 1351-5101 ; 1471-0552
    ISSN (online) 1468-1331
    ISSN 1351-5101 ; 1471-0552
    DOI 10.1111/ene.15912
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    Zs.A 4738: Show issues Location:
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    Zs.MO 592: Show issues

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  7. Article ; Online: Decline in Overall Pulmonary Embolism-Related Mortality and Increasing Prevalence of Cancer-Associated Events in the Veneto Region (Italy), 2008-2019.

    Valerio, Luca / Fedeli, Ugo / Schievano, Elena / Avossa, Francesco / Barco, Stefano

    Thrombosis and haemostasis

    2021  Volume 122, Issue 5, Page(s) 789–795

    Abstract: Background: Despite evidence of ongoing epidemiological changes in deaths from venous thromboembolism in high-income countries, little recent information is available on the time trends in mortality related to pulmonary embolism (PE) as underlying or ... ...

    Abstract Background: Despite evidence of ongoing epidemiological changes in deaths from venous thromboembolism in high-income countries, little recent information is available on the time trends in mortality related to pulmonary embolism (PE) as underlying or concomitant cause of death in Europe.
    Methods: We accessed the regional database of death certificates of Veneto Region (Northern Italy, population 4,900,000) from 2008 to 2019. We analyzed the trends in crude and age-adjusted annual rates of mortality related to PE (reported either as underlying cause or in any position in the death certificate) using Joinpoint regression; in the contribution of PE to mortality (proportionate mortality); and, using logistic regression, in the association between PE and cancer at death.
    Results: Between 2008 and 2019, the annual age-standardized mortality rate related to PE in Veneto decreased from 20.7 to 12.6 deaths per 100,000 population for PE in any position of the death certificate, and from 4.6 to 2.2 deaths per 100,000 population for PE as underlying cause of death. PE-related proportionate mortality remained up to twice as high in women. The age- and sex-adjusted odds ratio for cancer in deaths with versus without PE constantly increased from 1.01 (95% confidence interval [CI]: 0.88-1.16) in 2008 to 1.58 (95% CI: 1.35-1.83) in 2019.
    Conclusion: The descending trends in PE-related mortality reported for Europe up to 2015 for both sexes continued thereafter in this high-income region of Northern Italy. However, sex differences in proportionate mortality persist. The increasing strength in the association between cancer and PE may indicate a change in risk factor distribution, calling for tailored management practices in this patient group.
    MeSH term(s) Cause of Death ; Europe/epidemiology ; Female ; Humans ; Italy/epidemiology ; Male ; Mortality ; Neoplasms/epidemiology ; Prevalence ; Pulmonary Embolism/epidemiology
    Language English
    Publishing date 2021-08-24
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 518294-3
    ISSN 2567-689X ; 0340-6245
    ISSN (online) 2567-689X
    ISSN 0340-6245
    DOI 10.1055/a-1548-4948
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    Uh III Zs.192: Show issues Location:
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  8. Article ; Online: Suicide mortality among psychiatric patients in Northeast Italy: a 10-year cohort study.

    Girardi, Paolo / Boldrini, Tommaso / Braggion, Marco / Schievano, Elena / Amaddeo, Francesco / Fedeli, Ugo

    Epidemiology and psychiatric sciences

    2022  Volume 31, Page(s) e17

    Abstract: Aims: The present study investigated the relationship between suicide mortality and contact with a community mental health centre (CMHC) among the adult population in the Veneto Region (northeast Italy, population 4.9 million). Specifically, it ... ...

    Abstract Aims: The present study investigated the relationship between suicide mortality and contact with a community mental health centre (CMHC) among the adult population in the Veneto Region (northeast Italy, population 4.9 million). Specifically, it estimated the effects of age, gender, time elapsed since the first contact with a CMHC, calendar year of diagnosis and diagnostic category on suicide mortality and modality.
    Methods: The regional mortality archive was linked to electronic medical records for all residents aged 18-84 years who had been admitted to a CMHC in the Veneto Region in 2008. In total, 54 350 subjects diagnosed with a mental disorder were included in the cohort and followed up for a period of 10 years, ending in 2018. Years of life lost (YLL) were computed and suicide mortality was estimated as a mortality rate ratio (MRR).
    Results: During the follow-up period, 4.4% of all registered deaths were from suicide, but, given the premature age of death (mean 52.2 years), suicide death accounted for 8.7% of YLL; this percentage was particularly high among patients with borderline personality disorder (27.2%), substance use disorder (12.1%) and bipolar disorder (11.5%) who also presented the highest suicide mortality rates. Suicide mortality rates were halved in female patients (MRR 0.45; 95% CI 0.37-0.55), highest in patients aged 45-54 years (MRR 1.56; 95% CI 1.09-2.23), and particularly elevated in the 2 months following first contact with CMHCs (MRR 10.4; 95% CI 5.30-20.3). A sensitivity analysis restricted to patients first diagnosed in 2008 confirmed the results. The most common modalities of suicide were hanging (47%), jumping (18%), poisoning (13%) and drowning (10%), whereas suicide from firearm was rare (4%). Gender, age at death and time since first contact with CMHCs influenced suicide modality.
    Conclusions: Suicide prevention strategies must be promptly initiated after patients' first contact with CMHCs. Patients diagnosed with borderline personality disorder, substance use disorder and bipolar disorder may be at particularly high risk for suicide.
    MeSH term(s) Adolescent ; Adult ; Aged ; Aged, 80 and over ; Bipolar Disorder/epidemiology ; Cohort Studies ; Female ; Humans ; Italy/epidemiology ; Middle Aged ; Substance-Related Disorders/epidemiology ; Suicide/psychology ; Young Adult
    Language English
    Publishing date 2022-03-30
    Publishing country England
    Document type Journal Article
    ZDB-ID 2607964-1
    ISSN 2045-7979 ; 2045-7960
    ISSN (online) 2045-7979
    ISSN 2045-7960
    DOI 10.1017/S2045796021000792
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    Zs.A 5143: Show issues Location:
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  9. Article ; Online: Estimating Overall and Cause-Specific Excess Mortality during the COVID-19 Pandemic: Methodological Approaches Compared.

    Barbiellini Amidei, Claudio / Fedeli, Ugo / Gennaro, Nicola / Cestari, Laura / Schievano, Elena / Zorzi, Manuel / Girardi, Paolo / Casotto, Veronica

    International journal of environmental research and public health

    2023  Volume 20, Issue 11

    Abstract: During the COVID-19 pandemic, excess mortality has been reported worldwide, but its magnitude has varied depending on methodological differences that hinder between-study comparability. Our aim was to estimate variability attributable to different ... ...

    Abstract During the COVID-19 pandemic, excess mortality has been reported worldwide, but its magnitude has varied depending on methodological differences that hinder between-study comparability. Our aim was to estimate variability attributable to different methods, focusing on specific causes of death with different pre-pandemic trends. Monthly mortality figures observed in 2020 in the Veneto Region (Italy) were compared with those forecasted using: (1) 2018-2019 monthly average number of deaths; (2) 2015-2019 monthly average age-standardized mortality rates; (3) Seasonal Autoregressive Integrated Moving Average (SARIMA) models; (4) Generalized Estimating Equations (GEE) models. We analyzed deaths due to all-causes, circulatory diseases, cancer, and neurologic/mental disorders. Excess all-cause mortality estimates in 2020 across the four approaches were: +17.2% (2018-2019 average number of deaths), +9.5% (five-year average age-standardized rates), +15.2% (SARIMA), and +15.7% (GEE). For circulatory diseases (strong pre-pandemic decreasing trend), estimates were +7.1%, -4.4%, +8.4%, and +7.2%, respectively. Cancer mortality showed no relevant variations (ranging from -1.6% to -0.1%), except for the simple comparison of age-standardized mortality rates (-5.5%). The neurologic/mental disorders (with a pre-pandemic growing trend) estimated excess corresponded to +4.0%/+5.1% based on the first two approaches, while no major change could be detected based on the SARIMA and GEE models (-1.3%/+0.3%). The magnitude of excess mortality varied largely based on the methods applied to forecast mortality figures. The comparison with average age-standardized mortality rates in the previous five years diverged from the other approaches due to the lack of control over pre-existing trends. Differences across other methods were more limited, with GEE models probably representing the most versatile option.
    MeSH term(s) Humans ; Child, Preschool ; COVID-19 ; Pandemics ; Cardiovascular Diseases ; Italy/epidemiology ; Neoplasms/epidemiology ; Mortality
    Language English
    Publishing date 2023-05-24
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2175195-X
    ISSN 1660-4601 ; 1661-7827
    ISSN (online) 1660-4601
    ISSN 1661-7827
    DOI 10.3390/ijerph20115941
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  10. Article ; Online: Veneto Region dementia-related mortality during the COVID-19 pandemic: multiple causes of death and time series analysis.

    Basso, Cristina / Barbiellini Amidei, Claudio / Casotto, Veronica / Schievano, Elena / Dotto, Matilde / Tiozzo Netti, Silvia / Zorzi, Manuel / Fedeli, Ugo

    European journal of public health

    2023  Volume 33, Issue 2, Page(s) 190–195

    Abstract: Background: Older individuals with dementia have been severely affected by the COVID-19 pandemic. There is a lack of in-depth evaluation of mortality trends using both the underlying cause of death (UCOD) and the multiple causes of death (MCOD) ... ...

    Abstract Background: Older individuals with dementia have been severely affected by the COVID-19 pandemic. There is a lack of in-depth evaluation of mortality trends using both the underlying cause of death (UCOD) and the multiple causes of death (MCOD) approaches. The objective of this study was to determine the impact of the COVID-19 pandemic on dementia-related deaths considering comorbidities and the place of death.
    Methods: This retrospective, population-based study was conducted in Veneto, Italy. All the death certificates of individuals aged ≥65 years issued from 2008 to 2020 were analyzed for dementia-related mortality using age-standardized sex-stratified rates of dementia as UCOD and MCOD. Excess in monthly dementia-related mortality in 2020 was estimated by applying Seasonal Autoregressive Integrated Moving Average (SARIMA) model.
    Results: Overall, 70 301 death certificates reported dementia (MCOD proportional mortality: 12.9%), and 37 604 cases identified it as UCOD (proportional mortality: 6.9%). In 2020, the MCOD proportional mortality increased to 14.3% whereas that of UCOD remained static (7.0%). Compared to the SARIMA prediction, MCOD increased by 15.5% in males and 18.3% in females in 2020. Compared to the 2018-19 average, deaths in nursing homes increased by 32% in 2020, at home by 26% and in hospitals by 12%.
    Conclusions: An increase in dementia-related mortality during the first months of the COVID-19 pandemic could only be detected using the MCOD approach. MCOD proved to be more robust, and hence, should be included in future analyses. Nursing homes appeared to be the most critical setting which should guide establishing protective measures for similar situations.
    MeSH term(s) Male ; Female ; Humans ; Cause of Death ; Retrospective Studies ; Time Factors ; Pandemics ; COVID-19 ; Dementia/epidemiology ; Mortality
    Language English
    Publishing date 2023-04-01
    Publishing country England
    Document type Journal Article
    ZDB-ID 1129243-x
    ISSN 1464-360X ; 1101-1262
    ISSN (online) 1464-360X
    ISSN 1101-1262
    DOI 10.1093/eurpub/ckad005
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    Zs.A 3499: Show issues Location:
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