Fausto Francia, Paolo Pandolfi, Anna Odone, Carlo Signorelli
1 Department of Public Health, Local Health Authority of Bologna, Italy.
2 Department of Medicine and Surgery, University of Parma, Italy.
Scand J Public Health. 2018 Mar;46(2):170-174. doi: 10.1177/1403494817720102. Epub 2017 Oct 24.
The aims of this study were to explore 2015 mortality data further and to assess excess deaths' determinants.
We analysed data from a large metropolitan area in the north of Italy, the city of Bologna. We took advantage of a comprehensive local-level database and merged three different data sources to analitically explore reported 2014-2015 excess mortality and its determinants. Effect estimates were derived from multivariable Poisson regression analysis, according to vaccination status and frailty index.
We report 9.8% excess mortality in 2015 compared to 2014, with seasonal and age distribution patterns in line with national figures. All-cause mortality in the elderly population is 36% higher (risk ratio [RR]=1.36, 95% confidence interval [CI] 1.27-1.45) in subjects not vaccinated against seasonal flu compared to vaccinated subjects, with risk of death for influenza or pneumonia being 43% higher (RR=1.43, 95% CI 1.02-2.00) in unvaccinated subjects.
Reported excess mortality's determinants in Italy should be further explored. Elderly subjects not vaccinated against the flu appear to have increased risk of all-cause and cause-specific mortality compared to vaccinated subjects after accounting for possible confounders. Our findings raise awareness of the need to promote immunisation against the flu among elder populations and offer insights to plan and implement effective public-health interventions.
本研究旨在进一步探究2015年的死亡率数据，并评估超额死亡的决定因素。
我们分析了意大利北部大都市博洛尼亚市的数据。我们利用了一个全面的地方层面数据库，并合并了三个不同的数据源，以分析性地探究2014 - 2015年报告的超额死亡率及其决定因素。效应估计值来自多变量泊松回归分析，根据疫苗接种状况和虚弱指数进行分析。
与2014年相比，我们报告2015年超额死亡率为9.8%，其季节性和年龄分布模式与全国数据一致。与接种季节性流感疫苗的受试者相比，未接种疫苗的老年人群全因死亡率高36%（风险比[RR]=1.36，95%置信区间[CI] 1.27 - 1.45），未接种疫苗的受试者因流感或肺炎死亡的风险高43%（RR=1.43，95% CI 1.02 - 2.00）。
意大利报告的超额死亡率的决定因素应进一步探究。在考虑了可能的混杂因素后，未接种流感疫苗的老年受试者与接种疫苗的受试者相比，全因死亡率和特定病因死亡率似乎有所增加。我们的研究结果提高了人们对在老年人群中推广流感免疫接种必要性的认识，并为规划和实施有效的公共卫生干预措施提供了见解。
