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Morbosità e mortalità: un approccio multicausa al fenomeno della droga Roberta Crialesi, Alessandra Burgio, Francesco Grippo, Marilena Pappagallo Migliorare.

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Presentazione sul tema: "Morbosità e mortalità: un approccio multicausa al fenomeno della droga Roberta Crialesi, Alessandra Burgio, Francesco Grippo, Marilena Pappagallo Migliorare."— Transcript della presentazione:

1 Morbosità e mortalità: un approccio multicausa al fenomeno della droga Roberta Crialesi, Alessandra Burgio, Francesco Grippo, Marilena Pappagallo Migliorare la comprensione del fenomeno droga: quali dati per le politiche Roma, 26 gennaio 2015 Istat, Aula Magna

2 La riduzione della perdita di vite umane causata dal consumo di stupefacenti è una priorità strategica delle politiche di lotta alla droga e uno degli obiettivi di salute pubblica dell’Unione europea Valutare scientificamente le conseguenze dirette e indirette dell’uso di droghe non è semplice. Nel corso degli ultimi anni, le politiche di riduzione del danno hanno stimolato l’adozione di approcci basati su dati incontrovertibili. Uno degli approcci più innovativi per fornire un quadro realistico dell’impatto delle droghe sulla salute della popolazione italiana è quello basato sulla comorbidity e sulla cause multiple di decesso Occorrono indicatori innovativi per misurare, in modo più accurato, la reale dimensione del fenomeno estendendo l’osservazione a tutti i casi, direttamente o indirettamente, collegati all’abuso di droghe. Elementi chiave della strategia europea di riduzione del danno Roma, 26 gennaio 20152

3 Obiettivi dello studio Analizzare la mortalità indotta da droga e l’ospedalizzazione dei pazienti tossicodipendenti per descrivere l’evoluzione nel tempo dei principali indicatori secondo il genere, l’età e le macro aree di residenza Utilizzare l’approccio per cause multiple per  fornire nuovi indicatori basati su tutte le informazioni riportate sia nel certificato di morte sia nelle SDO  valutare statisticamente le associazioni tra l’abuso di droga e altre condizioni patologiche 3 Roma, 26 gennaio 2015

4 In Italy an average of 4,2 conditions are reported. The International Classification of Diseases (Icd) contains instruction for coding each condition and for the selection of the Underlying cause. Causes of Death Register Refers to all cases occurred in Italy Certifying physician reports a sequence of conditions leading to death on the death form: Part 1: Line a (Underlying cause) ___________________________________ Line b (complications) ___________________________________ Line c ___________________________________ Line d ___________________________________ Part 2 (Other causes ___________________________________ Contributing) ___________________________________ Hiv infection Kaposi’s sarcoma Heroin dependency for many years Pneumonia Septicemia Coding Each Condition: Icd-10 codes B24 C46 J18.9 A41.9 F11.2 SELECTION Process UC: B24 HIV disease In Italy, until 2003 data only this information was published Traditionally, final statistics are based on UNDERLYING CAUSE OF DEATH One for each record defined as: (a)the disease of injury which initiated the train of events leading directly to death, or (b)the circumstances of the accident or violence which produced the fatal injury Since 2003 data also this information is available MULTIPLE CAUSES OF DEATH Specimen based on Istat D4 4

5 Drug-induced mortality: selection of Icd codes (EMCDDA selction B for international comparison and time series) ICD-10: years 2003, Mental and behavioural disorders due to psychoactive substance use F11: opioids; F12: cannabinoids, F14: cocaine; F15: other stimulants, including caffeine; F16: hallucinogens; F19: other psychoactive substances Accidental poisoning X42 1) : narcotics and psychodysleptics [hallucinogens], not elsewhere classified; X41 2 antiepileptic, sedative-hypnotic, antiparkinsonism and psychotropic drugs, not elsewhere classified Intentional self-poisoning X62 1) : narcotics and psychodysleptics [hallucinogens], not elsewhere classified; X61 2) : antiepileptic, sedative-hypnotic, antiparkinsonism and psychotropic drugs, not elsewhere classified. Poisoning undetermined intent Y12 1) : psychodysleptics [hallucinogens], not elsewhere classified, undetermined intent; Y11 2) : antiepileptic, sedative-hypnotic, antiparkinsonism and psychotropic drugs, not elsewhere classified, undetermined intent. 1) in combination with the T-codes: T40.0-9: Poisoning by narcotics and psychodysleptics [hallucinogens]; 2) in combination with T code: T43.6 Poisoning by psychotropic drugs, Psychostimulants with abuse potential. 5

6 Numero di decessi droga-indotti avvenuti in Italia registrati nel database ISTAT sulle cause di morte (popolazione presente). Anni Confronto con Emcdda 6 Numero di decessi

7 Trends per genere ed età Anni

8 Mortalità indotta da droghe per macroarea e anno di decesso. Poolazione residente, anni Tassi std.di mortalità per abitanti Geografia

9 Underlying cause of death Multiple cause of death Ratio Multiple/ Underlying deaths crude rate standardiz ed rate deaths crude rate standardiz ed rate year 6050,878161,181, ,673981,532, ,15790,362,4 Total males 6921,191, ,911,841,6 females 1210,210,201780,300,291,5 Total 8130, ,101,071,6 Drug-related deaths in selected age groups as underlying and multiple cause. Years Total , ,391,361,3 9

10 Number of drug-induced deaths Year Number of deaths 10

11 Methods Age-standardized relative risk (RR) was used to measure association among drug related cause and the other conditions reported on the death certificate The relative risk can be seen as a measure of the strength of association of a certain cause with drug- related condition. Assumed that RR is approximately log-normally distributed: where Proportion of estimated deaths with a specific condition A among those WITH mention of drug-related cause Proportion of estimated deaths with a specific condition A among those WITHOUT mention of drug-related cause Cause A mentioned Cause A not mentioned Mention of drug-related cause Without mention of drug- related cause Associations of conditions with drug-related causes.

12 Associations of conditions with drug-related causes cases, Italy Icd10Condition Prevalence in drug users deaths Prevalence in non-drug users deaths Age- standardized RR CI95% Certificates mentioning the condition among drug users deaths A00-B99Infectious and parasitic diseases23,89,43,43,2-3,7308 B20-B24 AIDS7,11,25,94,8-7,292 B15-B19, B94.2 Viral hepatitis18,22,510,79,7-11,8235 F01-F99Mental and behavioural disorders (excluded those included in EMCDDA) 14,24,06,86,2-7,5184 F10Mental and behavioural disorders due to use of alcohol9,60,917,515,4-20,0124 I00-I99Diseases of the circulatory system40,448,01,11,0-1,2522 I33Acute and subacute endocarditis0,90,17,03,9-12,611 I38Endocarditis, valve unspecified1,20,32,01,0-3,915 J00-J99Diseases of the respiratory system32,624,61,21,1-1,3422 K00-K92Diseases of the digestive system22,116,11,81,6-1,9286 K70, K73-K74 Cirrhosis, fibrosis and chronic hepatitis16,26,23,63,2-4,0209 K70Alcoholic liver disease 3,31,32,72,0-3,643 K73Chronic hepatitis, not elsewhere classified 1,10,219,514,3-26,714 R00-R99Symptoms signs and ill-defined causes38,633,61,11,1-1,2499 R75Laboratory evidence of human immunodeficiency virus [HIV] 1,30,19,15,4-15,217 V00-Y99External causes of death (excluded those included in EMCDDA)52,614,02,42,2-2,6680 Roma, 26 gennaio

13 Schede di Dimissione Ospedaliera (SDO) La diagnosi principale è utilizzata per la costruzione di indicatori statistici (come per le cause di morte) International Classification of Diseases 9 th Revision, Clinical Modification (ICD9CM) Diagnosi principale e fino a 5 Diagnosi secondarie In media sono riportate 2.5 diagnosi per ricoveri ordinary e 1,6 per day hospital Le Diagnosi sono codificate direttamente in ospedale DIAGNOSI PRINCIPALE definita come la malattia che alla dimissione viene identificata come la principale responsabile del trattamento e delle procedure fornite dall’ospedale. DIAGNOSI SECONDARIA Definite come quelle condizioni che coesistono al momento del ricovero o che si sviluppano in seguito a tale momento e che influenzano il trattamento ricevuto e/o la durata della degenza Co-morbidity approach 13

14 Number of hospital discharges for drug-related disorders From 10,968 in 1999 to 5,857 in 2012 (-46.6%) Sharp decrease between 1999 and 2003, smoothed afterwards Number of patients treated in outpatient facilities for drug-related disorders 14

15 Trends by age Age-specific hospitalization rates for drug-related disorders per 100,000 residents Higher hospitalization rates in the age group years followed by years before 2009 and years too afterwards Age gaps reduced over time Roma, 26 gennaio

16 Drug-related hospitalizations years. Main diagnosis and All diagnosis. Years , All diagnosis:  Decreasing std rates…  …due to the decrease in the age group years…  …while rates slightly increase after 45 years of age Hospitalizations with mention of drug use or poisoning is 2.8 higher than the number based on the Main diagnosis Gender gap: std rates higher for men (1.5 times for main diag., 2.1 times for all diag.) 16

17 Drug-related hospitalizations by substance (dependence, abuse or poisoning) years - All diagnosis. Ratios All diagnosis / Main diagnosis Standardized hospitalization rates for drug-related disorders per 100,000 residents (absolute numbers in the bars) Ratios Males / Females 17

18 Associations of conditions with drug-related diagnosis (1) Roma, 26 gennaio

19 Associations of conditions with drug-related diagnosis (2) Roma, 26 gennaio

20 20 Istat, Navigando tra le fonti demografiche e sociali, WHO. International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10). Geneva: WHO; Emcdda methods and definitions Istat. Cause di morte. Anno vari. Emcdda, Data, drug related death and mortality Istat. Cause multiple di morte. Anno Istat, I.Stat, Salute e sanità, Ricorso ai servizi sanitari, Ospedalizzazione per disturbi psichici Ministero della Salute, La classificazione delle malattie ICD9CM. e&lingua=italiano e&lingua=italiano Riferimenti bibliografici Roma, 26 gennaio 2015

21 Grazie per l’attenzione Roma, 26 gennaio

22 1.The victims of drug poisoning or abuse sharply decreased during the last decades. 2.In the last twenty years, the percentage of individuals aged year increased. 3.The multiple cause approach estimates 60% more drug-related mortality. 4.The analysis of all conditions allows to describe the most relevant pathological pattern of drug-users deaths in Italy. 5.Further developments: linkage between sources. Roma, 26 gennaio

23 Limitations and Warning 1: the Multiple Causes of Death approach Results are strongly related to the quality of certificate completion (the percentage of unknown or uninformative causes of death, in the age group 25-44, the most affected by drug-induced mortality, shows about 4% of poorly informative or unknown causes of death while it is 0,3% when all the age groups) All results of MCOD approach refer to the deaths and cannot be extended to the general population If the drug condition is present at the time of death but non contributing to it, this condition is not reported by the physician Roma, 26 gennaio


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