Patterns of coronary heart disease mortality in Italy from 1931 to 2015 and a focus on a region with highly industrialized areas

Abstract

Background: Coronary Heart Disease (CHD) is associated with various risk factors, including environmental stressors. The aim of our paper is to study the mortality patterns in Italy with a focus on provinces of the Apulia Region from 1931 to 2015 to analyze the burden of the disease over time.

Methods: We conducted an ecological analysis of mortality from all causes and from CHD in main Italian geographical areas and in the Apulian provinces, from 1931 to 2015. Sex-specific mortality and population data were obtained from the Italian National Institute of Statistics since 1969. Direct standardized mortality rates (SDRs) per 10,000 inhabitants with 90% confidence intervals (90%CI) were calculated from 1969, using the European population as standard. The standardized mortality ratios (SMRs%) were calculated with 90%CI and the Italian population as reference.

Results: The SDRs indicate a decline in mortality from CHD in all geographical Italian areas and in the Apulian provinces for both sexes. However, this decline slowed over time, particularly in the South. The highest values of SMRs% were observed in the industrialized areas of Taranto and especially Brindisi, in both sexes.

Conclusions: The historical reconstruction over about 80 years highlighted critical issues for CHD at the start of the industrial development in the provinces of Brindisi and Taranto. This might suggest environmental pollution as risk factor for cardiovascular diseases. Furthermore, it would be necessary to verify how much other risk factors (eg. diabetes and obesity) affect the slowdown in the CHD mortality decline over the last decade.

Keywords: Cardiovascular diseases; Coronary heart disease; Geographical Italian areas; Historical analysis of mortality; Provinces of Apulia; Risk factors.