D. Balzi

In recent decades, the increase in incidence of melanoma (MM) and the consequent mortality pointed to the concept of a ‘melanoma epidemic’. More recently, the mortality has been slowly declining in many countries. This study is aimed at evaluating the incidence, mortality and survival in the Florentine area of Italy, using registry-based information. Between 1985 and 1994, 997 cases were notified with a survival of 713 patients (1985–92) and 316 deaths. Age-adjusted incidence, mortality rates and 95% confidence interval were calculated by period, gender and Breslow thickness. The relative survival rates were calculated and the effects of prognostic factors were evaluated using multivariate analysis. The incidence of MM increased during this period. This result referred only to ‘thin melanomas’, while the incidence rate for melanomas thicker than 1.00 mm remained unchanged both in young and old individuals. The mortality rate remained stable. The 5-year survival rate increased between 1985 and 1992. The inclusion of Breslow thickness in the multivariate model caused a reduction of the period effect. In conclusion, a changing pattern of MM epidemiology is being observed, with increase of ‘thin’ forms and a tendency for mortality to decline. The increasing awareness of population about MM prevention may partially explain these findings.

In the period 1989-94, mortality rates for the most important causes of death in people migrated to the Tuscany from other Italian regions were analysed. The area of birth was assessed according to the information on province of birth recorded on death certificates. For this analysis we classified Italy into Tuscany and five broad areas, each including a number of political regions: North-West, North-East, Centre, South and Islands. The number of person-years for calculation of the mortality risks was based on 1991 census data, which also included information on place of birth and on current residence. The risks of death of subjects born in other Italian areas and resident in Tuscany ("migrated populations") in comparison to Tuscany born population were assessed by means of Poisson multivariate regression models. For most sites (particularly for lung and breast), cancer mortality rates were higher among North-West and North-East born people and lower among Centre, South and Islands born people. Gastric cancer mortality was higher in Tuscany born subjects. Cardiovascular diseases mortality was generally lower among people born outside of the Tuscany, with the exception of ischaemic heart disease (higher in North-West and Islands born people). Liver cirrhosis mortality was generally higher in North-West, North-East, South and Islands born subjects (with some differences between males and females). Diabetes mellitus mortality was higher in South and Islands born people. AIDS and opioids overdose mortality was higher in North-West born subjects. Mortality for external causes was higher in people born outside of the Tuscany. Both in males and females, overall mortality was higher in North-West and lower in South born people and lower in Centre and Islands born males.

From the original records of the Italian Central Institute of Statistics (ISTAT) alcohol-related deaths in Italy during the 1980-1990 period were estimated applying alcohol-attributable fractions (AAFs), derived from the national and international literature, to a list of alcohol-related diagnoses. Age-adjusted mortality rates direct method) were computed for each year sex and geographic region. Alcohol-related years of potential life lost (YPLL) to age 70 were estimated only for 1990. In 1990 overall alcohol-related deaths were 18,033 (males: 12,937; females: 5,096), accounting for 3.3% of all deaths in Italy (males: 4.6%: females 2.0%. Over 200,000 YPLL (males: 162,318; females 38,367) to age 70 were attributable to alcohol-related causes each death contributing on average with 11.1 YPLL (males: 12.5; females: 7.5). Among individual causes of death, chronic disease (malignant neoplasms and liver diseases) represent 65% of ARM, while intentional and unintentional injuries account for almost 35% of ARM According to the decreasing temporal trend of alcohol intake in Italy, during the 1980-1990 period, ARM decreased by 17% in both sexes (from 51.3 x 100,000 to 42.4 in males from 18.1 to 15.2 in females). Geographic variability of ARM in Italy suggests that in Central regions some protection factors concomitant with alcohol and hepatitis viruses exposure (diet, type of alcoholic beverage, pattern of alcohol make genetic factors) could account for the reduced risk of alcohol-induced biologic damage.

In this paper we present the risk of death for stomach, colon, rectum and pancreas cancers in Italian migrants to Canada, Argentina, Australia, France and England and Wales. Estimations of relative risks (RR) in Italian migrants, in residents in Italy and in Southern Italy relative to the local born in the host country are shown. Relative risks in Italian migrants to Australia were analysed also by duration of stay in the host country. The Italian migrants' cancer profile in intermediate between the origin and the host population: a reduction of risk of death for stomach cancer and an increase of risk for colorectal cancers are the main results. The results are discussed taking into account the analysis by duration of residence and the pattern of food prevalent in the different countries considered.