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The Health profile in Tuscany Fabio Voller

Regional Health Agency of Tuscany fabio.voller@ars.toscana.it

Agenzia regionale di sanità della Toscana www.ars.toscana.it

Intersectoral approaches for active and healthy aging16--‐17 October 2014 –Villa la Quiete –Florence,Italy”

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• Residents are 3.692.828• 31.126 births and 43.456 deaths took place in 2012 • The currently high life expectancy at birth is

increasing, it is one of the highest in Italy and in the world

• Life expectancy is higher for women than for men• Life expectancy at the age of 65 is high and growing• Foreigners are 9.5% (350,761) and increasing• Births and fertility are low • Mortality is low• Ageing is pronounced

Tuscan demography in brief

Source: ISTAT data as at 31/12/2012

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Life expectancy at birth – Tuscany vs Italy

Age

For the last 30 years the life expectancy of the Tuscan population has been growing (+11.8% for M and +7.8% for F).Life expectancy at birth is higher for women: 84.8 years vs 80.1 for men. Tuscany presents a higher life expectancy in comparison to Italy (IT-M: 79.6 years; IT-F: 84.4).

Source: ARS on ISTAT data 1980-2012

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Life expectancy at birth in some developed countries

Country Age males Age femalesJapan 79 86

Tuscany 79 85Italy 79 84

Sweden 79 83France 78 85

Germany 77 83UK 78 82

USA 76 81………. ………….. ………………

Lithuania 66 78

Source: WHO 2008

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An overview of Tuscan demography

Low number of births, low fertility+

Low mortality

Ageing22.8% over 65

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Resident foreign population

350,761 foreigners are in Tuscany as at 12th Dec 2012.

%

Source: ARS on ISTAT data

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Effects of demographic change

• Increase in demented (97,600 in 2020) and disabled (85,600 in 2020) elderly people

• Increase in the prevalence of chronic diseases and disability

• Women living longer but with more health problems

• Weakening of women’s family care-giver role• Foreigners mitigating the negative

demographic impact

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Mortality in Tuscany

• General mortality is constantly and progressively decreasing, and is always lower than the Italian average

• Infant mortality is decreasing, and is always lower than the Italian average

• Maternal mortality is lower than the Italian average

• Premature mortality is decreasing, and is lower than the Italian average

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General mortality - Tuscany vs Italy 1972-2011

Standardized ratio *100.000 inhabitants

Source: ARS on ISTAT data. ISTAT data 2004-2006 are not available.

General mortality is constantly and progressively decreasing, and is always lower than the Italian average.

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Lifestyles in Tuscany

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Smoking habit (%) >14 years – Year 2012

In Tuscany:•The smoker’s profile is similar to the Italian one• 23% of smokers are adult (about 750.000)• smokers are decreasing, above all males• New smokers are not decreasing• girls (14-19) smoke more than boys, and the number is increasing• smoke-related mortality is decreasing, especially in males

Source: ARS on ISTAT data

Smoking habitTuscany Italy

2012 2012

Males

Smokers 26.6 27.3

Ex-smokers 31.5 29.0

Non-smokers 41.8 43.7

Females

Smokers 19.7 16.1

Ex-smokers 18.7 15.9

Non-smokers 61.6 68.0

Total

Smokers 23.0 21.5

Ex-smokers 24.9 22.2

Non-smokers 52.1 56.3

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Alcohol in Tuscany• Consumption is more regular (above all wine)• Adults drink more than in the rest of Italy, but above all during

meals• Binge drinking and getting drunk are less widespread• Total alcohol consumption is decreasing, and alcohol-related

mortality is decreasing (as it is in Italy)• Youths fit with national and international patterns (drinking at

weekends, more binge drinking, not at meals, on social occasions)

• The risk of road accidents is high for youths drinking while driving

• Adolescents (especially girls) prematurely start drinking in excess, as in the rest of Italy

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Binge drinking – Year 2012

Fonte: ARS su dati ISTAT

% population >11 years consuming at least 6 alcohol units (glass of wine and/or beer and/or aperitive and/or spririt in one occasion (binge drinking)

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Death causes of Tuscan residents

• Every year about 41,500 people die from all causes

• 2/3 die from cardiovascular diseases (CDV) and cancers

• CDV mortality is falling and lower than the national average (care is improving)

• Cancer mortality is falling and is lower than the national average (care and prevention are improving)

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Deaths by cause in Tuscany – Year 2011

Nr = 41,690

Source: ARS on Regional Mortality Registry data

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Cardiovascular mortality – Tuscany vs Italy 1972-2011

Standardized ratesby age

Adults: cardiovascular diseases represent the main cause of death, tumors the second highest cause.Elderly people: circulatory system diseases are the main cause of death after the age of 80 years, for both men and women.

Source: ARS on ISTAT data. ISTAT data 2004-2006 are not available.

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Cancer mortality – Tuscany vs Italy – 1972-2011

Standardized ratesby age * 100,000 inhabitants

Men: tumors are the first cause of death after the age of 45 years until the age of 84, then they are surpassed by circulatory system diseases.Women: tumors are the first cause of death after the age of 45 years until the age of 64, before being surpassed by circulatory system diseases.

Source: ARS on ISTAT data. ISTAT data 2004-2006 are not available.

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Tumors in Tuscany vs Italy

• Incidence (number of new cases) is stable or increasing, in line with the Italian average

• Mortality is decreasing because care and prevention are improving, more than in Italy: survival is improving but prevalence (number of cancer-deseased people) is increasing

• Stomach cancer incidence and mortality are high (diet and genetics)

• Female breast, and colon-rectum cancer incidence is high, but mortality is low (protective screening effect?)

• (Breast, uterus, colon-rectum) screening has better indicators than in Italy

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Cancer mortality in Tuscany – Year 2010 Standardized rates x 100,000 inhabitants

Tuscany Italy

All tumors 186.5 197.0

Stomach 13.0 11.3

Colon-rectum 22.8 24.8

Lung 35.5 41.3

Breast 20.5 23.6

Source: www.tumori.net (INT – ISS)

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