Italian National Register Of Major Coronary Events: Attack Rates And Lethality In Different Areas Of The Country

Background. The national register is a monitoring surveillance system of fatal and non-fatal events in the general population aged 35-74 years; it was launched in Italy at the end of the 1990's with the aim of estimating the occurrence and fatality of coronary events in different geographical areas of the country.Methods. Two sources of information were used to assess current events: death certificates and hospital discharge diagnosis registers. Once the events were identified through the International Classification for Diseases-ICD9 codes and the duration of the event, the number of current events in each single area was multiplied for the positive predictive value of each specific mortality or discharge code derived from suspected events validated by applying the MONICA Project diagnostic criteria. The attack rate was calculated as the mean value of a 2-year period, dividing the average number of estimated events by the average resident population; case fatality was calculated at 28 days from admission as fatal to total event ratio.Results. Attack rates are higher in men than in women: mean age-adjusted (Italian population 1998) attack rate of all areas was 33.9 per 10 000 men and 9.1 per 10 000 women; age-adjusted 28-day case fatality was higher in women (35.5%) than in men (27.3%). Statistically significant geographical differences in comparison with the mean attack rate of all areas were found both in men and women. Case fatality rates result significantly heterogeneous when compared among areas in men but not in women.Conclusions. Results show that there still exist some differences in the geographic distribution of attack rate and fatality of coronary events which seem to be independent of the North-South gradient. These data show the feasibility of implementing a population-based register, essential for cardiovascular disease surveillance.