Declining trends of premature mortality from ischemic heart disease and regional differences in Italy from 2011 to 2017

Aims: Data regarding the premature mortality (<65 years of age) due to ischemic heart disease (IHD) in Italy are scant. We sought to analyze the incidence of premature death due to IHD in Italy and its time trend between years 2011 and 2017.Methods and results: We used the free publicly available EUROSTAT death certificate database to examine pre-mature age-adjusted IHD mortality rates (per 100.000) and relative average annual percentage change (AAPC) in Italy from 2011 to 2017 using ICD-codes I20-I25. Over the study period, the proportional IHD-related mortality rates decline from 8.09% to 7.1% in the entire population (p for trend 0.012), showing a significant reduction in women (from 4.06% to 3.40%, p for trend: 0.02) but not in men (from 10.3% to 9.3%, p for trend 0.062). The age-adjusted IHD mortality rate decreased with an AAPC of-4.1 per year [(95% CI,-5.1 to-3.0), p < 0.001], resulting more pronounced in women [AAPC:-4.4 per year (95% CI:-6.4 to-2.3,), p = 0.001)] than in men [AAPC:-3.7 per year (95% CI:-5.4 to-2.0, p = 0.003)]. Age-adjusted IHD premature death rates above the 90th percentile were distributed in Italian southern regions and islands of Italy while premature death rates below the 10th percentile were clustered in the western and northeastern regions of the country. Conclusions: In Italy, premature IHD-related mortality remains an important contributor to overall mortality. Age-adjusted mortality declined in the last decade, especially in the northern regions and among women. Moreover, a marked region-level variations were observed.