Geographical and temporal trends in infant mortality in Italy and current limits of the routine data

Objective: to compare trends in infant, neonatal and post-neonatal mortality in Italy from 1991 to 2005 both at the national level anti among the three Italian large geographical macro-areas (North, Center, South-Islands). Design: observational study based on routine data. Setting and participants: the analyst's was performed on the cohort of newborns (up to the first age of life) in Italy from 1991 to 2005. Main outcome measures: infant, neonatal and post-neonatal mortality rate calculated for 3-year and 5-year periods, relative risks, attributable fraction. Results: during the study period infant mortality rates significantly decreased from 7.72 to 3.91 per 1,000 births, neonatal mortality rates from 5,87 to 2.84 per 1,000 births, and postneonatal mortality rates from 1.85 to 1.08. Despite these significant reductions, important disparities persist in different geographical areas within hilly In particular, rates appears to be much higher in the southern regions of the country: during the period 2001-2005 the excess of mortality in the South comparing with the North was 37%. Since 1998, following a change in legislation, individual matching of Certificates of Delivery Care (CedAP) and Death Certificates during the first year of life, at a national level, is not possible. Conclusion: during the period 1991-2005 Italy experienced significant infant mortality reduction, but important geographical disparities still remain. In order to investigate these disparities and the determinants of infant mortality in Italy, the lack of routine data could represent an important limit to conduct update epidemiologic studies.