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Atti LA STATISTICA A SUPPORTO DELLA SALUTE: DALLA PREVENZIONE ALLA CONTINUITÀ DELLE CURE ATTI DEL IX CONGRESSO NAZIONALE SISMEC Segreteria di rediazione: Anna Bossi, Elena Spada, WebMarketingMedia Edizione: Marzo 2018 A cura di: Consiglio Direttivo SISMEC Copyright: SISMEC ISBN 978-88-943456-0-5 Si ingraziano Bristol-Myers Squibb e Novartis per il contributo non condizionato alla realizzazione degli Atti I Atti Comitato Scientifico Elia Biganzoli (Università degli Studi di Milano) Flavia Carle (Università Politecnica delle Marche) Giovanni Corrao (Università degli Studi di Milano-Bicocca) Ivan Cortinovis (Università degli Studi di Milano) Adriano Decarli (Università degli Studi di Milano) Monica Ferraroni (Università degli Studi di Milano) Ciro Gallo (Università degli Studi della Campania "Luigi Vanvitelli") Carlo La Vecchia (Università degli Studi di Milano) Umberto Genovese (Università degli Studi di Milano) Francesco Masedu (Università degli Studi dell'Aquila) Rocco Micciolo (Università di Trento) Silvano Milani (Università degli Studi di Milano) Antonella Piga (Università degli Studi di Milano) Patrizio Pasqualetti (AFaR-Associazione Fatebenefratelli per la Ricerca - Roma) Paolo Trerotoli (Università degli Studi di Bari) Maria Grazia Valsecchi (Università degli Studi di Milano-Bicocca) Anna Zolin (Università degli Studi di Milano) Consiglio Direttivo Franco Cavallo (Presidente) Anna Bossi (Presidente eletto) Simona Villani (Segretario) Rosaria Gesuita (Tesoriere) Giulia Barbati Lucia Simoni Simone Accordini Paolo Chiodini Comitato Organizzatore Anna Bossi Ivan Cortinovis Valeria Edefonti Elena Spada Anna Zolin Segreteria Organizzativa WebMarketingMedia webmarketingmedia.it LECCO - MONZA - BERGAMO - BARI – VARSAVIA II Atti Gli articoli pubblicati su prestigiose riviste scientifiche (per un pubblico di esperti) e le notizie riportate dai media (per un pubblico più vasto) ci informano, quasi giornalmente, sulle conseguenze per la salute, dell'invecchiamento, di errati stili di vita, della ricomparsa di malattie che si ritenevano eradicate, delle strategie di prevenzione e dell’uso di nuovi farmaci. Spesso però le informazioni riportate sono contrastanti, di non facile interpretazione o provengono da analisi non corrette, da studi mal programmati o male interpretati. Infatti, le tecnologie dell’informazione rendono disponibili, facilmente e in tempo reale, i risultati della ricerca biomedica e la “medicina basata sulle evidenze” (EBM) insegna come utilizzare appropriatamente questi risultati nella pratica corrente. Tuttavia, come riportato dal Prof. Vettore (Presidente emerito della Società Italiana di Pedagogia Medica) sul Bollettino d'Informazione sui Farmaci dell’AIFA - … non bisogna farsi prendere da “deliri di onnipotenza”: i risultati scientifici non sono sempre corretti, e soprattutto non sono mai certi, completi e definitivi, ma solo probabili e provvisori; e poi nella clinica anche la migliore delle conoscenze scientifiche va filtrata attraverso l’esperienza del medico e le aspettative del paziente, perché l’EBM – come diceva Sackett – non è un “libro di ricette da cucina”. Prendere decisioni razionali, e corrette, in ambito sanitario richiede quindi non solo competenza clinica, ma anche capacità di usare metodi adeguati a valutare l'efficacia degli interventi che si attuano per la salute dei singoli e della collettività. Inoltre, perché tutti capiscano la razionalità dei risultati delle ricerche scientifiche e li accolgano, è di importanza cruciale che i mezzi di comunicazione (specializzati, o di massa) forniscano informazioni corrette e comprensibili sugli effetti che gli stili di vita, le condizioni ambientali, nonché le strategie di prevenzione, diagnosi, cura e riabilitazione hanno sulla salute di ciascuno. In questo ambito, il metodo statistico riveste un ruolo indispensabile sia nell'assicurare l'attendibilità delle statistiche sanitarie correnti, sia nel pianificare studi osservazionali e sperimentazioni cliniche eticamente accettabili, sia infine nell'interpretare i risultati e disseminarli in modo chiaro e non distorto. Il IX Congresso Nazionale SISMEC intende contribuire a consolidare il rapporto di collaborazione tra ricercatori clinici e statistici per migliorare la salute di tutti. Con questo intento, l’argomento principale della prima giornata sarà relativo all’impatto dello stile di vita sulla salute e quello della seconda, alle nuove strategie terapeutiche e alla valutazione del danno e dell’accertamento della colpa nel caso di “errori” nella cura. Infine, nella terza giornata, sarà discusso come poter monitorare la continuità delle cure quando sono coinvolti molteplici interlocutori e differenti modalità assistenziali. Con l’augurio che la partecipazione attiva dei Soci della Società e dei ricercatori e professionisti della salute, interessati ad approfondire e discutere l’applicazione del metodo biostatistico ed epidemiologico per arricchire le conoscenze e promuovere la salute, possa far germogliare e crescere alberi robusti… III Atti Continua a piantare i tuoi semi, perché non saprai mai quali cresceranno – forse lo faranno tutti Albert Einstein IV Atti - Epidemiologia Generale e Clinica EPIDEMIOLOGIA GENERALE E CLINICA 1 Atti - Epidemiologia Generale e Clinica CARDIOVASCULAR DISEASE RISK ESTIMATION IN THE WORKING POPULATION: DISCRIMINATION ABILITY OF LIFESTYLE RISK FACTORS AND JOB-RELATED CONDITIONS Veronesi Giovanni1, Gianfagna Francesco1,2, Borchini Rossana3, Grassi Guido4, Iacoviello Licia1,2, Cesana Giancarlo4, Tayoun Patrick5, Ferrario Marco Mario1,3 1. Research Centre in Epidemiology and Preventive Medicine, Department of Medicine and Surgery, University of Insubria, Varese, Italy. 2. IRCCS Neuromed, Pozzilli, Italy 3. Occupational Medicine Unit, Varese Hospital, Varese, Italy 4. Department of Medicine, University of Milano-Bicocca, Monza, Italy. 5. School of Medicine, University of Insubria, Varese, Italy Introduction Lifestyle and job-related (LS&JR) conditions are recognized risk factors for cardiovascular disease (CVD), but their prognostic utility remains to be established in prospective studies. We investigated the discrimination ability at 10 years of LS&JR risk factors in a Northern Italian working male population. Methods N=2532 men, 35-64 years, free of CVD and employed at the time of recruitment (1989-1996) in either the MONICA-Brianza and PAMELA (3 population-based surveys) or the SEMM (1 factory-based survey) studies, were available for the analyses. At baseline, the following LS&JR conditions were ascertained: measured height and weight; self-reported smoking (current vs. non-current) and alcohol intake (drinks/day; less than 1, 1-3, 4-5 and 6 or more); job strain (high vs. non-high; Job Content Questionnaire); physical activity (PA) at work (low, intermediate and intense, according to sample tertiles) and doing sport (minutes/week of moderate or intense activity) from the Baecke questionnaire. Workers were followed-up to the first occurrence of coronary event, acute revascularizations, or ischemic stroke, fatal and non-fatal. A 10-year risk estimation model was developed using LS&JR risk factors satisfying the Akaike Information Criterion for the selection of candidate predictors, and contrasted to a standard risk score including blood lipids, blood pressure, smoking and diabetes. Model discrimination was estimated by the Area Under the ROC-Curve (AUC), in the overall sample and among workers at “low” risk and therefore not qualifying for preventive actions according to European guidelines [1]. Results During 14 years of median follow-up, we observed n=162 events (10-year risk: 4.3%). Body mass index was not associated with the endpoint. The following risk factors met the AI Criterion and entered into the LS&JR model: smoking (Hazard Ratio=2.49, p<.0001); alcohol intake (less than 1 drink/day: HR=1.52, 95%CI 1.03- 2.23; 6+ drinks/day: HR=1.81, 1.11-2.95; 3df p=0.07); job strain (HR=1.39, p=0.06); combined sport and occupational PA (5df p=0.02), as the HRs for sport PA changed between workers at low (HR=0.42) and intense (HR=1.55) occupational PA (interaction test p=0.001). The model was well-calibrated (Gronnesby- Borgan chi-square statistic 7.7, p=0.6) and its discrimination ability (AUC=0.750, bootstrapped 95% CI: 0.702-0.780) did not differ from the standard model (AUC=0.749) in the overall sample. The AUC for the LS&JR model was 0.743 among “low” risk workers (1832, with 91 events). Of these, 38% could have been selected for preventive action based on their estimated LS&JR risk; 1 every 16 was a CVD case. 2 Atti - Epidemiologia Generale e Clinica Conclusions In our working male population, lifestyle and job-related conditions had the same discriminant ability than clinical and biological risk factors in identifying future cardiovascular events, and they may improve stratification of the overwhelming majority of workers classified at low risk by standard scores. A LS&JR risk score may increase feasibility and lower costs of CVD screening at the workplace. References [1] Piepoli MF, Hoes AW, Agewall S, et al. European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice. Eur Heart J 2016;37:2315-81. 3 Atti - Epidemiologia Generale e Clinica SEDENTARINESS AND EDUCATION CONTRIBUTE SIGNIFICANTLY TO SOCIOECONOMIC INEQUALITIES IN NON-COMMUNICABLE DISEASES Matranga Domenica1, Bono Filippa2 1. Dipartimento di Scienze
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