Most people prefer to receive end-of-life care in familiar surroundings rather than in hospital. This study examines variation in place of death for people dying from Parkinson’s disease (PD) across 11 European and non-European countries. Using death certificate data of 2008 for Belgium, France, Italy, Hungary, Czech Republic, New Zealand, USA, Canada, Mexico, South Korea and Spain for all deaths with PD as an underlying cause (ICD-10 code: G20) cross-national differences in place of death were examined. Associations between place of death and patient socio-demographic and regional characteristics were evaluated using multivariable binary logistic regression analyses. The proportion of deaths in hospital ranged from 17% in the USA to 75% in South Korea. Hospital was the most prevalent place of death in France (40%), Hungary (60%) and South Korea; nursing home in New Zealand (71%), Belgium (52%), USA (50%), Canada (48%) and Czech Republic (44%); home in Mexico (73%), Italy (51%) and Spain (46%). The chances of dying in hospital were consistently higher for men (Belgium, France, Italy, USA, Canada), those younger than 80 years (Belgium, France, Italy, USA, Mexico), and those living in areas with a higher provision of hospital beds (Italy, USA). In several countries a substantial proportion of deaths from PD occurs in hospitals, although this may not be the most optimal place of terminal care and death. The wide variation between countries in the proportion of deaths from PD occurring in hospital indicates a potential for many countries to reduce these proportions.

Italy was a country severely hit by the first coronavirus disease 2019 (COVID-19) pandemic wave in early 2020. Mortality studies have focused on the overall excess mortality observed during the pandemic. This paper investigates the cause-specific mortality in Italy from March 2020 to April 2020 and the variation in mortality rates compared with those in 2015–2019 regarding sex, age, and epidemic area. Causes of death were derived from the national cause-of-death register. COVID-19 was the leading cause of death among males and the second leading cause among females. Chronic diseases, such as diabetes and hypertensive, ischemic heart, and cerebrovascular diseases, with decreasing or stable mortality rates in 2015–2019, showed a reversal in the mortality trend. Moreover, mortality due to pneumonia and influenza increased. No increase in neoplasm mortality was observed. Among external causes of death, mortality increased for accidental falls but reduced for transport accidents and suicide. Mortality from causes other than COVID-19 increased similarly in both genders and more at ages 65 years or above. Compared with other areas in Italy, the Lombardy region showed the largest excess in mortality for all leading causes. Underdiagnosis of COVID-19 at the beginning of the pandemic may, to some extent, explain the mortality increase for some causes of death, especially pneumonia and other respiratory diseases.

Background: Death certificates are considered the most reliable source of information to compare cause-specific mortality across countries. The aim of the present study was to examine death certificates of persons who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to (a) quantify the number of deaths directly caused by coronavirus 2019 (COVID-19); (b) estimate the most common complications leading to death; and (c) identify the most common comorbidities. Methods: Death certificates of persons who tested positive for SARS-CoV-2 provided to the National Surveillance system were coded according to the 10th edition of the International Classification of Diseases. Deaths due to COVID-19 were defined as those in which COVID-19 was the underlying cause of death. Complications were defined as those conditions reported as originating from COVID-19, and comorbidities were conditions independent of COVID-19. Results: A total of 5311 death certificates of persons dying in March through May 2020 were analysed (16.7% of total deaths). COVID-19 was the underlying cause of death in 88% of cases. Pneumonia and respiratory failure were the most common complications, being identified in 78% and 54% of certificates, respectively. Other complications, including shock, respiratory distress and pulmonary oedema, and heart complications demonstrated a low prevalence, but they were more commonly observed in the 30–59 years age group. Comorbidities were reported in 72% of certificates, with little variation by age and gender. The most common comorbidities were hypertensive heart disease, diabetes, ischaemic heart disease, and neoplasms. Neoplasms and obesity were the main comorbidities among younger people. Discussion: In most persons dying after testing positive for SARS-CoV-2, COVID-19 was the cause directly leading to death. In a large proportion of death certificates, no comorbidities were reported, suggesting that this condition can be fatal in healthy persons. Respiratory complications were common, but non-respiratory complications were also observed.

Background: Short-term exposure to particulate matter (PM) has been related to mortality worldwide. Most evidence comes from studies conducted in major cities, while little is known on the effects of low concentrations of PM and in less urbanized areas. We aim to investigate the relationship between PM and all-cause mortality at national level in Italy. Methods: Daily numbers of all-cause mortality were collected for all 8092 municipalities of Italy, from 2006 to 2015. A satellite-based spatiotemporal model was developed to estimate daily PM₁₀ (inhalable particles) and PM_2.5 (fine particles) concentrations at 1-km resolution. Multivariate Poisson regression models were fit to estimate the association between daily PM and mortality at province level, and then, results were pooled with a random-effects meta-analysis. Associations were estimated by combination of age and sex and degree of urbanization of the municipalities. Flexible functions were estimated to explore the shape of the associations at low PM concentrations. Results: We analyzed 5,884,900 deaths (40% among subjects older than 85 years, 60% occurring outside the main urban areas). National daily mean (interquartile range) PM₁₀ and PM_2.5 concentrations were 23 (14) μg/m³ and 15 (11) μg/m³, respectively. Relative increases of mortality per 10 μg/m³ variation in lag 0–5 (average of last six days since death) PM₁₀ and PM_2.5 were 1.47% (95% Confidence Intervals (CI): 1.15%, 1.79%) and 1.96% (1.33%, 2.59%), respectively. Associations were highest among elderly and women for PM₁₀ only, similar between rural and urbanized areas, and were present even at low concentrations, e.g., below WHO guidelines. Conclusions: Air pollution was robustly associated with peaks in daily all-cause mortality in Italy, both in large cities and in less urbanized areas of Italy. Current WHO Air Quality Guidelines (2021) for PM₁₀ and PM_2.5 are not sufficient to protect public health.

With over 1 million HIV-related deaths annually, quality end-of-life care remains a priority. Given strong public preference for home death, place of death is an important consideration for quality care. This 11 country study aimed to i) describe the number, proportion of all deaths, and demographics of HIV-related deaths; ii) identify place of death; iii) compare place of death to cancer patients iv), determine patient/health system factors associated with place of HIV-related death. In this retrospective analysis of death certification, data were extracted for the full population (ICD-10 codes B20-B24) for 1-year period: deceased’s demographic characteristics, place of death, healthcare supply. i) 19,739 deaths were attributed to HIV. The highest proportion (per 1000 deaths) was for Mexico (9.8‰), and the lowest Sweden (0.2‰). The majority of deaths were among men (75%), and those aged <50 (69.1%). ii) Hospital was most common place of death in all countries: from 56.6% in the Netherlands to 90.9% in South Korea. The least common places were hospice facility (3.3%–5.7%), nursing home (0%–17.6%) and home (5.9%–26.3%).iii) Age-standardised relative risks found those with HIV less likely to die at home and more likely to die in hospital compared with cancer patients, and in most countries more likely to die in a nursing home. iv) Multivariate analysis found that men were more likely to die at home in UK, Canada, USA and Mexico; a greater number of hospital beds reduced the likelihood of dying at home in Italy and Mexico; a higher number of GPs was associated with home death in Italy and Mexico. With increasing comorbidity among people ageing with HIV, it is essential that end-of-life preferences are established and met. Differences in place of death according to country and diagnosis demonstrate the importance of ensuring a “good death” for people with HIV, alongside efforts to optimise treatment.

Studies comparing cause-of-death patterns across countries during the COVID-19 outbreak are still lacking although such studies would contribute to the understanding of the direct and indirect effect of the virus on mortality. In this report, we compare the mortality pattern observed in Italy during the first pandemic wave (March–April 2020) with that of some European countries. We calculated cause-specific, age-standardized mortality ratios (SMR) for Spain, England, and Sweden for the two mentioned months from 2016 to 2020, using already published data. Although Italy presented the highest crude overall mortality rate (267 per 100,000 population), age-adjusted ratios showed that all-cause and COVID-19 mortality in Italy were higher than in Sweden but lower than in the other two countries. Some causes had a similar increase in 2020 compared to previous years in all countries, i.e., endocrine diseases (especially diabetes), dementia and Alzheimer’s (in general mental disorders), and hypertensive heart diseases. Conversely, respiratory diseases, in particular pneumonia and influenza, increased to a greater extent in Italy. This latter result could be, in part, related to the underreporting of COVID-19 on death certificates during the first period of the pandemic, when Italy was the first European country severely hit by the virus.