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[Project of contrast to avoidable mortality in a metropolitan local health authority].

INTRODUCTION
The avoidable mortality (ME)represents the share of deaths that occurs at an early age (0-74 aa) for causes that cannot be faced by means of public health or health care measures. The work develops a strategic intervention plan aimed at the reduction of ME by identifying local priority actions based on epidemiologic and social-health data.


METHODS
a working group among the Department of Prevention, Health Information Systems and Health District was set up. The databases used were: "State of Health Lazio" of the Department of Epidemiology of the Lazio Region; ASL Roma 2 local health data on general mortality (2014-2016) and the local health profile of the surveillance systems "OKkio alla Salute", Passi and HBSC Lazio. The analysis results in an estimation of Asl Roma 2's data and in a comparison of this data set with the regional level of three indicators: avoidable mortality, prevalence and incidence of chronic diseases and lifestyle profile.


RESULTS
in the three-year period (2014-2016) there were about 1,900 avoidable deaths per year; in the ASL Roma2 the ME represents about 16% of the total mortality and 60% of them are borne by the male sex. 51% of ME concerns cancer, 27% is linked to cardio-vascular diseases, 10% to trauma and poisoning. A preliminary comparison of standardized ASL Roma 2 rates of prevalence and incidence with regional values shows higher figures for some pathologies in ASL Roma 2: COPD prevalence (114 vs 107), breast neoplasia incidence (174 vs 153), incidence of lung neoplasia (71 vs 65). Prevalence and incidence of chronic diseases at the District level are not entirely consistent with the regional values according to a two level score. Incorrect lifestyles are widespread in at least 30% of the population and are more frequent in families with low educational level and with reported economic difficulties.


CONCLUSIONS
despite the intrinsic limitations of a precise estimate of the data and the possible biases in a process of inference, the method has allowed to identify the priorities to assign in primary and secondary prevention interventions planning and for the improvement of health care; this analysis has been structured in a three years Local Strategic Plan to face the ME and was articulated in general and operational objectives and actions measured by indicators both process and, where possible, outcome evaluation.