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ORIGINAL RESEARCH article

Front. Public Health
Sec. Environmental health and Exposome
Volume 12 - 2024 | doi: 10.3389/fpubh.2024.1380609
This article is part of the Research Topic Effect-Based Tools: Safeguarding Public Health by Assessing Environmental Contamination View all articles

Sex, environment, and death rate in a dementia cohort: a seven-years Bayesian survival analysis using medications data from a contaminated area in Italy

Provisionally accepted
Antonia Mincuzzi Antonia Mincuzzi 1Paolo Lodeserto Paolo Lodeserto 1Jennifer Zollino Jennifer Zollino 1Rodolfo Sardone Rodolfo Sardone 1Lucia Bisceglia Lucia Bisceglia 2Francesco Addabbo Francesco Addabbo 1Sante Minerba Sante Minerba 3Vito G. Colacicco Vito G. Colacicco 4Orazio Valerio Giannico Orazio Valerio Giannico 1*
  • 1 Unit of Statistics and Epidemiology, Local Health Authority of Taranto, Taranto, Italy
  • 2 Regione Puglia, Bari, Italy
  • 3 Healthcare management, Local Health Authority of Taranto, Taranto, Italy
  • 4 General Management, Local Health Authority of Taranto, Taranto, Italy, Taranto, Italy

The final, formatted version of the article will be published soon.

    Introduction: Studies have analyzed the effects of industrial installations on the environment and human health in Taranto, Southern Italy. Literature documented associations between different variables and dementia mortality among both women and men. The present study aims to investigate the associations between sex, environment, age, disease duration, pandemic years, antidementia drugs, and death rate. Methods: Data from the regional medication registry were used. All women and men with an antidementia medication between 2015 and 2021 were included and followed-up to 2021. Bayesian mixed effects logistic and Cox regression models with time varying exposures were fitted using integrated nested Laplace approximations and adjusting for patients and therapy characteristics. Results: A total of 7,961 person-years were observed. Variables associated with lower prevalence of acetylcholinesterase inhibitors (AChEIs) medication were male sex (OR 0.63, 95% CrI 0.42-0.96), age 70-79 (OR 0.17, 95% CrI 0.06-0.47) and ≥80 years (OR 0.08, 95% CrI 0.03-0.23), disease duration of 2-3 years (OR 0.43, 95%CrI 0.32-0.56) and 4-6 years (OR 0.21, 95% CrI 0.13-0.33), and pandemic years 2020 (OR 0.50, 95% CrI 0.37-0.67) and 2021 (OR 0.47, 95% CrI 0.33-0.65). Variables associated with higher mortality were male sex (HR 2.14, 95% CrI 1.75-2.62), residence in the contaminated site of national interest (SIN) (HR 1.25, 95% CrI 1.02-1.53), age ≥80 years (HR 6.06, 95% CrI 1.94-18.95), disease duration of 1 year (HR 1.50, 95% CrI 1.12-2.01), 2-3 years (HR 1.90, 95% CrI 1.45-2.48), 4-6 years (HR 2.21, 95% CrI 1.60.3.07), and pandemic years 2020 (HR 1.38, 95% CrI 1.06-1.80) and 2021 (HR 1.56, 95% CrI 1.21-2.02). Variables associated with lower mortality were medication of AChEIs alone (HR 0.69, 95% CrI 0.56-0.86) and in combination with memantine (HR 0.54, 95% CrI 0.37-0.81). Discussion: Male sex, age, disease duration, and pandemic years appeared to be associated with lower AChEIs medications. Male sex, residence in the SIN of Taranto, age, disease duration, and pandemic years seemed to be associated with an increased death rate, while AChEIs medication seemed to be associated with improved survival rate.

    Keywords: Dementia, Anti-dementia drug, anti-dementia medication, dementia survival, Environmental contamination, Environmental Pollution, Dementia epidemiology

    Received: 01 Feb 2024; Accepted: 14 May 2024.

    Copyright: © 2024 Mincuzzi, Lodeserto, Zollino, Sardone, Bisceglia, Addabbo, Minerba, Colacicco and Giannico. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Orazio Valerio Giannico, Unit of Statistics and Epidemiology, Local Health Authority of Taranto, Taranto, Italy

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