The decomposition of gain in life expectancy in Tuscany Region (Central Italy) for age-group and cause of death.

Background: changing of life expectancy at birth (LE) over time is an important indicator of welfare and healthcare infrastructure of a Country.

Objectives: to evaluate the impact of age and cause-specific mortality on the change in LE in the Tuscany Region (Central Italy).

Design: the decomposition of LE gain was realized with Pollard's method, using Epidat software.

Setting And Participants: mortality data relative to residents that died during the period 1987-2015 were provided by the Tuscan Regional Mortality Registry. The analyzed causes of death were cardiovascular (CVS), respiratory (RESP), infective (INF) diseases and cancer (TUM).

Main Outcome Measures: changing of LE expressed in years in relation to cause and age-specific mortality.

Results: the overall LE gain was 6.5 years for males and 4.3 years for females, the major gain was observed in the age groups 65-89 years (for females 75-89 years) and <1 year. The highest gain (2.6 years) was attributable to the reduction of mortality for CVS, followed by TUM (males: 1.42 vs females: 0.83) and RESP (males: 0.4 vs females: 0.1). The causes responsible for the loss of LE were INF (females: -0.16 vs males: -0.07) and lung cancer in females (-0.13).

Conclusions: the prompt treatment of acute CVS events and prevention (both primary and secondary) are responsible for the gain in LE. The reduction of mortality for TUM can be attributed to the evolution of diagnostic-therapeutic possibilities, but also to the implementation of the cancer screening programmes. Lung cancer was responsible for the loss of LE in Tuscan females; the targeted anti-smoke campaigns should, therefore, be intensified. The INF comported the loss of LE; explainable by diffusion of multi-drug resistant bacteria. The programmes of Hospital Infection Control and Antimicrobial Stewardship should be potentiated to contain the phenomenon.