European Journal of Epidemiology 10: 669-673, 1994. © t994 Kluwer Academic Publishers. Printed in the Netherlands. AIDS as a leading cause of death among young adults in Italy Susanna Conti, Gino Farchi & Sabrina Prati Istituto Superiore di Sanit& Rome, Italy Accepted in revised form 17 September 1994 Abstract. The objective of this study is to describe the impact of AIDS on the mortality of young adult (aged 25 to 44 years) in Italy, at both the national and regional level. We analyzed the official mortality data for Italy: the most recent data available being from 1990. General mortality trends show that while mortality among young women is still decreasing (i.e. from a standardized rate of 83.8 per 100,000 in 1980 to 68.4 in 1990), mortality among young men began to rise in the mid-1980s, after a steady decrease over many years. Among the 25-34 year olds, however, this reversal in trend is more marked, notwith- standing a decrease or stabilization in most major causes of death. In fact it coincides with the appear- ance and spread of AIDS in Italy, which has affected Key words: AIDS, Mortality trends, Young adults young men in particular. (The peak age group for AIDS deaths is the 25-34 year olds). Mortality data from 1990 reveal that AIDS is the fourth leading cause of death in Italy among men between the ages of 25 and 44 years. Among 25-34 year-old men, however, AIDS is the second leading cause of death, after road accidents. AIDS also contributes greatly to the general mortality in individual regions, both among 25-44 year-old men (Lombardy, Liguria, Lazio, Emilia-Romagna, Tuscany), and especially among 25-34 year-old men (Lombardy, Liguria, Lazio, Sardinia, where it is the number one cause of death, Emilia-Romagna, Tuscany, and Veneto, where it is the number two cause of death). Introduction In Italy, as in all developed countries, there has been a decreasing trend in general mortality among all age groups and in both sexes over the past 15 years [1, 2]. However, since the mid-1980's, there has been an increasing trend in general mortality among 'young adult' men (a widely used term referring to 25-44 year-olds). This phenomenon has also been observed in other countries [3, 4] and coincides with the spread of AIDS, which affects young men in particular. It is especially evident in geographic areas and countries where the AIDS epidemic is most severe [5]. The objective of our study is to describe the mortality situation in Italy at the national and regional level among 25 to 44 year-olds, a large proportion of whom are known to be affected by AIDS. In par- ticular, we focus on the 25 to 34 year-olds, since in Italy, the average age at death due to AIDS is approx- imately 30 years. Materials and methods We analyzed data from the Italian mortality database, which is collected by ISTAT (The National Institute of Statistics) and processed by the Laboratory of Epidemiology and Biostatistics at the Istituto Superiore di Sanit~ (The National Institute of Health in Italy). The most recent available data refer to 1990. In 1990, the total number of deaths among 25 to 44 year-old males was 12,867 with 5,831 being between the ages of 25 and 34. The 9th edition of the International Classification of Diseases (ICD) was used to classify causes of death (the 'N' codes for diseases and the supplementary codes 'E' for external causes) [6] and the direct method was used to cal- culate standardized mortality rates, using the Italian population (based on the 1981 census) as the refer- ence population. We classified as 'death from AIDS' all those individuals whose cause of death was given the code 279.1 by ISTAT and are reasonably confident in doing so since, in examining official mortality data, we observed that this code appeared in Italy in 1985 (at the beginning of the AIDS epidemic in Italy) and that over 80% were within the age class 25-44 years, typical of AIDS. We are also aware that there are some problems about the specificity and sensibility of the code 279.1, but the studies that have been carried out about this argument showed acceptable values [7].