Leader: Giovanna Boccuzzo (UNIPD); Other collaborator(s): Pietro Belloni (UNIPD), Annalisa Donno (UNIPD), Maurizio Nicolaio (UNIPD), Enrico Bovo (UNIPD).
Using longitudinal data coming from large population administrative registers, the task addresses the following broad research questions: i) proposal of vulnerability indicators in the life course which could be used to stratify population; ii) implementation of the stratification procedures both in terms of health and socio-economic conditions with different administrative health databases; iii) evaluation of the different stratification procedures in terms of adverse health outcomes; iv) socioeconomic characterisation of different strata within different longitudinal studies, and identification of the critical points in health, employment and social trajectories associated with vulnerable health conditions in old age; v) tools for implement stratification of population in local health authorities
Brief description of the activities and of the intermediate results
TOPIC: Measures of Frailty
- Detailed analysis by systematic reviews of measures of frailty (physical, social, and mental) and preparation of a book (in Italian) “Misurare la fragilità negli anziani. Metodi e strumenti a supporto delle politiche e della ricerca” (Measuring frailty in the elderly. Methods and tools to support policy and research) (edited by G. Boccuzzo, authors G. Boccuzzo, E. Bovo, M.Nicolaio, S. Mondini, G. Sebastianutto, A: Ghirardo, D. Vo, M. Silan), submitted to Franco Angeli, open access and peer-reviewed Series “Salute e Società” (Health & Society). Awaiting the Reviewers' response.
- Preparation of anonymized health administrative databases aimed at creating frailty indices that can stratify the population (done)
- Implementation of algorithms for estimating the prevalence of chronic diseases: collaboration with the Epidemiological Unit of the Department of Prevention of ULSS 6 "Euganea" to identify and estimate the prevalence of diseases and other conditions using administrative health sources. Identification of relevant sources and coding within sources (done)
- Analysis on frailty outcomes: analysis and selection of the best subset of outcomes. Evaluation of relationships between outcomes and availability at administrative health sources (in progress)
- Research on new statistical approaches for frailty indicators in elderly population. Study of innovative method for a multivariate frailty indicator based on a sensitivity/specificity combination using administrative data flow. Study of variables selection for frailty indicators with survey data (in progress)
TOPIC “Causal pathways between healthy ageing and individual, social and contextual variables”
- Disease mapping research on new statistical methods of disease mapping and spatial clustering. Development of new models for mortality pattern identification. On this topic, one article is under review (E Bovo, P. Belloni1, A. Sottosanti, G. Boccuzzo, Where are people dying the most? Detecting territorial patterns of high mortality risk: a case study from northeastern Italy, Population Health Metrics, under revision) and another will be submitted shortly. Organization of the session (accepted) “Advancements in Spatial Epidemiology and Disease Mapping” at the annual conference of the American Statistical Association (August 2024).
- Multiple treatments in causal inference. Research on techniques for multiple treatments in a causal framework. Development of the R library “MARMoT” (P.Belloni, A.Calore, M. Silan; https://cran.rproject.org/package=MARMoT)
- Invited presentation at the international conference Data Science for Social Research (https://dssr2024.unina.it/page1.html): A simulation study to compare marmot adjustment and template matching in a multiple treatment framework (P. Belloni, A. Calore, M. Silan), specialised session “Unraveling Complexity: Causal Inference in Social Sciences”, March 27, 2024, Naples.
- Creation of a Data base composed by detailed socio-economic information for several years of a population at territorial level (census/neighbourhood) in the province of Padova (Italy) with the aim of improving analyses in frailty, enabling the inclusion of social and economic variables in the modelling phase.
- Analysis of the role of social frailty on physical frailty and causal mediation approaches using SHARE survey. Research done, two scientific articles are being prepared.
- Research in frailty and ageing with the aim of assessing the life histories of a population and checking possible characteristics that may lead one person rather than another to a frail state. Study of models for longitudinal data in the presence of information censoring and the healthy survivor effect (in progress).
OTHER:
- Published (March 20, 2024) the Explorative announcement for the project analysis longitudinal health and socio-economic data and development of a project on "Aging in good health in a life history and intergenerational view." (ex Task 5.6)
- Collaboration with Task 5.4 (Mondini) in the study of batteries of instruments measuring cognitive decline and risk factors for decline, with particular reference to the role of work activity. The research is completed; the preparation of scientific articles is in progress.
Main policy, industrial and scientific implications
Frailty measure: Stratifying the population according to care needs is a key public health goal defined by the National Plan for Chronicity (NPC) (Ministry of Health, 2016), and the Sector Reform of the National Recovery and Resilience Plan (PNRR), Decree No. 77 - May 23, 202
Collaboration with ULSS6 Euganea (province of Padua) to use administrative health data to stratify the population according to care needs has led to the preparation of rigorous anonymization procedures in order to make administrative data available for research purposes. This activity will be one piece of the products of the AGE-IT Data Management Board.
The implementation of algorithms for estimating the prevalence of chronic diseases represents a topic of fundamental importance in public health and in the use of health administrative data. It involves complex algorithms that, from several administrative flows, can identify the presence of multiple conditions and diseases. The sharing of such algorithms is a key support to health planning.
The software produced and published in the CRAN library is free to use and available to the very wide audience of R users.
TOPIC: Measures of Frailty
Detailed analysis by systematic reviews of measures of frailty (physical, social, and mental) and preparation of a book (in Italian) “Misurare la fragilità negli anziani. Metodi e strumenti a supporto delle politiche e della ricerca” (Measuring frailty in the elderly. Methods and tools to support policy and research) (edited by G. Boccuzzo and A. Donno), submitted to Franco Angeli, open access and peer-reviewed Series “Salute e Società” (Health & Society). We have received the Reviewers' response, the book will be published after revisions that should be done within the end of October. In addition, an invited presentation in plenary session of a conference was made by invitation (see Outputs), and an article is being prepared.
Analysis on frailty outcomes: analysis and selection of the best subset of outcomes. Evaluation of relationships between outcomes and availability at administrative health sources. The work is concluded and was presented at the AGE-IT General Meeting (see Outputs).
The study continued with two innovative proposals and the validation and improvement of proposals already published by the research group (in progress). This study is related to the output “Creation of new tools for frailty assessment, to be used in different care settings”
TOPIC “Causal pathways between healthy ageing and individual, social and contextual variables”
- Disease mapping research on new statistical methods of disease mapping and spatial clustering. A new article has been submitted (see Outputs).
- Analysis of the role of social frailty on physical frailty and causal mediation approaches using SHARE survey. The article is being written.
- Research in frailty and ageing with the aim of assessing the life histories of a population and checking possible characteristics that may lead one person rather than another to a frail state. Study of models for longitudinal data in the presence of information censoring and the healthy survivor effect (in progress)
Conferences
- P. Belloni, E. Bovo, A. Sottosanti, G. Boccuzzo. Where are people dying the most? Detecting territorial patterns of high mortality risk: a case study from northeastern Italy. 35TH Reves meeting, 22-24 maggio 2024, Bogotá, Colombia
- M. Silan, G.Boccuzzo, A.Donno (2024) Measuring frailty in the elderly. Methods and tools to support policy and research. LX Riunione scientifica Società Italiana di Economia Demografia e Statistica “Salute, ambiente e disuguaglianze: istituzioni, imprese e società”, Milano, 22 maggio 2024. Plenary Session.
- M. Silan, M. Nicolaio, E. Banzato, G. Boccuzzo (2024) Unravelling the connections between adverse health outcomes related to frailty for a better understanding of frailty and ageing. Poster, General Meeting Age-It, 22-24 maggio 2024, Venezia
- E. Banzato, G. Boccuzzo, A. Roverato, A. Buja. (2024) The analysis of multimorbidity patterns via graphical models. General Meeting Age-It, 22-24 maggio 2024, Venezia
In the months of June, July and August, the work done was finalized, through the preparation of conference reports and the submission of articles to scientific journals (output "~3 scientific publications on new models and algorithms to better stratify the different degrees of vulnerability).
In August and September we worked on arranging the revised book “Misurare la fragilità negli anziani. Metodi e strumenti a supporto delle politiche e della ricerca” to be sent back to the Franco Angeli publishing house. The book is related to the output ”Guidelines for professionals on tools for identifying subjects at risk of frailty".
TOPIC: Measures of Frailty
We have concluded the analyses related to MS 4.4 "Validation of an innovative tool to detect and prevent frailty in old age", and we are preparing a detailed report on the construction of the frailty indicator and its validation.
In September, the tender for the recruitment of an IT figure was also released to support the finalization of the output "Creation of new tool for frailty assessment, to be used in different care settings"
Articles submitted / under review:
- A. Donno, A. Ghrirardo, G.Boccuzzo. The influence of Social Frailty on Physical Frailty in older adults: Evidence from SHARE Survey. Submitted to The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences.
- A. Donno, M. Silan, G. Boccuzzo. Assessing Frailty in Older Adults: Strategies and Tools for Effective Policy and Research. Invited submission to Rivista Italiana di Economia Demografia e Statistica
- A. Sottosanti, P. Belloni, E. Bovo, G. Boccuzzo. Bayesian Mapping of Mortality Clusters, under revision in Biostatistics (preprint available on https://arxiv.org/abs/2407.19135).
Conferences:
- A. Sottosanti, P. Belloni, E. Bovo, G. Boccuzzo. (2024) Hierarchical Bayesian modelling for detecting and clustering mortality profiles in space, Joint Statistical Meetings (JSM), Portland, August, 3-8 2024
- M. Silan, M. Nicolaio, E. Banzato, G. Boccuzzo. Unraveling frailty: Starting from the outcomes. 2nd workshop SOFIA – SOcial and health Frailty as determinants of Inequality in Ageing, University of Padua, September 9-10, 2024.
- E. Cisotto, G. Cavrini, A. Ghirardo, G. Boccuzzo. Proposal for a Social Frailty Index. 2nd workshop SOFIA – SOcial and health Frailty as determinants of Inequality in Ageing, University of Padua, September 9-10, 2024.
- A. Donno, A. Ghirardo, G. Boccuzzo. The impact of social frailty on physical frailty in old age: a longitudinal study based on SHARE data. 2nd workshop SOFIA – SOcial and health Frailty as determinants of Inequality in Ageing, University of Padua, September 9-10, 2024.
- P. Belloni, S. Rebottini. Measuring frailty in old age population: a new indicator based on a combination of classifiers. 2nd workshop SOFIA – SOcial and health Frailty as determinants of Inequality in Ageing, University of Padua, September 9-10, 2024.
Work continued on the preparation of articles and the revision of the book “Misurare la fragilità negli anziani. Metodi e strumenti a supporto delle politiche e della ricerca”. The book is now accepted for publication from Franco Angeli publishing house and now undergoing proofreading.
A resource was recruited for the development of the ouput ‘Tools for measuring frailty in population’, which is working on the creation of a Shiny App for the calculation and tabular and graphical representation of the frailty indicator.
One article has been accepted and already published, others are still under revision and two were unfortunately rejected and are currently being resubmitted to other journals. New projects for the creation of frailty measures based on health administrative data and new master's theses were launched.
The first draft of the MS 4.4 Report "Validation of an innovative tool to detect and prevent frailty in old age" is ready, the final version will be delivered by the end of March 2025.
Writing of the paper “Protective and risk factors for cognitive decline: The role of Sex and Occupational Status” Sebastianutto, G., Salvi Bentivoglio, S., Montemurro, S., Pucci, V., Boccuzzo G., Mondini, S.
Published Articles:
- A. Donno, M. Silan, G. Boccuzzo (2024). Assessing Frailty in Older Adults: Strategies and Tools for Effective Policy and Research. Rivista Italiana di Economia Demografia e Statistica, Vol. LXXVIII-3 July-September 2024. DOI: https://doi.org/10.71014/sieds.v78i3.398. Freely available at https://www.rieds-journal.org/rieds/article/view/398.
Dissemination:
- Presentation of Spoke 4 to DigitalMeet 2024, Padova, October 24. https://digitalmeet.it/programma-2024/
- Presentation of AGE-IT to StatisticAll, Festival della Statistica e della Demografia, Treviso, October 20. In collaboration with LoLa (Laboratory of Longevity and Ageing). www.festivalstatistica.it.