[Distribution of causes of death in communities with different urbanization levels]

The aim of the present work was to compare mortality data during 1980-94 (24 causes of death for males and 25 for females) in populations living in municipalities with different urbanization levels of seven Italian regions (Piemonte, Lombardia, Emilia Romagna, Marche, Lazio, Campania and Sicilia). Urbanization levels were established following the classification of the Italian Institute of Statistics (ISTAT, Classificazione dei comuni secondo le caratteristiche urbane e rurali, 1986). A quite uniform configuration of causes of death with characteristic excesses in the urban environment was evident. The only exception was represented by the male population in Lombardia, probably due to the prevalence of occupational exposure. The urban excesses included: all tumors (also for the population < 64 year old), trachea, bronchi and lung tumors (also < 64 year old people), colorectal cancer, bladder cancer, male liver cancer and female breast cancer. Mortality due to stomach cancer and, only in males, to larynx cancer was lower in urban than in the other types areas, except the Southern regions. Concerning some non tumoral pathologies a more dyshomogeneous situation was observed, with a prevalence of urban defects in Piemonte and Lombardia, of urban excesses in the Southern regions and of both excesses and defects in Emilia Romagna and the Central regions. The "semi-rural" and "rural" types municipalities resulted quite similar, with the exception of Campania and Lazio. In fact, in these two regions a greater association with stomach cancer and lower mortality for all other tumors compared to the urban and, at a lesser extent, to the semi-urban municipalities was found. However, the lower tumor mortality was partly balanced by some other causes of death, again with the exception of Campania and at a lesser extent of Sicilia. On the basis of the causes of death comparisons, the semi-urban municipalities seem to represent a transition type between the urban and the rural ones.