DOI: 10.5061/dryad.ns1rn8pvg
title: A ten-year (2009–2018) database of cancer mortality rates in Italy

description: AbstractIn Italy, approximately 400.000 new cases of malignant tumors are
 recorded every year. The average of annual deaths caused by tumors,
 according to the Italian Cancer Registers, is about 3.5 deaths and about
 2.5 per 1,000 men and women respectively, for a total of about 3 deaths
 every 1,000 people. Long-term (at least a decade) and spatially detailed
 data (up to the municipality scale) are neither easily accessible nor
 fully available for public consultation by the citizens, scientists,
 research groups, and associations. Therefore, here we present a ten-year
 (2009–2018) database on cancer mortality rates (in the form of
 Standardized Mortality Ratios, SMR) for 23 cancer macro-types in Italy on
 municipal, provincial, and regional scales. We aim to make easily
 accessible a comprehensive, ready-to-use, and openly accessible source of
 data on the most updated status of cancer mortality in Italy for local and
 national stakeholders, researchers, and policymakers and to provide
 researchers with ready-to-use data to perform specific studies.
description: For a
 given locality, year, and cause of death, the SMR is the ratio between the
 observed number of deaths (<sup>O</sup>m) and the number of
 expected deaths (<sup>E</sup>m): <em>SMR</em> =
 <sup>O</sup>m/<sup>E</sup>m (1)  where <sup>O</sup>m should be an
 available observational data and <sup>E</sup>m is estimated as
 the weighted sum of age-specific population size for the given locality
 (n<sub>i</sub>) per age-specific death rates of the reference
 population (<sup>M</sup>R<sub>i</sub>): 
 <sup>E</sup>m =
 sum(<sup>M</sup>R<sub>i</sub> x
 n<sub>i</sub>) (2) <sup>M</sup>R<sub>i
 </sub>could be provided by a public health organization or be
 estimated as the ratio between the age-specific number of deaths of
 reference population (M<sub>i</sub>) to the age-specific
 reference population size (N<sub>i</sub>): <sup>M</sup>R<sub>i</sub> =
 M<sub>i</sub>/N<sub>i</sub> (3) Thus, the value of Em is weighted by the age
 distribution of deaths and population size. SMR assumes
 value 1 when the number of observed and expected deaths are equal.
 Following eqns. (1-3), the SMR was computed for single years of the period
 2009-2018 and for single cause of death as defined by the International
 ICD-10 classification system by using the following data: age-specific
 number of deaths by cause of reference population (i.e.,
 <em>M<sub>i</sub></em>) from the Italian National Institute of Statistics (ISTAT,  (http://www.istat.it/en/, last access: 26/01/2022)); age-specific census data on reference population (i.e., <em>N<sub>i</sub></em>) from ISTAT; the observed number of deaths by cause (i.e., <em><sup>O</sup>m</em>) from ISTAT; the age-specific census data on population (<em>n<sub>i</sub></em>); the SMR was estimated at three different level of aggregation: municipal, provincial (equivalent to the European classification NUTS 3) and regional (i.e., NUTS2). The SMR was also computed for the broad category of malignant tumors (i.e. C00-C979, hereinafter cancer macro-type C), and for the broad category of malignant tumor plus non-malignant tumors  (i.e. C00-C979 plus D0-D489, hereinafter cancer macro-type CD). Lower 90% and 95% confidence intervals of 10-year average values were computed according to the Byar method.
description: The interannual variability of
 SMR for a given administrative unit might be large under small
 populations. Indeed, being the SMR a rate standardized over the population
 size, the expected mortality (i.e.,
 <em><sup>E</sup>m</em>) in small populations will result low (say
 10<sup>-2</sup>) and in turn, according to eq. (1), even a few
 deaths (say 1 or 2) in a year could yield a relatively high SMR as shown
 in Figure 3.   For this reason, we recommend avoiding using single-year
 estimates and using the average SMR and/or lower 90% or 95% confidence
 intervals.