Objective: In the last decades unusual mortality excesses were observed in the small area of Montaione, where the main activities are agriculture and tourism. The aim of this study was to evaluate if the observed excess mortality had to be attributed to the deaths occurred among the local large Nursing Home's guests which were half of the total deaths registered among residents.
Design: Empirical Bayesian Mortality Ratios (EBMR), applying the method of Clayton and Kaldor, were calculated either including or excluding the guests of the Nursing Home from the deaths and from the population. Only the population with age > or = 65 was included in the analysis. The expected deaths were calculated using the Tuscan population mortality rates by sex, age and specific cause of death (all causes, cardiovascular diseases, cerebrovascular diseases, digestive diseases and respiratory diseases).
Results: Excluding the guests of the Nursing Home from the analysis it was observed a strong decrease of the EBMRs for almost all causes considered, but those for cerebrovascular and respiratory diseases.
Conclusion: The results obtained underline the necessity to take in consideration also a possible "Nursing Home effect" in evaluating mortality excesses in small areas.