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Pellegrino A, Calabrese M, Boddi M, Vacirca I, Baccari C, Bonvicini L, Venturelli F, Petrelli A, Di Napoli A, Perticone M, Rossi PG, Modesti PA. Cardiovascular risk and access to primary care: Comparisons among Chinese documented and undocumented immigrants. Diabetes Res Clin Pract 2024; 210:111645. [PMID: 38554810 DOI: 10.1016/j.diabres.2024.111645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/02/2024]
Abstract
AIMS The aim of this study was to examine main risk factors of undocumented Chinese migrants living in Italy when compared with Chinese migrants registered with National Health Service (NHS). METHODS A cohort of 3435 Chinese first-generation immigrants living in Prato underwent blood pressure (BP) measurement and blood tests. Hypertension was diagnosed for BP ≥ 140/90 mmHg at 2 visits, and/or antihypertensive drug use; type 2 diabetes (T2DM) for fasting glucose ≥ 126 mg/dL at 2 visits, and/or use of hypoglycemic drugs; hypercholesterolemia (HC) for cholesterol ≥ 240 mg/dL and/or statins use. Subjects diagnosed with hypertension, T2DM, or HC unaware of their condition were considered newly diagnosed. Comparisons were performed using multivariable adjusted logistic regression analysis. RESULTS A large proportion of Chinese migrants were undocumented (1766, 51 %); newly diagnoses of risk factors were performed especially among undocumented migrants; registration with NHS was associated with higher level of awareness for hypertension and T2DM and with 6 times higher rate of treatment for T2DM. Only a small minority of subjects with high cholesterol were treated with statins. CONCLUSIONS Undocumented immigrants had high prevalence of risk factors with lower levels of awareness than migrants registered with the NHS. Health policies targeting this hard-to-reach population needs to be improved.
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Affiliation(s)
- Alessio Pellegrino
- Medicina dello Sport e dell'Esercizio Fisico, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; Department of Medicina Sperimentale e Clinica, University of Florence, Florence, Italy
| | - Maria Calabrese
- Diabetology Unit, Ospedale Misericordia e Dolce, Prato, Italy
| | - Maria Boddi
- Medicina dello Sport e dell'Esercizio Fisico, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; Department of Medicina Sperimentale e Clinica, University of Florence, Florence, Italy
| | - Irene Vacirca
- Medicina dello Sport e dell'Esercizio Fisico, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Cecilia Baccari
- Medicina dello Sport e dell'Esercizio Fisico, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Laura Bonvicini
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Alessio Petrelli
- Epidemiology Unit, National Institute for Health, Migration and Poverty (INMP), Rome, Italy
| | - Anteo Di Napoli
- Epidemiology Unit, National Institute for Health, Migration and Poverty (INMP), Rome, Italy
| | - Maria Perticone
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Pietro Amedeo Modesti
- Medicina dello Sport e dell'Esercizio Fisico, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; Department of Medicina Sperimentale e Clinica, University of Florence, Florence, Italy.
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Petrelli A, Ventura M, Di Napoli A, Pappagallo M, Simeoni S, Frova L. Socioeconomic inequalities in avoidable mortality in Italy: results from a nationwide longitudinal cohort. BMC Public Health 2024; 24:757. [PMID: 38468229 DOI: 10.1186/s12889-024-18205-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/24/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Disparities in avoidable mortality have never been evaluated in Italy at the national level. The present study aimed to assess the association between socioeconomic status and avoidable mortality. METHODS The nationwide closed cohort of the 2011 Census of Population and Housing was followed up for 2012-2019 mortality. Outcomes of preventable and of treatable mortality were separately evaluated among people aged 30-74. Education level (elementary school or less, middle school, high school diploma, university degree or more) and residence macro area (North-West, North-East, Center, South-Islands) were the exposures, for which adjusted mortality rate ratios (MRRs) were calculated through multivariate quasi-Poisson regression models, adjusted for age at death. Relative index of inequalities was estimated for preventable, treatable, and non-avoidable mortality and for some specific causes. RESULTS The cohort consisted of 35,708,459 residents (48.8% men, 17.5% aged 65-74), 34% with a high school diploma, 33.5% living in the South-Islands; 1,127,760 deaths were observed, of which 65.2% for avoidable causes (40.4% preventable and 24.9% treatable). Inverse trends between education level and mortality were observed for all causes; comparing the least with the most educated groups, a strong association was observed for preventable (males MRR = 2.39; females MRR = 1.65) and for treatable causes of death (males MRR = 1.93; females MRR = 1.45). The greatest inequalities were observed for HIV/AIDS and alcohol-related diseases (both sexes), drug-related diseases and tuberculosis (males), and diabetes mellitus, cardiovascular diseases, and renal failure (females). Excess risk of preventable and of treatable mortality were observed for the South-Islands. CONCLUSIONS Socioeconomic inequalities in mortality persist in Italy, with an extremely varied response to policies at the regional level, representing a possible missed gain in health and suggesting a reassessment of priorities and definition of health targets.
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Affiliation(s)
- Alessio Petrelli
- National Institute for Health, Migration and Poverty (INMP), Via di San Gallicano, 25/a, 00153, Rome, Italy.
| | - Martina Ventura
- National Institute for Health, Migration and Poverty (INMP), Via di San Gallicano, 25/a, 00153, Rome, Italy
| | - Anteo Di Napoli
- National Institute for Health, Migration and Poverty (INMP), Via di San Gallicano, 25/a, 00153, Rome, Italy
| | - Marilena Pappagallo
- National Institute of Statistics (Istat), Viale Liegi 13, 00198, Rome, Italy
| | - Silvia Simeoni
- National Institute of Statistics (Istat), Viale Liegi 13, 00198, Rome, Italy
| | - Luisa Frova
- National Institute of Statistics (Istat), Viale Liegi 13, 00198, Rome, Italy
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Fadda GL, Urbanelli A, Petrelli A, Trossarello M, Nitro L, Saibene AM, De Corso E, Gned D, Panfili M, Cavallo G. Type IV optic nerve and Onodi cell: is there a risk of injury during sphenoid sinus surgery? Acta Otorhinolaryngol Ital 2024; 44:36-41. [PMID: 38165204 PMCID: PMC10914358 DOI: 10.14639/0392-100x-n2462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 06/13/2023] [Indexed: 01/03/2024]
Abstract
Objective This study aims to determine the prevalence and types of Onodi cells through computed tomography and investigate the relationship between Onodi cell and the surrounding structures, paying particular attention to the risky proximity to the optic nerve canal. Methods In this study, 430 computed tomography scans of paranasal sinuses were analysed to establish the prevalence and different types of Onodi cells. Furthermore, the relationship between Onodi cell and different patterns of sphenoid sinus pneumatisation and surrounding structures were investigated. Special attention was paid to the relationship between Onodi cell and the optic nerve canal, particularly in cases when the optic nerve canal was bulging by more than 50% into the Onodi cell (Type IV). Results The Onodi cell was detected in 21.6% of cases, with the most common being Type I (48.5% right, 54.3% left). Type IV bulging of the optic nerve canal into the Onodi cell was observed in 47.1% of cases on the right side, 41.2% on the left side and bilateral in 11.7% of cases. Conclusions In our series, we observed a high prevalence of Type IV optic nerve bulging into the Onodi cell. For this reason, we suggest that clinicians should always try to identify it in a pre-operative setting with computed tomography to avoid catastrophic consequences during endoscopic sinus surgery approaching the sphenoid area.
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Affiliation(s)
- Gian Luca Fadda
- Department of Otorhinolaryngology, University of Turin, “San Luigi Gonzaga” Hospital, Orbassano (TO), Italy
| | - Anastasia Urbanelli
- Department of Otorhinolaryngology, University of Turin, “San Luigi Gonzaga” Hospital, Orbassano (TO), Italy
| | - Alessio Petrelli
- National Institute for Health, Migration and Poverty (INMP), Rome, Italy
| | - Marta Trossarello
- Department of Otorhinolaryngology, University of Turin, “San Luigi Gonzaga” Hospital, Orbassano (TO), Italy
| | - Letizia Nitro
- Otolaryngology Unit, “Santi Paolo e Carlo” Hospital, Department of Health Sciences, University of Milan, Milan, Italy
| | - Alberto Maria Saibene
- Otolaryngology Unit, “Santi Paolo e Carlo” Hospital, Department of Health Sciences, University of Milan, Milan, Italy
| | - Eugenio De Corso
- Otorhinolaryngology, “A. Gemelli” Unversitary Hospital IRCCS, Rome, Italy
| | - Dario Gned
- Department of Diagnostic Imaging, University of Turin, “San Luigi Gonzaga” Hospital, Orbassano (TO), Italy
| | - Marco Panfili
- Unit of Radiology, “A. Gemelli” University Hospital Foundation IRCCS, Rome, Italy
| | - Giovanni Cavallo
- Department of Otorhinolaryngology, University of Turin, “San Luigi Gonzaga” Hospital, Orbassano (TO), Italy
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Ferroni E, Gennaro N, Maifredi G, Leoni O, Profili F, Stasi C, Cacciani L, Calandrini E, di Napoli A, Petrelli A, Zorzi M. Access to SARS-CoV-2 vaccination in immigrants in Italy, by geographical area of origin. Vaccine 2024; 42:375-382. [PMID: 38097455 DOI: 10.1016/j.vaccine.2023.11.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/25/2023] [Accepted: 11/20/2023] [Indexed: 01/01/2024]
Abstract
OBJECTIVE Immigrants are commonly considered disadvantaged and at high risk of not receiving appropriate care, including vaccination. This study aimed to evaluate the access to SARS-CoV-2 vaccination in immigrants, by geographical area of origin, compared with Italian citizens. We also evaluated sex differences in vaccine's coverage by geographical area of origin. METHODS We performed a retrospective observational study in four Italian regions, including all resident subjects aged 5-69 years, and undergoing first dose SARS-CoV-2 vaccination in the period 28th December 2020- 3rd April 2022. We estimated cumulative coverage percentages, by age class and geographical area. To compare first-dose vaccine coverage by geographical area of origin, we estimated, through a Poisson analysis, Vaccine Coverage Ratios (VCR) with 95 % confidence intervals (95 %CI), adjusting for age and sex. RESULTS We included 16,294,785 Italian citizens and 2,534,351 immigrants aged 5-69 years and resident in the four regions considered. Regarding the geographical area of origin, 40.7 % of immigrants came from Eastern Europe, 13.5 % from North Africa and 13.1 % from Western Asia. A great variability in the first dose vaccine coverage emerged. We documented substantial heterogeneity in the first-dose vaccine coverage within immigrant's population, expressed with Italy as a reference, ranging from 0,768 (95 %CI: 0,766-0,769) in Eastern Europe countries to 1,013 (95 %CI: 1,009 - 1,018) in Eastern Asia. The chance of being vaccinated was found higher in males compared with females for African countries (VCR 1.07, 95 %CI 1.06-1.08) and Western Asian countries (VCR 1.08, 95 %CI 1.07-1.09). CONCLUSION We observed substantial heterogeneity in first-dose SARS-CoV-2 vaccination coverage in immigrants, suggesting a different propensity to vaccines according to the geographical area of origin. These data can help define appropriate and tailored strategies in order to improve vaccine coverage in some specific immigrant groups at the local health district level.
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Affiliation(s)
- Eliana Ferroni
- Epidemiological Department (SER), Azienda Zero of the Veneto Region, Padua, Italy.
| | - Nicola Gennaro
- Epidemiological Department (SER), Azienda Zero of the Veneto Region, Padua, Italy
| | | | - Olivia Leoni
- Directorate General for Health, Lombardy Region, Milan, Italy
| | | | - Cristina Stasi
- Epidemiology Unit, Tuscany Regional Health Agency, Florence, Italy
| | - Laura Cacciani
- Department of Epidemiology - Regional Health Service, ASL Roma 1, Rome, Italy
| | - Enrico Calandrini
- Department of Epidemiology - Regional Health Service, ASL Roma 1, Rome, Italy
| | - Anteo di Napoli
- Epidemiology Unit, National Institute for Health, Migration and Poverty (INMP), Rome, Italy
| | - Alessio Petrelli
- Epidemiology Unit, National Institute for Health, Migration and Poverty (INMP), Rome, Italy
| | - Manuel Zorzi
- Epidemiological Department (SER), Azienda Zero of the Veneto Region, Padua, Italy
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Aragona M, Ventura M, DI Napoli A, Petrelli A, Calvi C, Cavani A, Carbone D, Finelli M, Favretto AR, Mirisola C. Impact of the COVID-19 pandemic on Italian students' mental health and relationships: differences between adolescent males and females. Minerva Pediatr (Torino) 2023:S2724-5276.23.07115-X. [PMID: 38015429 DOI: 10.23736/s2724-5276.23.07115-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
BACKGROUND The negative effects of the COVID-19 pandemic on the mental health of young people have been reported, often with possible differences between the sexes. This study explores the impact of the COVID-19 pandemic on the differences in mental health status and healthy behaviors between adolescent males and females. METHODS An online questionnaire exploring sociodemographic characteristics, living conditions, mental health, behaviors, and relationships during the implementation of the COVID-19 social restriction measures, was administered to 16-18 years old high school students living in the metropolitan area of Turin. The World Health Organization-5 Well-Being Index (WHO-5) questionnaire was used to evaluate self-perceived psychological health status. Descriptive analyses of the sample were carried out by sex. Chi-squared test and the associated P value were evaluated. The spatial sign method was used to assess multivariate differences by sex. RESULTS Seventy-two Italian high school students completed the questionnaire. Sixty-eight percent of the students reported psychological problems, more often females (86% vs. 50%). Those living with multiple cohabitants and in dwellings with less personal space reported lower well-being. Females were also more likely to report stress when talking about COVID-19, difficulties in concentration and in falling asleep, daytime sleepiness, less physical activity, and concerns about losing control of eating. Finally, females spent more time with family members and, compared to males, found it harder to spend time and share experiences with friends and schoolmates. CONCLUSIONS The pandemic has greatly impacted adolescents in terms of their mental well-being, routines, relationships with friends, and sleeping and eating patterns. Females reported more stress, boredom, bad mood, eating concerns, reduced relationships with friends, and possible difficulty in falling asleep than did males. These issues should be addressed when developing and promoting support programs, particularly at school.
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Affiliation(s)
| | - Martina Ventura
- National Institute for Health, Migration and Poverty (INMP), Rome, Italy
| | - Anteo DI Napoli
- National Institute for Health, Migration and Poverty (INMP), Rome, Italy
| | - Alessio Petrelli
- National Institute for Health, Migration and Poverty (INMP), Rome, Italy
| | | | - Andrea Cavani
- National Institute for Health, Migration and Poverty (INMP), Rome, Italy
| | | | - Manuel Finelli
- University of Modena and Reggio Emilia, Reggio nell'Emilia, Italy
| | | | - Concetta Mirisola
- National Institute for Health, Migration and Poverty (INMP), Rome, Italy
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Candela S, Bisanti L, Canova C, Caranci N, Petrelli A. Editorial: Immigrant's health in different migration contexts. Front Public Health 2023; 11:1188061. [PMID: 37521987 PMCID: PMC10374296 DOI: 10.3389/fpubh.2023.1188061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 03/27/2023] [Indexed: 08/01/2023] Open
Affiliation(s)
- Silvia Candela
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Local Health Authority of Reggio Emilia, Reggio Emilia, Italy
| | | | - Cristina Canova
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Nicola Caranci
- Department of Innovation in Health and Social Care, General Directorate of Health and Welfare, Bologna, Italy
| | - Alessio Petrelli
- Epidemiology Unit, National Institute for Health, Migration and Poverty (INMP), Rome, Italy
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Sisti LG, Di Napoli A, Petrelli A, Diodati A, Cavani A, Mirisola C, Costanzo G. Newly arrived migrants did not represent an additional COVID-19 burden for Italy: data from the italian information flow. Global Health 2023; 19:32. [PMID: 37131222 PMCID: PMC10152432 DOI: 10.1186/s12992-023-00926-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 04/01/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, migrants arriving in host countries irregularly have not infrequently been perceived as increasing the COVID-19 burden. Italy is a transit and destination country for migrants who cross the Central Mediterranean route and, during the pandemic, all migrants who landed on Italian shores were COVID-19 tested and quarantined. Our study aimed to investigate the impact of the SARS-CoV-2 infection among migrants who landed on the Italian coasts by analyzing both incidence and health outcomes. METHODS A retrospective observational study has been designed. The population of interest was represented by 70,512 migrants (91% male, 99% <60 years old) who landed in Italy between January 2021 and 2022. SARS-CoV-2 incidence rate per 1,000 (with 95%CI) in migrants and the resident population in Italy of the corresponding age group was computed. The incidence rate ratio (IRR) was used to compare the incidence rates in migrants and the resident population. RESULTS 2,861 migrants out of those landed in Italy during the observation period tested positive, with an incidence rate of 40.6 (39.1-42.1) cases per 1,000. During the same period, 177.6 (177.5-177.8) cases per 1,000 were reported in the resident population, with an IRR of 0.23 (0.22-0.24). 89.7% of cases were male and 54.6% belonged to the 20-29 age group. 99% of cases reported no symptoms, no relevant comorbidities were reported and no cases were hospitalized. CONCLUSIONS Our study found a low rate of SARS-CoV-2 infection in migrants reaching Italy by sea with an incidence rate that is roughly a quarter of that of the resident population. Thus, irregular migrants who arrived in Italy during the observation period did not increase the COVID-19 burden. Further studies are needed to investigate possible reasons for the low incidence observed in this population.
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Affiliation(s)
- Leuconoe Grazia Sisti
- Health Directorate, National Institute for Health, Migration and Poverty (INMP), Via di San Gallicano, 25/a, 00153, Roma, Italy.
- Center for Global Health Research and Studies, Department Life Sciences and Public Health, Università Cattolica del Sacro Cuore, L.go F. Vito, 1, 00168, Roma, Italy.
| | - Anteo Di Napoli
- Epidemiology Unit, National Institute for Health, Migration and Poverty (INMP), Via di San Gallicano, 25/a, 00153, Roma, Italy
| | - Alessio Petrelli
- Epidemiology Unit, National Institute for Health, Migration and Poverty (INMP), Via di San Gallicano, 25/a, 00153, Roma, Italy
| | - Alessandra Diodati
- Global Health and Health Cooperation Unit, National Institute for Health, Migration and Poverty (INMP), Via di San Gallicano, 25/a, 00153, Roma, Italy
| | - Andrea Cavani
- Scientific Directorate, National Institute for Health, Migration and Poverty (INMP), Via di San Gallicano, 25/a, 00153, Roma, Italy
| | - Concetta Mirisola
- Directorate General, National Institute for Health, Migration and Poverty (INMP), Via di San Gallicano, 25/a, 00153, Roma, Italy
| | - Gianfranco Costanzo
- Health Directorate, National Institute for Health, Migration and Poverty (INMP), Via di San Gallicano, 25/a, 00153, Roma, Italy
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Petrelli A, Ventura M, Di Napoli A, Mateo-Urdiales A, Pezzotti P, Fabiani M. Geographic heterogeneity of the epidemiological impact of the COVID-19 pandemic in Italy using a socioeconomic proxy-based classification of the national territory. Front Public Health 2023; 11:1143189. [PMID: 37151598 PMCID: PMC10160611 DOI: 10.3389/fpubh.2023.1143189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/04/2023] [Indexed: 05/09/2023] Open
Abstract
Objectives This study aimed to evaluate the differences in incidence, non-intensive care unit (non-ICU) and intensive care unit (ICU) hospital admissions, and COVID-19-related mortality between the "inner areas" of Italy and its metropolitan areas. Study design Retrospective population-based study conducted from the beginning of the pandemic in Italy (20 February 2020) to 31 March 2022. Methods The municipalities of Italy were classified into metropolitan areas, peri-urban/intermediate areas and "inner areas" (peripheral/ultra-peripheral). The exposure variable was residence in an "inner area" of Italy. Incidence of diagnosis of SARS-CoV-2 infection, non-ICU and ICU hospital admissions and death within 30 days from diagnosis were the outcomes of the study. COVID-19 vaccination access was also evaluated. Crude and age-standardized rates were calculated for all the study outcomes. The association between the type of area of residence and each outcome under study was evaluated by calculating the ratios between the standardized rates. All the analyses were stratified by period of observation (original Wuhan strain, Alpha variant, Delta variant, Omicron variant). Results Incidence and non-ICUs admissions rates were lower in "inner areas." ICU admission and mortality rates were much lower in "inner areas" in the early phases of the pandemic, but this protection progressively diminished, with a slight excess risk observed in the "inner areas" during the Omicron period. The greater vaccination coverage in metropolitan areas may explain this trend. Conclusion Prioritizing healthcare planning through the strengthening of the primary prevention policies in the peripheral areas of Italy is fundamental to guarantee health equity policies.
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Affiliation(s)
- Alessio Petrelli
- Epidemiology Unit, National Institute for Health, Migration and Poverty (INMP), Rome, Italy
- *Correspondence: Alessio Petrelli,
| | - Martina Ventura
- Epidemiology Unit, National Institute for Health, Migration and Poverty (INMP), Rome, Italy
| | - Anteo Di Napoli
- Epidemiology Unit, National Institute for Health, Migration and Poverty (INMP), Rome, Italy
| | - Alberto Mateo-Urdiales
- Unit of Epidemiology, Biostatistics and Mathematical Modelling, Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Patrizio Pezzotti
- Unit of Epidemiology, Biostatistics and Mathematical Modelling, Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Massimo Fabiani
- Unit of Epidemiology, Biostatistics and Mathematical Modelling, Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
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Sisti LG, Di Napoli A, Petrelli A, Diodati A, Cavani A, Mirisola C, Costanzo G. Do newly arrived migrants represent a COVID-19 burden? Data from the Italian information flow. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac130.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Migrants who reach host countries irregularly are often perceived as increasing the COVID-19 burden. Italy is a transit and destination country for migrants who cross the Central Mediterranean route. During the pandemic, all migrants who disembarked on the Italian shores have been COVID-19 tested and quarantined. To investigate the incidence of SARS-CoV-2 infection in this population, the INMP, together with the Italian Ministry of the Interior, set a specific information flow collecting data about the infection and possible outcomes.
Methods
The observation period was from January 2021 to January 2022. COVID-19 tests used were molecular and antigenic. Positive cases detected both at the arrival and during the quarantine period, have been registered on an ad hoc INMP online platform. Migrants’ SARS-CoV-2 incidence rate (per 1,000) - with 95% CI - was therefore calculated. The Incidence Ratio (IR) was used to compare the migrants’ incidence rate with that of the resident population in Italy, in the same period and corresponding age group.
Results
Among 70,512 migrants (91% males and 9% females, all <60years old) who landed in Italy during the observation period, 2,861 tested positive, with an incidence rate of 40.6 (39.1-42.1) cases per 1,000. In the same period, an incidence rate of 177.6 (177.5-177.8) has been recorded in the resident population, with an IR of 0.22 (0.22-0.23). 89.9% of cases were males and almost half (49.6%) belonged to the age group 25-39years old. 99% of cases reported no symptoms, no relevant comorbidity has been reported and no cases have been hospitalized.
Conclusions
Our findings clearly highlight the low rate of SARS-CoV-2 infection in migrants reaching Italy by sea with an incidence rate that is roughly a quarter of that of the resident population, encouraging the opportunity to investigate the reasons for such an observation. Moreover, our study confirms the “healthy migrant effect” in migrants reaching Italy by sea.
Key messages
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Affiliation(s)
- LG Sisti
- National Institute for Health, Migration and Poverty , Rome, Italy
| | - A Di Napoli
- National Institute for Health, Migration and Poverty , Rome, Italy
| | - A Petrelli
- National Institute for Health, Migration and Poverty , Rome, Italy
| | - A Diodati
- National Institute for Health, Migration and Poverty , Rome, Italy
| | - A Cavani
- National Institute for Health, Migration and Poverty , Rome, Italy
| | - C Mirisola
- National Institute for Health, Migration and Poverty , Rome, Italy
| | - G Costanzo
- National Institute for Health, Migration and Poverty , Rome, Italy
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10
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Fadda GL, Petrelli A, Urbanelli A, Castelnuovo P, Bignami M, Crosetti E, Succo G, Cavallo G. Risky anatomical variations of sphenoid sinus and surrounding structures in endoscopic sinus surgery. Head Face Med 2022; 18:29. [PMID: 36057720 PMCID: PMC9440488 DOI: 10.1186/s13005-022-00336-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 08/23/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose This study aimed to examine the relationship between the sphenoid sinus (SS) and surrounding vital structures such as the internal carotid artery (ICA) and optic nerve canal (ONC) as well as the types of attachment of the sphenoidal septa onto these structures. Methods In total, 230 computed tomography (CT) scans were reviewed to study the type of sphenoid sinus pneumatization (SSP), the protrusion and dehiscence of the ICA and ONC, the relationship between the sphenoidal septa and surrounding vital structures as well as pterygoid recess pneumatization (PRP). Results The most common SSP was sellar type (58.7%). The rates of protrusion and dehiscence of the ICA were 26.3 and 0.4%, and for the ONC, they were 13 and 1.5%, respectively. The ICA and ONC were most protruded and dehiscent in more extensive SSP. In 21.6% of patients, the intersphenoidal septa (IS) were attached to the wall of the ICA and in 8.6% they were attached to the wall of the ONC. The attachment of IS to the ICA correlated statistically significantly (p < 0.0001) with protrusion of the ICA. Accessory septa were detected in 30.4% of cases with various sites of attachment. Conclusion To reduce the risk of injury and complications during endoscopic sinus surgery (ESS), surgeons should consider using CT to identify possible bulging and dehiscence of the ICA/ONC and their relationship to the extent of SSP and also to establish the presence of deviation of the sphenoid septum, and the presence of accessory septa.
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Affiliation(s)
- Gian Luca Fadda
- Department of Otorhinolaryngology, University of Turin, San Luigi Gonzaga Hospital, Regione Gonzole 10, Orbassano, 10043, Turin, Italy.
| | - Alessio Petrelli
- National Institute for Health, Migration and Poverty (INMP), Rome, Italy
| | - Anastasia Urbanelli
- Department of Otorhinolaryngology, University of Turin, San Luigi Gonzaga Hospital, Regione Gonzole 10, Orbassano, 10043, Turin, Italy
| | - Paolo Castelnuovo
- Department of Otorhinolaryngology, University of Insubria, Varese, Italy
| | - Maurizio Bignami
- Department of Otorhinolaryngology, Head & Neck Surgery, University of Insubria, Como, Italy
| | - Erika Crosetti
- Department of Otorhinolaryngology, University of Turin, San Luigi Gonzaga Hospital, Regione Gonzole 10, Orbassano, 10043, Turin, Italy
| | - Giovanni Succo
- Oncology Department, Head & Neck Surgery, University of Turin, Turin, Italy
| | - Giovanni Cavallo
- Department of Otorhinolaryngology, University of Turin, San Luigi Gonzaga Hospital, Regione Gonzole 10, Orbassano, 10043, Turin, Italy
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11
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Ventura M, Di Napoli A, Petrelli A, Pappagallo M, Mirisola C, Frova L. Male and Female Differences in Homicide Mortality: Results of an Italian Longitudinal Study, 2012–2018. Front Public Health 2022; 10:919335. [PMID: 35910885 PMCID: PMC9326256 DOI: 10.3389/fpubh.2022.919335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/17/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction Italy has one of the lowest homicide rates in Europe. However, while it is decreasing overall, the proportion of murdered women is increasing. This study aimed to analyze the demographic and socioeconomic characteristics associated with homicide mortality in Italy, focusing specifically on male and female differences. Methods Using a longitudinal design, the Italian 2011 General Census population was followed up to 2018. Deaths from homicide were retrieved by a record linkage with the Causes of Death Register. Age-standardized mortality rates, stratified by sex, citizenship, education, and geographic area of residence were calculated. The association between sociodemographic characteristics and homicide mortality was evaluated using quasi-Poisson regression models. Results Between 2012 and 2018, 1,940 homicides were recorded in Italy: 53% were females over age 55, 10% were immigrant females, 34% were males aged 40–54 years, 76% had a medium-low education level, and 57% lived in the South and Islands. Foreign citizenship increased a female's risk of dying from homicide (adjusted rate ratio (RRadj): 1.85; 95% CI: 1.54–2.23), while no differences between Italian and immigrant males were found. An inverse association between education and mortality was observed for both sexes, stronger for males (RRadj: 3.68; 95% CI: 3.10–4.36, low vs. high) than for females (RRadj: 1.38; 95%CI: 1.17–1.62, low vs. high). Moreover, a male residing in the South or the Islands had almost 2.5 times the risk of dying from homicide than a resident in the North-West. Finally, old age (over 75) increased a female's risk of being murdered, whereas the highest risk for males was observed for those aged 25–54 years. Conclusions Male and female differences in homicide mortality profiles by age were expected, but the results by residence, citizenship, and education highlight that living in disadvantaged socioeconomic contexts increases the risk of dying from homicide, suggesting the need to implement specific prevention and intervention strategies.
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Affiliation(s)
- Martina Ventura
- Department of Epidemiology, National Institute for Health, Migration and Poverty (INMP), Rome, Italy
- *Correspondence: Martina Ventura
| | - Anteo Di Napoli
- Department of Epidemiology, National Institute for Health, Migration and Poverty (INMP), Rome, Italy
| | - Alessio Petrelli
- Department of Epidemiology, National Institute for Health, Migration and Poverty (INMP), Rome, Italy
| | - Marilena Pappagallo
- Directorate for Social Statistics and Welfare, Italian National Institute of Statistics (Istat), Rome, Italy
| | - Concetta Mirisola
- Department of Epidemiology, National Institute for Health, Migration and Poverty (INMP), Rome, Italy
| | - Luisa Frova
- Directorate for Social Statistics and Welfare, Italian National Institute of Statistics (Istat), Rome, Italy
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Maifredi G, Magoni M, Ercolanoni M, Lazzeretti M, Gennaro N, Ferroni E, Silvestri C, Profili F, Spadea T, Rusciani R, Bartolini L, Caranci N, Cacciani L, Calandrini E, Ventura M, Petrelli A, Cernigliaro A, Allotta AV, Leoni O, Bortolan F. [SARS-CoV-2 epidemic among Italians e resident immigrant population: differential incidence from an interregional multicentre study]. Epidemiol Prev 2022; 46:41-48. [PMID: 35862559 DOI: 10.19191/ep22.4s1.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVES to describe differences in the incidence of SARS-CoV-2 infections between Italians and foreigners residing in seven Italian Regions during the different phases of the pandemic and by gender. DESIGN retrospective observational study. SETTING AND PARTICIPANTS all confirmed SARS-CoV-2 infections from 02.02. 2020 to 16.07.2021 in the seven Regions under study were included. Italian resident population calculated by the National Institute of Statistics as of 01.01.2020 was used to calculate the rates. The considered period is divided into 5 sub-periods (phases). MAIN OUTCOME MEASURES number of confirmed SARS-CoV-2 infections in the five phases of the pandemic and crude rates by citizenship (Italian vs foreign). Distribution of infections by age group and by week. Crude and age-adjusted incidence rates ratios (IRR) were calculated, by Region, gender, and phase of the pandemic. RESULTS an epidemic curve delay was observed in foreigners in the first phase of the epidemic, in particular in the northern Regions, the most affected in that phase. The first phase of the epidemic was characterized by a greater proportion of cases occurred in people aged over 60 years than the other phases, both in Italians and in foreigners. The incidence among foreigners is higher during the summer of 2020 (intermediate period: June-September 2020) and during the last period (May-July 2021) in all Regions. The overall figure shows a lower incidence among foreigners than Italians, except for males in Tuscany. CONCLUSIONS the lower incidence rates among foreigners should be interpreted with caution as the available data suggest that it is at least partly attributable to less access to diagnostic tests. Regional differences found in the study deserve further research together with the effect of gender and country of origin.
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Affiliation(s)
- Giovanni Maifredi
- UO epidemiologia, Agenzia di tutela della salute di Brescia, Brescia;
| | - Michele Magoni
- UO epidemiologia, Agenzia di tutela della salute di Brescia, Brescia
| | - Michele Ercolanoni
- UO osservatorio epidemiologico regionale, Direzione generale welfare, Regione Lombardia, Milano
| | - Marco Lazzeretti
- UO osservatorio epidemiologico regionale, Direzione generale welfare, Regione Lombardia, Milano
- Osservatorio di epidemiologia, Agenzia regionale di sanità, Regione Toscana, Firenze
| | - Nicola Gennaro
- Servizio epidemiologico regionale e registri, Azienda Zero, Regione Veneto, Padova
| | - Eliana Ferroni
- Servizio epidemiologico regionale e registri, Azienda Zero, Regione Veneto, Padova
| | - Caterina Silvestri
- Osservatorio di epidemiologia, Agenzia regionale di sanità, Regione Toscana, Firenze
| | - Francesco Profili
- Osservatorio di epidemiologia, Agenzia regionale di sanità, Regione Toscana, Firenze
| | - Teresa Spadea
- SCaDU Servizio sovrazonale di epidemiologia, Azienda sanitaria locale TO3, Grugliasco (TO)
| | - Raffaella Rusciani
- SCaDU Servizio sovrazonale di epidemiologia, Azienda sanitaria locale TO3, Grugliasco (TO)
| | - Letizia Bartolini
- Agenzia sanitaria e sociale regionale, Regione Emilia-Romagna, Bologna
| | - Nicola Caranci
- Agenzia sanitaria e sociale regionale, Regione Emilia-Romagna, Bologna
| | - Laura Cacciani
- Dipartimento di epidemiologia del Servizio sanitario regionale, Regione Lazio, ASL Roma 1, Roma
| | - Enrico Calandrini
- Dipartimento di epidemiologia del Servizio sanitario regionale, Regione Lazio, ASL Roma 1, Roma
| | - Martina Ventura
- Istituto nazionale per la promozione della salute delle popolazioni migranti e per il contrasto delle malattie della povertà (INMP), Roma
| | - Alessio Petrelli
- Istituto nazionale per la promozione della salute delle popolazioni migranti e per il contrasto delle malattie della povertà (INMP), Roma
| | - Achille Cernigliaro
- Dipartimento per le attività sanitarie e osservatorio epidemiologico, Assessorato della salute, Regione Siciliana, Palermo
- Azienda sanitaria provinciale, Trapani
| | - Alessandra Vincenza Allotta
- Dipartimento per le attività sanitarie e osservatorio epidemiologico, Assessorato della salute, Regione Siciliana, Palermo
| | - Olivia Leoni
- UO osservatorio epidemiologico regionale, Direzione generale welfare, Regione Lombardia, Milano
| | - Francesco Bortolan
- UO osservatorio epidemiologico regionale, Direzione generale welfare, Regione Lombardia, Milano
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Petrelli A, Di Napoli A. [The impact of COVID-19 on the immigrant population in Italy (February 2020-July 2021). Results of a collaborative project between the National Institute for Health, Migration and Poverty and Italian Regions]. Epidemiol Prev 2022; 46:1-88. [PMID: 35862564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Alessio Petrelli
- Istituto nazionale per la promozione della salute delle popolazioni migranti e per il contrasto delle malattie della povertà (INMP), Roma;
| | - Anteo Di Napoli
- Istituto nazionale per la promozione della salute delle popolazioni migranti e per il contrasto delle malattie della povertà (INMP), Roma
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14
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Petrelli A, Di Napoli A. [The impact of COVID-19 on the immigrant population in Italy. Context, methodology and synthesis of the main evidence from the project of the National Institute for Health, Migration and Poverty (INMP) and Italian Regions]. Epidemiol Prev 2022; 46:7-13. [PMID: 35862555 DOI: 10.19191/ep22.4s1.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
COVID-19 acted on health inequalities in two ways: directly, in terms of infection risk and outcomes; indirectly, through effects on the economy, which exacerbated social inequalities. Immigrants have particularly suffered the effects of the pandemic.The Italian National Institute for Health, Migration and Poverty (INMP) has promoted the project "Epidemiology of SARS-CoV-2 (COVID-19) infection and use of health services in immigrant and vulnerable population groups in Italy" in collaboration with the Regions of Piedmont, Lombardy, Veneto, Emilia-Romagna, Tuscany, Lazio, and Sicily, to assess the impact of the pandemic in the immigrant population.This is an observational population-based study design, based on weekly monitoring data from the COVID-19 National Surveillance System of the Italian National Health Institute (ISS). The observation period was split into five sub-periods: February-May 2020 (wave I), June-September 2020 (intermediate period I), October 2020-January 2021 (wave II), February-April 2021 (wave III), May-July 2021 (intermediate period II).Access to diagnostic testing was higher among Italians; the incidence curve showed a lower level of infection among immigrants during the three waves and higher in the two intermediate periods. Age-standardized hospitalization rates were higher among immigrants both in noncritical care areas and in the intensive care unit, particularly in the intermediate stages of the epidemic. Immigrant standardized mortality rates were higher than those of Italians since the third period among males and in the fourth period among females.Differences were also observed on a regional basis and by the immigrants' area of origin.
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Affiliation(s)
- Alessio Petrelli
- Istituto nazionale per la promozione della salute delle popolazioni migranti e il contrasto delle malattie della povertà (INMP), Roma;
| | - Anteo Di Napoli
- Istituto nazionale per la promozione della salute delle popolazioni migranti e il contrasto delle malattie della povertà (INMP), Roma
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15
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Profili F, Stasi C, Silvestri C, Ferroni E, Zorzi M, Ventura M, Petrelli A, Spadea T, Rusciani R, Bartolini L, Caranci N, Cacciani L, Calandrini E, Maifredi G, Leoni O, Voller F. [The impact of the COVID-19 pandemic on the Italian and foreign population in the various phases: the results of an interregional multicentre project]. Epidemiol Prev 2022; 46:71-79. [PMID: 35862562 DOI: 10.19191/ep22.4s1.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVES to analyze the difference of the SARS-CoV-2 infection impact between Italian and foreigner subjects, evaluating the trend of infections and access to diagnostic tests (molecular or antigenic swabs for the detection of SARS- CoV-2) in the two different populations, inducing the detection of new positive cases in the population. DESIGN retrospective population study for the period February 2020-June 2021. SETTING AND PARTICIPANTS Italian and foreign resident population on 1st January of the years 2020 and 2021 in the Regions participating to the project: Piedmont, Lombardy, Veneto, Emilia-Romagna (Northern Italy), Tuscany, Lazio (Central Italy), and Sicily (Southern Italy). MAIN OUTCOME MEASURES in the two populations, for every week and aggregated by macropandemic period were calculated: • the test rate (people tested on the population); • the swab positivity rate (positive subjects on those who are tested); • the new positives (positive subjects on study population); • the percentage of foreigners among the new positive cases. The ratio of the value of the indicators in the foreign and Italian populations (with 95% confidence interval) was calculated to evaluate the association between nationality (Italian vs not Italian) and outcome. The analyses were conducted at the regional level and at pool level. RESULTS the trend of new positives by nationality (Italian vs not Italian) has a similar tendency in the different pandemic waves. However, the incidence of new positives during pandemic waves among foreigners is lower than in Italians, while it tends to increase during intermediate periods. Except for the summer periods, foreigners are less tested than Italians, but the percentage of new positives out of the total of new ones tested is higher among foreigners compared to Italians. The relative weight of new positives among foreigners tends to increase in periods with the greatest risk of inflow of SARS-CoV-2 for foreigners. CONCLUSIONS the epidemic trends in the two populations are similar, although foreigners tend to show lower incidence values, probably in part because they are tested less frequently. Furthermore, in foreigners compared to Italians, there is a greater risk of contracting SARS-CoV-2 infection, especially in periods of relaxation of containment Coronavirus measures, reopening of national borders, production and commercial activities.
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Affiliation(s)
- Francesco Profili
- Osservatorio di epidemiologia, Agenzia regionale di sanità, Regione Toscana, Firenze;
| | - Cristina Stasi
- Osservatorio di epidemiologia, Agenzia regionale di sanità, Regione Toscana, Firenze
| | - Caterina Silvestri
- Osservatorio di epidemiologia, Agenzia regionale di sanità, Regione Toscana, Firenze
| | - Eliana Ferroni
- Servizio epidemiologico regionale e registri, Azienda Zero, Regione Veneto, Padova
| | - Manuel Zorzi
- Servizio epidemiologico regionale e registri, Azienda Zero, Regione Veneto, Padova
| | - Martina Ventura
- Istituto nazionale per la promozione della salute delle popolazioni migranti e per il contrasto delle malattie della povertà (INMP), Roma
| | - Alessio Petrelli
- Istituto nazionale per la promozione della salute delle popolazioni migranti e per il contrasto delle malattie della povertà (INMP), Roma
| | - Teresa Spadea
- SCaDU Servizio sovrazonale di epidemiologia, Azienda sanitaria locale TO3, Grugliasco (TO)
| | - Raffaella Rusciani
- SCaDU Servizio sovrazonale di epidemiologia, Azienda sanitaria locale TO3, Grugliasco (TO)
| | - Letizia Bartolini
- Agenzia sanitaria e sociale regionale, Regione Emilia-Romagna, Bologna
| | - Nicola Caranci
- Agenzia sanitaria e sociale regionale, Regione Emilia-Romagna, Bologna
| | - Laura Cacciani
- Dipartimento di epidemiologia del Servizio sanitario regionale, Regione Lazio, ASL Roma 1, Roma
| | - Enrico Calandrini
- Dipartimento di epidemiologia del Servizio sanitario regionale, Regione Lazio, ASL Roma 1, Roma
| | - Giovanni Maifredi
- UO epidemiologia, Agenzia di tutela della salute di Brescia, Brescia
| | - Olivia Leoni
- UO osservatorio epidemiologico regionale, Direzione generale welfare, Regione Lombardia, Milano
| | - Fabio Voller
- Osservatorio di epidemiologia, Agenzia regionale di sanità, Regione Toscana, Firenze
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Ferroni E, Gennaro N, Barbiellini Amidei C, Avossa F, Maifredi G, Spadea T, Cacciani L, Silvestri C, Bartolini L, Petrelli A, Di Napoli A, Zorzi M. [Impact of COVID-19 on the immigrant population in the Veneto Region (Northern Italy), by geographical area of origin]. Epidemiol Prev 2022; 46:81-88. [PMID: 35862563 DOI: 10.19191/ep22.4s1.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVES to examine the differences in SARS-CoV-2 infection and hospitalization rates among migrant populations in Veneto Region (Northern Italy), according to the geographic area of origin. SETTING AND PARTICIPANTS all residents in Veneto Region aged <65 years were included in the analyses. All subjects infected by SARS-CoV-2 and hospitalized for COVID-19 were identified by means of the regional biosurveillance system. MAIN OUTCOME MEASURES age- and gender-specific infection and hospitalization rates were stratified by geographic area of origin and were estimated using the number of incident cases over the resident population in Veneto on 01.01.2021. Incidence rate ratios (IRR) for infection and hospitalization rates were estimated using a Poisson model, adjusted for age and gender, among migrants compared to Italians. RESULTS compared to Italians, SARS-CoV-2 infection rates were significantly higher among migrants from Central and South America and Central and South Asia, lower among those from North Africa and High-Income Countries (HIC), and were approximately halved for those coming from Other Asian Countries (mainly represented by China). Hospitalization rates were significantly higher for all migrant populations when compared to Italians, with the exception of those coming from HIC. Neither age nor gender seemed to modify the association of the geographic area of origin with SARS-CoV-2 infection and hospitalization rates. IRR for SARS-CoV-2 infection of migrants compared to Italians showed how migrants from Other Asian Countries had the lowest infection rates (-53%), followed by people from HIC (-25%), North Africa (-21%), and Eastern Europe (-10%). Higher infection rates were present for Central and South America and Central and South Asia (+17% and +10, respectively). Hospitalization rates were especially high among migrants from Central and South Asia, Africa, and Central and South America, ranging from 1.84 to 3.14 times those observed for Italians. CONCLUSIONS a significant heterogeneity in SARS-CoV-2 infection and hospitalization rates of migrant populations from different geographic areas of origin were observed. The significantly lower incidence rate ratio for infections, compared to that observed for hospitalizations, is suggestive of a possible under-diagnosis of SARS-CoV-2 infection among migrant populations. Public health efforts should be targeted at increasing support among migrants to contrast the spread of the pandemic by potentiating vaccination campaigns, contact tracing, and COVID-19 diagnostic tests.
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Affiliation(s)
- Eliana Ferroni
- Servizio epidemiologico regionale e registri, Azienda Zero, Regione Veneto, Padova
| | - Nicola Gennaro
- Servizio epidemiologico regionale e registri, Azienda Zero, Regione Veneto, Padova
| | | | - Francesco Avossa
- Servizio epidemiologico regionale e registri, Azienda Zero, Regione Veneto, Padova
| | - Giovanni Maifredi
- UO epidemiologia, Agenzia di tutela della salute di Brescia, Brescia
| | - Teresa Spadea
- SCaDU Servizio sovrazonale di epidemiologia, Azienda sanitaria locale TO3, Grugliasco (TO)
| | - Laura Cacciani
- Dipartimento di epidemiologia del Servizio sanitario regionale, Regione Lazio, ASL Roma 1, Roma
| | - Caterina Silvestri
- Osservatorio di epidemiologia, Agenzia regionale di sanità, Regione Toscana, Firenze
| | - Letizia Bartolini
- Agenzia sanitaria e sociale regionale, Regione Emilia-Romagna, Bologna
- Servizio interaziendale di epidemiologia e comunicazione del rischio, Azienda unità sanitaria locale - IRCCS Reggio Emilia
| | - Alessio Petrelli
- Istituto nazionale per la promozione della salute delle popolazioni migranti e per il contrasto delle malattie della povertà (INMP), Roma
| | - Anteo Di Napoli
- Istituto nazionale per la promozione della salute delle popolazioni migranti e per il contrasto delle malattie della povertà (INMP), Roma
| | - Manuel Zorzi
- Servizio epidemiologico regionale e registri, Azienda Zero, Regione Veneto, Padova
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Cacciani L, Calandrini E, Cascini S, Spadea T, Rusciani R, Ercolanoni M, Maifredi G, Ferroni E, Bartolini L, Caranci N, Silvestri C, Profili F, Cernigliaro A, Petrelli A, Di Napoli A, Davoli M, Agabiti N. [Hospital assistance for COVID-19: a comparison between non-Italian and Italian resident population in five Italian Regions since the beginning of the pandemic until June 2021]. Epidemiol Prev 2022; 46:49-58. [PMID: 35862560 DOI: 10.19191/ep22.4s1.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVES to describe trends of overall and intensive care hospitalization for COVID-19 since the beginning of the pandemic in Italy until June 2021, and to compare the results between foreign and Italian population. DESIGN retrospective observational study. SETTING AND PARTICIPANTS hospital discharges of 28 million people living in Lombardy, Piedmont, Emilia-Romagna (Northern Italy), Toscana and Lazio (Central Italy) occurred between 22.02.2020 and 02.07.2021 in the hospitals located in each considered Region. MAIN OUTCOME MEASURES two weekly outcomes were examined: 1. the overall number of COVID-19 hospitalizations; 2. the number of COVID-19 hospitalizations in intensive care units. RESULTS a higher COVID-19 overall and intensive care unit hospitalization was found among the foreign population compared to Italians. The association emerged only after the adjustment for age, and it was consistent among all Regions, though less marked in Lombardy. The association varied across epidemic phases. CONCLUSIONS the issue of vulnerability of migrants to the risk of severe COVID-19 calls for a diversity-sensitive approach in prevention. The specific country of origin and the prevalence of preventable co-morbidities that are often underestimated in the migrant populations, and related to COVID-19 complications, should be taken into consideration in future analyses.
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Affiliation(s)
- Laura Cacciani
- Dipartimento di epidemiologia del Servizio sanitario regionale, Regione Lazio, ASL Roma 1, Roma;
| | - Enrico Calandrini
- Dipartimento di epidemiologia del Servizio sanitario regionale, Regione Lazio, ASL Roma 1, Roma
| | - Silvia Cascini
- Dipartimento di epidemiologia del Servizio sanitario regionale, Regione Lazio, ASL Roma 1, Roma
| | - Teresa Spadea
- SCaDU Servizio sovrazonale di epidemiologia, Azienda sanitaria locale TO3, Grugliasco (TO)
| | - Raffaella Rusciani
- SCaDU Servizio sovrazonale di epidemiologia, Azienda sanitaria locale TO3, Grugliasco (TO)
| | - Michele Ercolanoni
- UO osservatorio epidemiologico regionale, Direzione generale welfare, Regione Lombardia, Milano
| | - Giovanni Maifredi
- UO epidemiologia, Agenzia di tutela della salute di Brescia, Brescia
| | - Eliana Ferroni
- Servizio epidemiologico regionale e registri, Azienda Zero, Regione Veneto, Padova
| | - Letizia Bartolini
- Agenzia sanitaria e sociale regionale, Regione Emilia-Romagna, Bologna
- Servizio interaziendale di epidemiologia e comunicazione del rischio, Azienda unità sanitaria locale - IRCCS Reggio Emilia
| | - Nicola Caranci
- Agenzia sanitaria e sociale regionale, Regione Emilia-Romagna, Bologna
| | - Caterina Silvestri
- Osservatorio di epidemiologia, Agenzia regionale di sanità, Regione Toscana, Firenze
| | - Francesco Profili
- Osservatorio di epidemiologia, Agenzia regionale di sanità, Regione Toscana, Firenze
| | - Achille Cernigliaro
- Dipartimento per le attività sanitarie e osservatorio epidemiologico, Assessorato della salute, Regione Siciliana, Palermo
| | - Alessio Petrelli
- Istituto nazionale per la promozione della salute delle popolazioni migranti e per il contrasto delle malattie della povertà (INMP), Roma
| | - Anteo Di Napoli
- Istituto nazionale per la promozione della salute delle popolazioni migranti e per il contrasto delle malattie della povertà (INMP), Roma
| | - Marina Davoli
- Dipartimento di epidemiologia del Servizio sanitario regionale, Regione Lazio, ASL Roma 1, Roma
| | - Nera Agabiti
- Dipartimento di epidemiologia del Servizio sanitario regionale, Regione Lazio, ASL Roma 1, Roma
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18
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Di Napoli A, Ventura M, Grande E, Frova L, Mirisola C, Petrelli A. Nationwide longitudinal population-based study on mortality in Italy by immigrant status. Sci Rep 2022; 12:10986. [PMID: 35768625 PMCID: PMC9243023 DOI: 10.1038/s41598-022-15290-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 06/22/2022] [Indexed: 11/09/2022] Open
Abstract
A systematic analysis of the mortality of immigrant residents throughout Italy has never been carried out. The present study aimed to evaluate differences in mortality by immigrant status. A longitudinal study of the Italian resident population (native and immigrants) recorded in the 2011 National Institute of Statistics Census was conducted. This cohort was followed up from 2012 to 2018 until death, emigration, or end of the study period. The exposure variable was the immigrant status, measured through citizenship, dichotomized into Italian and immigrant. The main outcome was overall and cause-specific mortality. Age-standardized mortality ratios (SMRs) were calculated. The SMRs among immigrants were half that of Italians, both for men (SMR 0.52) and women (SMR 0.51), with the lowest SMRs observed for subjects from North Africa and Oceania. For some causes of death, mortality was higher among immigrants: tuberculosis in both men (SMR 4.58) and women (SMR 4.72), and cervical cancer (SMR 1.58), complications of pregnancy, childbirth, and puerperium (SMR 1.36), and homicide (SMR 2.13) for women. A multivariable quasi-Poisson regression analysis, adjusted for age and macro area of residence in Italy, confirmed a lower all-cause mortality for immigrants compared to Italians, both for men (RR 0.46) and women (RR 0.44). Although immigration to Italy is no longer a recent phenomenon, and the presence of immigrants is acquiring structural characteristics, our study confirms their health advantage, with a lower mortality than that of Italians for almost all causes of death and for all areas of origin.
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Affiliation(s)
- Anteo Di Napoli
- National Institute for Health, Migration and Poverty (INMP), Via di San Gallicano, 25a - 00153, Rome, Italy.
| | - Martina Ventura
- National Institute for Health, Migration and Poverty (INMP), Via di San Gallicano, 25a - 00153, Rome, Italy
| | - Enrico Grande
- National Institute of Statistics (Istat), Rome, Italy
| | - Luisa Frova
- National Institute of Statistics (Istat), Rome, Italy
| | - Concetta Mirisola
- National Institute for Health, Migration and Poverty (INMP), Via di San Gallicano, 25a - 00153, Rome, Italy
| | - Alessio Petrelli
- National Institute for Health, Migration and Poverty (INMP), Via di San Gallicano, 25a - 00153, Rome, Italy
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Di Napoli A, Ventura M, Spadea T, Giorgi Rossi P, Bartolini L, Battisti L, Cacciani L, Caranci N, Cernigliaro A, De Giorgi M, Fanolla A, Lazzeretti M, Mininni M, Mirisola C, Petrelli A. Barriers to Accessing Primary Care and Appropriateness of Healthcare Among Immigrants in Italy. Front Public Health 2022; 10:817696. [PMID: 35223739 PMCID: PMC8864157 DOI: 10.3389/fpubh.2022.817696] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/06/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The health status and health care needs of immigrant populations must be assessed. The aim of this study was to evaluate barriers to accessing primary care and the appropriateness of health care among resident immigrants in Italy, using indicators regarding maternal health, avoidable hospitalization, and emergency care. METHODS Cross-sectional study using some indicators of the National Monitoring System of Health Status and Healthcare of the Immigrant Population (MSHIP), coordinated by the National Institute for Health, Migration and Poverty (INMP), calculated on perinatal care, hospital discharge, and emergency department databases for the years 2016-2017 in nine Italian regions (Piedmont, Trento, Bolzano, Emilia-Romagna, Tuscany, Umbria, Latium, Basilicata, Sicily). The analyses were conducted comparing immigrant and Italian residents. RESULTS Compared to Italian women, immigrant women had fewer than five gynecological examinations (8.5 vs. 16.3%), fewer first examinations after the 12th week of gestational age (3.8 vs. 12.5%), and fewer than two ultrasounds (1.0 vs. 3.8%). Compared to Italians, immigrants had higher standardized rates (× 1,000 residents) of avoidable hospitalizations (males: 2.1 vs. 1.4; females: 0.9 vs. 0.7) and of access to emergency departments for non-urgent conditions (males: 62.0 vs. 32.7; females: 52.9 vs. 31.4). CONCLUSIONS In Italy, there appear to be major issues regarding accessing services and care for the immigrant population. Policies aimed at improving socioeconomic conditions and promoting integration can promote healthy lifestyles and appropriate access to health care, counteracting the emergence of health inequities in the immigrant population.
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Affiliation(s)
- Anteo Di Napoli
- National Institute for Health, Migration and Poverty (INMP), Roma, Italy
| | - Martina Ventura
- National Institute for Health, Migration and Poverty (INMP), Roma, Italy
| | - Teresa Spadea
- Epidemiology Unit, Local Health Unit TO3 Piedmont Region, Grugliasco, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale - Istituto di Ricovero e Cura a Carattere Scientifico di Reggio Emilia, Reggio Emilia, Italy
| | - Letizia Bartolini
- Epidemiology Unit, Azienda Unità Sanitaria Locale - Istituto di Ricovero e Cura a Carattere Scientifico di Reggio Emilia, Reggio Emilia, Italy
| | - Laura Battisti
- Epidemiological Observatory, Public Health Department - Local Health Unit, Trento, Italy
| | - Laura Cacciani
- Department of Epidemiology of the Lazio Regional Health Service, Roma, Italy
| | | | - Achille Cernigliaro
- Health Authority Sicily Region and Local Authority Trapani Province, Palermo, Italy
| | - Marcello De Giorgi
- Umbria Digitale - Health Information and Communication Technology Service, Regional Health Authority of Umbria, Perugia, Italy
| | - Antonio Fanolla
- Provincial Government South Tyrol, Observatory for Health, Bolzano, Italy
| | | | | | - Concetta Mirisola
- National Institute for Health, Migration and Poverty (INMP), Roma, Italy
| | - Alessio Petrelli
- National Institute for Health, Migration and Poverty (INMP), Roma, Italy
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20
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Petrelli A, Sebastiani G, Di Napoli A, Macciotta A, Di Filippo P, Strippoli E, Mirisola C, d'Errico A. Education inequalities in cardiovascular and coronary heart disease in Italy and the role of behavioral and biological risk factors. Nutr Metab Cardiovasc Dis 2022; 32:918-928. [PMID: 35067447 DOI: 10.1016/j.numecd.2021.10.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 10/20/2021] [Accepted: 10/26/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND AIMS Behavioral and biological risk factors (BBRF) explain part of the variability in socioeconomic differences in health. The present study aimed at evaluating education differences in incidence of cardiovascular disease (CVD) and coronary heart disease (CHD) in Italy and the role of BBRF. METHODS AND RESULTS All subjects aged 30-74 years (n = 132,686) who participated to the National Health Interview Surveys 2000 and 2005 were included and followed-up for ten years. Exposure to smoking, physical activity, overweight/obesity, diabetes and hypertension at baseline was considered. Education level was used as an indicator of socioeconomic status. The outcomes were incident cases of CVD and CHD. Hazard ratios by education level were estimated, adjusting for sociodemographic covariates and stratifying by sex and geographic area. The contribution of BBRF to education inequalities was estimated by counterfactual mediation analysis, in addition to the assessment of the risk attenuation by comparing the models including BBRF or not. 22,214 participants had a CVD event and 6173 a CHD event. After controlling for sociodemographic factors, the least educated men showed a 21% higher risk of CVD and a 17% higher risk of CHD compared to the most educated (41% and 61% among women). The mediating effect (natural indirect effect) of BBRF between extreme education levels was 52% for CVD and 84% for CHD among men (16% among women for CVD). CONCLUSIONS More effective strategies aiming at reducing socioeconomic disparities in CVD and CHD are needed, through programs targeting less educated people in combination with community-wide initiatives.
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Affiliation(s)
- Alessio Petrelli
- National Institute for Health, Migration and Poverty (INMP), Italy.
| | | | - Anteo Di Napoli
- National Institute for Health, Migration and Poverty (INMP), Italy
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21
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Mondello S, Visalli C, Kobeissy F, Cacciani L, Cruciani F, D'Amato S, Di Napoli A, Giorgi Rossi P, Milli C, Petrelli A, Silvestri C, Cernigliaro A, Scondotto S. Exploring the evidence for the effectiveness of health interventions for COVID-19 targeting migrants: a systematic review protocol. BMJ Open 2021; 11:e057985. [PMID: 34937727 PMCID: PMC8704024 DOI: 10.1136/bmjopen-2021-057985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 11/25/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Owing to their inherent vulnerabilities, the burden of COVID-19 and particularly of its control measures on migrants has been magnified. A thorough assessment of the value of the interventions for COVID-19 tailored to migrants is essential for improving their health outcomes as well as promoting an effective control of the pandemic. In this study, based on evidence from primary biomedical research, we aimed to systematically identify health interventions for COVID-19 targeting migrants and to assess and compare their effectiveness. The review will be conducted within a programme aimed at defining and implementing interventions to control the COVID-19 pandemic in Italy, funded by the Italian Ministry of Health and conducted by a consortium of Italian regional health authorities. METHODS AND ANALYSES Data sources will include the bibliographic databases MEDLINE, Embase, LOVE Platform COVID-19 Evidence, and Cochrane Central Register of Controlled Trials. Eligible studies must evaluate health interventions for COVID-19 in migrants. Two independent reviewers will screen articles for inclusion using predefined eligibility criteria, extract data of retained articles and assess methodological quality by applying the Cochrane Risk of Bias tool. Disagreements will be resolved through consensus or arbitrated by a third reviewer if necessary. In synthesising the evidence, we will structure results by interventions, outcomes and quality. Where studies are sufficiently homogenous, trial data will be pooled and meta-analyses will be performed. Data will be reported according to methodological guidelines for systematic review provided by the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. ETHICS AND DISSEMINATION This is a review of existing literature, and ethics approval is not required. We will submit results for peer-review publication and present at relevant conferences. The review findings will be included in future efforts to develop evidence-informed recommendations, policies or programmatic actions at the national and regional levels and address future high-quality research in public health.
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Affiliation(s)
- Stefania Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Carmela Visalli
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Firas Kobeissy
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
- Department of Biochemistry and Molecular Genetics, American University of Beirut Medical Center, Beirut, Lebanon
| | - Laura Cacciani
- Dipartimento di Epidemiologia, SSR Lazio, Azienda Sanitaria Locale Roma 1, Roma, Italy
| | - Fabio Cruciani
- Dipartimento di Epidemiologia, SSR Lazio, Azienda Sanitaria Locale Roma 1, Roma, Italy
| | | | | | - Paolo Giorgi Rossi
- Servizio Interaziendale Epidemiologia, AUSL Reggio Emilia, Reggio Emilia, Italy
| | - Caterina Milli
- 'Agenzia Regionale di Sanità della Toscana, Firenze, Toscana, Italy
| | | | | | - Achille Cernigliaro
- Department of Health Services and Epidemiological Observatory, Regional Health Authority, Palermo, Italy
| | - Salvatore Scondotto
- Department of Health Services and Epidemiological Observatory, Regional Health Authority, Palermo, Italy
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22
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Sisti LG, Cammilli M, Diodati A, Menghini M, Fazioli C, Petrelli A, Di Napoli A, Cavani A, Mirisola C, Costanzo G. Managing the pandemic in the reception system for migrants: the Italian experience. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Issue
Italy represents a well-known European transit and destination country for Migrants and Refugees (M&Rs) with more than 77.000 migrants currently hosted in the reception system. Pandemic did not impact the M&Rs' influx with more than 30.000 disembarked in 2020. In line with the WHO and international organizations alerts to protect the health of M&Rs, Italy included M&Rs in its pandemic response.
Description of the practice
With the mandate of the Ministry of Health and thanks to the collaboration with the Ministry of the Interior and other institutional and governmental bodies, the Italian National Institute for Health, Migration and Poverty developed a comprehensive strategy to protect M&Rs' health in Italy during the COVID-19 pandemic, either into the reception system and outside.
Results
Interim evidence - based operating procedures including instructions regarding the early detection and the management of potential suspected and confirmed COVID-19 cases, from the first arrival throughout the entire reception system path, have been published. A national survey on the incidence of COVID-19 cases in the reception system has been performed in 2020. Dedicated information flows on the incidence of COVID-19 cases at the arrival in Italy and in the reception system and a periodic monitoring of the implementation of the afore-mentioned operating procedures have been established in 2021. Data collected have shown a daily mean incidence ratio lower for migrants hosted in the reception system than for the general population, as well as the same regarding the new COVID-19 cases among newly arrived migrants.
Lessons
The strategy adopted was found to be effective in protecting M&Rs' health during the pandemic. In particular, the Italian reception system has globally shown a good performance in limiting the COVID-19 spread. Moreover, the influx of newly arrived migrants did not represent an additional epidemiological risk in terms of burden of infection.
Key messages
The production of evidence-based procedures and the establishment of effective information flows have proved to be effective in managing and monitoring the pandemic in regards to M&Rs. The Italian reception system has turned to play as a protective factor in limiting the COVID-19 spread and the systematic screening of newly arrived M&Rs did not shown an additional COVID-19 burden.
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Affiliation(s)
- LG Sisti
- National Institute for Health, Migration and Poverty, Rome, Italy
- Department of Public Health, Catholic University of the Sacred Heart, Rome, Italy
| | - M Cammilli
- National Institute for Health, Migration and Poverty, Rome, Italy
| | - A Diodati
- National Institute for Health, Migration and Poverty, Rome, Italy
| | - M Menghini
- National Institute for Health, Migration and Poverty, Rome, Italy
| | - C Fazioli
- National Institute for Health, Migration and Poverty, Rome, Italy
| | - A Petrelli
- National Institute for Health, Migration and Poverty, Rome, Italy
| | - A Di Napoli
- National Institute for Health, Migration and Poverty, Rome, Italy
| | - A Cavani
- National Institute for Health, Migration and Poverty, Rome, Italy
| | - C Mirisola
- National Institute for Health, Migration and Poverty, Rome, Italy
| | - G Costanzo
- National Institute for Health, Migration and Poverty, Rome, Italy
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23
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Dalla Zuanna T, Cacciani L, Barbieri G, Batzella E, Tona F, Ferracin E, Spadea T, Di Girolamo C, Caranci N, Petrelli A, Marino C, Canova C. Avoidable Hospitalization for Heart Failure Among a Cohort of 18- to 64-Year-Old Italian Citizens and Immigrants: Results From the Italian Network for Longitudinal Metropolitan Studies. Circ Heart Fail 2021; 14:e008022. [PMID: 34235937 DOI: 10.1161/circheartfailure.120.008022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Heart failure (HF) represents a severe public health burden. In Europe, differences in hospitalizations for HF have been found between immigrants and native individuals, with inconsistent results. Immigrants face many barriers in their access to health services, and their needs may be poorly met. We aimed to compare the rates of avoidable hospitalization for HF among immigrants and native individuals in Italy. METHODS All 18- to 64-year-old residents of Turin, Venice, Reggio Emilia, Modena, Bologna, and Rome between January 1, 2001 and December 31, 2013 were included in this multicenter open-cohort study. Immigrants from high migratory pressure countries (divided by area of origin) were compared with Italian citizens. Age-, sex-, and calendar year-adjusted hospitalization rate ratios and the 95% CIs of avoidable hospitalization for HF by citizenship were estimated using negative binomial regression models. The hospitalization rate ratios were summarized using a random effects meta-analysis. Additionally, we tested the contribution of socioeconomic status to these disparities. RESULTS Of the 4 470 702 subjects included, 15.8% were immigrants from high migratory pressure countries. Overall, immigrants showed a nonsignificant increased risk of avoidable hospitalization for HF (hospitalization rate ratio, 1.26 [95% CI, 0.97-1.68]). Risks were higher for immigrants from Sub-Saharan Africa and for males from Northern Africa and Central-Eastern Europe than for their Italian citizen counterparts. Risks were attenuated adjusting for socioeconomic status, although they remained consistent with nonadjusted results. CONCLUSIONS Adult immigrants from different geographic macroareas had higher risks of avoidable hospitalization for HF than Italian citizens. Possible explanations might be higher risk factors among immigrants and reduced access to primary health care services.
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Affiliation(s)
- Teresa Dalla Zuanna
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy (T.D.Z., G.B., E.B., C.C.)
| | - Laura Cacciani
- Department of Epidemiology, Regional Health Service, Lazio Region, Rome, Italy (L.C., C.M.)
| | - Giulia Barbieri
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy (T.D.Z., G.B., E.B., C.C.)
| | - Erich Batzella
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy (T.D.Z., G.B., E.B., C.C.)
| | - Francesco Tona
- Department of Cardiac, Thoracic and Vascular Sciences, Padova University-Hospital, Italy (F.T.)
| | - Elisa Ferracin
- Epidemiology Department, Local Health Unit TO3, Piedmont Region, Grugliasco, Turin, Italy (E.F., T.S.)
| | - Teresa Spadea
- Epidemiology Department, Local Health Unit TO3, Piedmont Region, Grugliasco, Turin, Italy (E.F., T.S.)
| | - Chiara Di Girolamo
- Regional Health and Social Care Agency, Emilia-Romagna Region, Bologna, Italy (C.D.G., N.C.)
| | - Nicola Caranci
- Regional Health and Social Care Agency, Emilia-Romagna Region, Bologna, Italy (C.D.G., N.C.)
| | - Alessio Petrelli
- National Institute for Health, Migration and Poverty (INMP), Rome, Italy (A.P.)
| | - Claudia Marino
- Department of Epidemiology, Regional Health Service, Lazio Region, Rome, Italy (L.C., C.M.)
| | - Cristina Canova
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy (T.D.Z., G.B., E.B., C.C.)
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24
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Spadea T, Fano V, Piovesan C, Rusciani R, Salamina G, Greco G, Colaiocco G, Ramigni M, Declich S, Petrelli A, Pezzotti P, Fabiani M. Early childhood vaccination coverage and timeliness by macro-area of origin in children born to foreign women residing in Italy. Public Health 2021; 196:138-145. [PMID: 34214751 DOI: 10.1016/j.puhe.2021.05.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/03/2021] [Accepted: 05/21/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Country of origin might affect vaccine uptake in children born to immigrants. We aimed to evaluate differences in childhood vaccination coverage (VC) and timeliness by macro-area of origin of foreign mothers residing in Italy. STUDY DESIGN Multicentre retrospective birth cohorts. METHODS We analysed data of 23,287 children born in 2009-2014 to foreign women in the cities of Rome, Turin and Treviso. We retrieved data through record-linkage of the population, vaccination and birth registries. We estimated VCs at different ages for vaccines against tetanus, measles and meningococcal group-C, using the Kaplan-Meier method. Factors associated with vaccine uptake were evaluated using multilevel Poisson models. RESULTS Estimates of VC at any age and for all antigens were significantly lower in children born to women from Asia and higher in children born to women from Africa, as compared to other macro-areas. Similar differences by area of origin were observed for timeliness; independently of mother's sociodemographic characteristics and neonatal outcomes, the probability of delay vaccination after 2 years of age for each antigen was highest in children born to women from Asia. The risk of missed vaccination for all antigens was significantly higher in children born to younger and unemployed women. CONCLUSIONS Factors related to area of origin (e.g., cultural habits, language skills) are likely to affect parents' decision to vaccinate their children. These factors, as well as sociodemographic characteristics, should be adequately investigated and addressed to increase vaccine uptake in foreign children, especially those born to Asian women.
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Affiliation(s)
- T Spadea
- Regional Epidemiology Unit, Asl TO3 Piedmont Region, Via Sabaudia 164, 10095, Grugliasco, Turin, Italy.
| | - V Fano
- Department of Prevention, Asl RM2, Via Maria Brighenti 23, 00159, Rome, Italy
| | - C Piovesan
- Department of Prevention, Ulss 2 Marca Trevigiana, Via S. Ambrogio di Fiera 37, 31100, Treviso, Italy
| | - R Rusciani
- Regional Epidemiology Unit, Asl TO3 Piedmont Region, Via Sabaudia 164, 10095, Grugliasco, Turin, Italy
| | - G Salamina
- Department of Hygiene and Public Health, Asl Città di Torino, Via Della Consolata 10, 10122, Turin, Italy
| | - G Greco
- Department of Hygiene and Public Health, Asl Città di Torino, Via Della Consolata 10, 10122, Turin, Italy
| | - G Colaiocco
- Department of Prevention, Asl RM2, Via Maria Brighenti 23, 00159, Rome, Italy
| | - M Ramigni
- Department of Prevention, Ulss 2 Marca Trevigiana, Via S. Ambrogio di Fiera 37, 31100, Treviso, Italy
| | - S Declich
- National Centre for Global Health, Italian National Institute of Health (ISS), Viale Regina Elena 299, 00161 Rome, Italy
| | - A Petrelli
- National Institute for Health, Migration, and Poverty (INMP), Via di S. Gallicano 25, 00153, Rome, Italy
| | - P Pezzotti
- Infectious Diseases Department, Italian National Institute of Health (ISS), Viale Regina Elena 299, 00161, Rome, Italy
| | - M Fabiani
- Infectious Diseases Department, Italian National Institute of Health (ISS), Viale Regina Elena 299, 00161, Rome, Italy
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25
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Di Napoli A, Rossi A, Battisti L, Cacciani L, Caranci N, Cernigliaro A, De Giorgi M, Fanolla A, Fateh-Moghadam P, Franchini D, Lazzeretti M, Melani C, Mininni M, Mondo L, Recine M, Rosaia EM, Rusciani R, Scondotto S, Silvestri C, Trappolini E, Petrelli A. [Evaluating health care of the immigrant population in Italy through indicators of a national monitoring system]. Epidemiol Prev 2021; 44:85-93. [PMID: 33415950 DOI: 10.19191/ep20.5-6.s1.p085.077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES to evaluate maternal and child healthcare, avoidable hospitalisation, access to emergency services among immigrants in Italy. DESIGN cross sectional study of some health and health care indicators among Italian and foreign population residing in Italy in 2016-2017. SETTING AND PARTICIPANTS indicators based on the national monitoring system coordinated by the Italian National Institute for Health, Migration and Poverty (INMP) of Rome, calculated on perinatal care (CedAP), hospital discharge (SDO), emergency services (EMUR) archives for the years 2016-2017, by of the following regions: Piedmont, Trento, Bolzano, Emilia-Romagna, Tuscany, Umbria, Lazio, Basilicata, Sicily. MAIN OUTCOME MEASURES number and timeliness of pregnancy visits, number of ultrasounds, invasive prenatal investigations; perinatal mortality rates, birth weight, Apgar score at 5 minutes, need for neonatal resuscitation; standardized rates of avoidable hospitalisation and access to emergency services by triage code. RESULTS more often than Italians, immigrant women have during pregnancy: less than 5 gynaecological examination (16.3% vs 8.5%), first examination after the 12th week of gestational age (12.5% vs 3.8%), less than 2 ultrasounds (3.8% vs 1.0%). Higher perinatal mortality rates among immigrants compared to Italians (3.6 vs 2.3 x1,000). Higher standardized rates (x1,000) among immigrants compared to Italians of avoidable hospitalisation (men: 2.1 vs 1.4; women: 0.9 vs 0.7) and of white triage codes in emergency (men: 62.0 vs 32.7; women: 52.9 vs 31.4). CONCLUSIONS study findings show differences in access and outcomes of healthcare between Italians and immigrants. National monitoring system of indicators, coordinated by INMP, represents a useful tool for healthcare intervention policies aimed to health equity.
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Affiliation(s)
- Anteo Di Napoli
- Istituto nazionale per la promozione della salute delle popolazioni migranti e per il contrasto delle malattie della povertà (INMP), Roma;
| | - Alessandra Rossi
- Istituto nazionale per la promozione della salute delle popolazioni migranti e per il contrasto delle malattie della povertà (INMP), Roma
| | - Laura Battisti
- Istituto nazionale per la promozione della salute delle popolazioni migranti e per il contrasto delle malattie della povertà (INMP), Roma
| | - Laura Cacciani
- Dipartimento di epidemiologia del SSR del Lazio, ASL Roma 1, Roma
| | - Nicola Caranci
- Agenzia sanitaria e sociale regionale, Regione Emilia-Romagna, Bologna
| | - Achille Cernigliaro
- Dipartimento attività sanitarie e osservatorio epidemiologico, Assessorato alla sanità, Regione Siciliana, Palermo
| | - Marcello De Giorgi
- Servizio mobilità sanitaria, gestione del sistema informativo sanitario e sociale, Osservatorio epidemiologico regionale, Regione Umbria, Perugia
| | - Antonio Fanolla
- Osservatorio per la salute, Ufficio governo sanitario, Provincia autonoma di Bolzano, Bolzano
| | | | - David Franchini
- Servizio mobilità sanitaria, gestione del sistema informativo sanitario e sociale, Osservatorio epidemiologico regionale, Regione Umbria, Perugia
| | - Marco Lazzeretti
- Osservatorio di epidemiologia, Agenzia regionale di sanità della Toscana, Firenze
| | - Carla Melani
- Osservatorio per la salute, Ufficio governo sanitario, Provincia autonoma di Bolzano, Bolzano
| | - Mariangela Mininni
- Ufficio prevenzione primaria, Dipartimento politiche della persona, Regione Basilicata, Potenza
| | - Luisa Mondo
- SC a DU servizio sovrazonale di epidemiologia ASL TO3, Regione Piemonte, Grugliasco (TO)
| | - Michele Recine
- Sistema informativo sociosanitario, Dipartimento politiche della persona, Regione Basilicata, Potenza
| | - Eva Miriam Rosaia
- Dipartimento di scienze statistiche, Alma Mater Studiorum, Università di Bologna, Bologna
| | - Raffaella Rusciani
- SC a DU servizio sovrazonale di epidemiologia ASL TO3, Regione Piemonte, Grugliasco (TO)
| | - Salvatore Scondotto
- Dipartimento per le attività sanitarie e Osservatorio epidemiologico, Assessorato della salute, Regione Siciliana, Palermo
| | - Caterina Silvestri
- Osservatorio di epidemiologia, Agenzia regionale di sanità della Toscana, Firenze
| | | | - Alessio Petrelli
- Istituto nazionale per la promozione della salute delle popolazioni migranti e per il contrasto delle malattie della povertà (INMP), Roma
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Asciutto R, Di Napoli A, Vecchi S, Sicuro J, Mirisola C, Petrelli A. A systematic review of economic evaluations of neonatal and maternal healthcare in immigrant and ethnic minority women. Epidemiol Prev 2021; 44:142-152. [PMID: 33415957 DOI: 10.19191/ep20.5-6.s1.p142.084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND less access to appropriate care during pregnancy for immigrant/ethnic minority women can lead to worse health outcomes and higher costs for health services. OBJECTIVES to conduct a systematic review of studies on the economic evaluation of maternal and child healthcare among immigrants and racial/ethnic minority groups in advanced economy countries. METHODS the main biomedical/economic bibliographic databases and institutional sources were searched. The systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS encouraging breastfeeding and reducing inappropriate hospital use/length of hospital stay proved potentially able to reduce costs. Most studies showed a cost reduction if immigrant and ethnic minority women were included both in national and targeted programmes, such as nutritional programmes or case management. Screening campaigns targeting immigrants and ethnic minority groups were more cost-effective than broader, universal or non-screening strategies. Screenings were cost-effective when extended to newborns/relatives of pregnant women (Chagas disease) and were cost-effective for unvaccinated women in low-vaccination rates regions (rubella), immigrant women reporting no/uncertain vaccination history (varicella), and first-generation immigrants (HCV). DISCUSSION promoting inclusion in pregnancy healthcare programmes or in targeted screening campaigns could be effective in cost saving for health services.
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Affiliation(s)
- Rosario Asciutto
- National Institute for Health, Migration and Poverty (INMP), Rome (Italy)
| | - Anteo Di Napoli
- National Institute for Health, Migration and Poverty (INMP), Rome (Italy)
| | - Simona Vecchi
- Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Rome (Italy)
| | - Jacopo Sicuro
- National Institute for Health, Migration and Poverty (INMP), Rome (Italy)
| | - Concetta Mirisola
- National Institute for Health, Migration and Poverty (INMP), Rome (Italy)
| | - Alessio Petrelli
- National Institute for Health, Migration and Poverty (INMP), Rome (Italy);
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Fadda GL, Petrelli A, Martino F, Succo G, Castelnuovo P, Bignami M, Cavallo G. Anatomic Variations of Ethmoid Roof and Risk of Skull Base Injury in Endoscopic Sinus Surgery: Statistical Correlations. Am J Rhinol Allergy 2021; 35:871-878. [PMID: 34039073 DOI: 10.1177/19458924211020549] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recent developments in endoscopic sinus surgery (ESS) have increased the need to investigate the complex anatomic variations in the ethmoid roof and skull base, to inform the surgeon about the risk of damaging these crucial areas during ESS. OBJECTIVE To offer a detailed description of sinus anatomy focusing on the key surgical landmarks in ESS and frontal recess surgery to standardize a systematic approach during the preoperative sinuses imaging evaluation.Methodology: A total of 220 computed tomography (CT) scans were reviewed to obtain six sets of measurements: the depth of the cribriform plate (CP); the length of the lateral lamella of the cribriform plate (LLCP); the angle formed by the LLCP and the continuation of the horizontal plane passing through the CP; the position of the anterior ethmoidal artery (AEA) at the skull base; the extent of frontal sinus pneumatization (FSP); the type of superior attachment of the uncinate process (SAUP). RESULTS The length of the LLCP was statistically significantly correlated with the different Keros classification types, the angle formed by the LLCP with the continuation of the horizontal plane passing through the CP, and with the AEA position at the skull base. The depth of the olfactory fossa was correlated with FSP. CONCLUSIONS According to the Keros and Gera classifications, the data obtained from these evaluations allow the assessment of anatomic-radiological risk profiles and can help identify those patients who are high risk for ethmoid roof injury.
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Affiliation(s)
- Gian Luca Fadda
- Department of Otorhinolaryngology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Alessio Petrelli
- National Institute for Health, Migration and Poverty (INMP), Rome, Italy
| | - Federica Martino
- Otorhinolaryngology Unit, Department of Clinical Sciences and Translational Medicine, Tor Vergata University, Rome, Italy
| | - Giovanni Succo
- FPO IRCCS, Head and Neck Oncology Unit, Candiolo Cancer Institute, Turin, Italy.,Oncology Department, University of Turin, Italy
| | - Paolo Castelnuovo
- Department of Otorhinolaryngology, University of Insubria, Varese, Italy
| | - Maurizio Bignami
- Department of Otorhinolaryngology, University of Insubria, Varese, Italy
| | - Giovanni Cavallo
- Department of Otorhinolaryngology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
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Di Napoli A, Rossi A, Baralla F, Ventura M, Gatta R, Perez M, Sarchiapone M, Mirisola C, Petrelli A. Self-perceived workplace discrimination and mental health among immigrant workers in Italy: a cross-sectional study. BMC Psychiatry 2021; 21:85. [PMID: 33563258 PMCID: PMC7871130 DOI: 10.1186/s12888-021-03077-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 01/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The process of immigration is associated with poor mental and physical health. While the workplace represents an important context of social integration, previous studies evaluating the effect of discrimination experienced in the workplace found worse mental health status among immigrants. The aim of this study was to investigate whether self-perceived workplace discrimination has any role in the mental health status of immigrants living and working in Italy, evaluating the contribution of other personal experiences, such as loneliness and life satisfaction. METHODS A cross-sectional study was conducted on a sample of 12,408 immigrants (aged 15-64) living and working in Italy. Data were derived from the first national survey on immigrants carried out by the Italian National Institute of Statistics (Istat). Mental health status was measured through the Mental Component Summary (MCS) of the SF-12 questionnaire. A linear multivariate linear regression was carried out to evaluate the association between mental health status, self-perceived workplace discrimination, and sociodemographic factors; path analysis was used to quantify the mediation effect of self-perceived loneliness, level of life satisfaction, and the Physical Component Summary (PCS). RESULTS Mental health status was inversely associated (p < 0.001) with self-perceived workplace discrimination (β:-1.737), self-perceived loneliness (β:-2.653), and physical health status (β:-0.089); it was directly associated with level of life satisfaction (β:1.122). As confirmed by the path analysis, the effect of self-perceived workplace discrimination on MCS was mediated by the other factors considered: self-perceived loneliness (11.9%), level of life satisfaction (20.7%), and physical health status (3.9%). CONCLUSIONS Our study suggests that self-perceived workplace discrimination is associated with worse mental health status in immigrant workers through personal experiences in the workplace and explains the effect of the exposure to workplace discrimination on immigrants' psychological well-being. Our findings suggest that an overall public health response is needed to facilitate the social integration of immigrants and their access to health services, particularly those services that address mental health issues.
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Affiliation(s)
- Anteo Di Napoli
- National Institute for Health, Migration and Poverty (INMP), Epidemiology Unit, Via di San Gallicano 25/a, 00153, Rome, Italy.
| | - Alessandra Rossi
- grid.416651.10000 0000 9120 6856National Institute for Health, Migration and Poverty (INMP), Epidemiology Unit, Via di San Gallicano 25/a, 00153 Rome, Italy
| | - Francesca Baralla
- grid.10373.360000000122055422Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy
| | - Martina Ventura
- grid.416651.10000 0000 9120 6856National Institute for Health, Migration and Poverty (INMP), Epidemiology Unit, Via di San Gallicano 25/a, 00153 Rome, Italy
| | - Rosaria Gatta
- Médecins Sans Frontières (MSF), Via Magenta 5, 00185 Rome, Italy
| | - Monica Perez
- grid.425381.90000 0001 2154 1445National Institute of Statistics (Istat), Viale Liegi 13, 00198 Rome, Italy
| | - Marco Sarchiapone
- grid.10373.360000000122055422Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy
| | - Concetta Mirisola
- grid.416651.10000 0000 9120 6856National Institute for Health, Migration and Poverty (INMP), Epidemiology Unit, Via di San Gallicano 25/a, 00153 Rome, Italy
| | - Alessio Petrelli
- grid.416651.10000 0000 9120 6856National Institute for Health, Migration and Poverty (INMP), Epidemiology Unit, Via di San Gallicano 25/a, 00153 Rome, Italy
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Di Napoli A, Morgillo T, Rossi A, Ventura M, Nosotti L, Cavani A, Costanzo G, Mirisola C, Petrelli A. Sociodemographic Characteristics Associated with Harmful Use of Alcohol Among Economically and Socially Disadvantaged Immigrant Patients in Italy. J Immigr Minor Health 2021; 22:426-431. [PMID: 31399903 PMCID: PMC7066102 DOI: 10.1007/s10903-019-00928-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In many contexts, individuals with lower socioeconomic status, especially immigrants, have a higher burden of negative alcohol-related consequences and a higher probability of receiving a psychiatric diagnosis. This study aimed at exploring sociodemographic and clinical characteristics associated with harmful use of alcohol (HUA) among immigrant patients. A cross-sectional study was conducted in Rome (Italy) on a sample of 330 immigrant patients admitted to the gastroenterology outpatient clinic of the INMP (March 2013–October 2014). HUA was evaluated through the Alcohol Use Disorders Identification Test (AUDIT) questionnaire. The presence of psychiatric disorders was diagnosed through SCID I–II interviews. The association between sociodemographic characteristics and psychiatric disorders and HUA was evaluated through a multivariate log-binomial regression model. HUA was associated with unemployment, longer stay in Italy, mood disorder and not being married, especially among African immigrants. We provide original findings about a selected, hard-to-investigate population, suggesting priorities in interventions on HUA among specific vulnerable subgroups.
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Affiliation(s)
- Anteo Di Napoli
- National Institute for Health, Migration and Poverty (INMP), Via di San Gallicano, 25/a, 00153 Rome, Italy
| | - Teresa Morgillo
- National Institute for Health, Migration and Poverty (INMP), Via di San Gallicano, 25/a, 00153 Rome, Italy
| | - Alessandra Rossi
- National Institute for Health, Migration and Poverty (INMP), Via di San Gallicano, 25/a, 00153 Rome, Italy
| | - Martina Ventura
- National Institute for Health, Migration and Poverty (INMP), Via di San Gallicano, 25/a, 00153 Rome, Italy
| | - Lorenzo Nosotti
- National Institute for Health, Migration and Poverty (INMP), Via di San Gallicano, 25/a, 00153 Rome, Italy
| | - Andrea Cavani
- National Institute for Health, Migration and Poverty (INMP), Via di San Gallicano, 25/a, 00153 Rome, Italy
| | - Gianfranco Costanzo
- National Institute for Health, Migration and Poverty (INMP), Via di San Gallicano, 25/a, 00153 Rome, Italy
| | - Concetta Mirisola
- National Institute for Health, Migration and Poverty (INMP), Via di San Gallicano, 25/a, 00153 Rome, Italy
| | - Alessio Petrelli
- National Institute for Health, Migration and Poverty (INMP), Via di San Gallicano, 25/a, 00153 Rome, Italy
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Baralla F, Ventura M, Negay N, Di Napoli A, Petrelli A, Mirisola C, Sarchiapone M. Clinical Correlates of Deliberate Self-Harm Among Migrant Trauma-Affected Subgroups. Front Psychiatry 2021; 12:529361. [PMID: 34630170 PMCID: PMC8492940 DOI: 10.3389/fpsyt.2021.529361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 08/18/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Studies have shown that exposure to potentially traumatic events (PTEs) during the migration process has serious consequences on mental health. Migrants with a history of PTEs are more likely to inflict deliberate self-harm (DSH), a spectrum of behavior that includes non-suicidal self-injury (NSSI). With reference to a nonclinical sample of trauma-exposed migrants, this study aims to explore the prevalence of DSH and to assess the association with sociodemographic characteristics and clinical conditions, with particular attention to post-traumatic stress disorder (PTSD) symptoms, resilience capabilities, and feelings of hopelessness. Methods: A sample of migrants underwent a baseline evaluation at an outpatient department of the National Institute for Health, Migration and Poverty (INMP). Migrants with a history of torture, rape, or other severe forms of psychological, physical, or sexual violence were invited to undergo screening at the Institute's Mental Health Unit. Trauma-exposed migrants completed a series of self-report questionnaires that assessed the presence of PTSD, depression, anxiety, suicidal ideation, resilience, and feelings of hopelessness, in addition to DSH. Univariate and multivariate log-binomial regression models were used to test the association of age and clinical characteristic of migrants with DSH. Prevalence ratio (PR) with 95% confidence intervals (95% CI) and p-values were estimated. Results: A total of 169 migrants (76.9% males), aged between 18 and 68 years, M = 28.93; SD = 8.77), were selected. Of the sample, 26.6% were frequently engaging in some form of DSH, and 30.2% were diagnosed with at least one trauma-related disorder. DSH behaviors were most common in single and unemployed migrants as well as in subjects with post-traumatic stress symptoms, feelings of anxiety, hopelessness, low capability of resilience, and suicidal ideation. Taking into account age and hopelessness, we found that PTSD and low resilience capabilities were associated with a higher risk of DSH [PR adj: 2.21; 95% CI: (1.30-3.75) and PR adj: 2.32; 95% CI: (1.16-4.62), respectively]. Conclusion: Given the association between trauma exposure and DSH among migrants, exploring the presence of DSH behavior within the immigrant community is crucial for the implementation of measures to develop intervention in a clinical setting.
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Affiliation(s)
- Francesca Baralla
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - Martina Ventura
- National Institute for Health, Migration and Poverty, Rome, Italy
| | - Nikolay Negay
- Department of Psychiatry and Narcology of Asfendiyarov, Kazakh National Medical University, Almaty, Kazakhstan
| | - Anteo Di Napoli
- National Institute for Health, Migration and Poverty, Rome, Italy
| | - Alessio Petrelli
- National Institute for Health, Migration and Poverty, Rome, Italy
| | | | - Marco Sarchiapone
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy.,National Institute for Health, Migration and Poverty, Rome, Italy
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Dalla Zuanna T, Cacciani L, Barbieri G, Ferracin E, Zengarini N, Di Girolamo C, Caranci N, Petrelli A, Marino C, Agabiti N, Canova C. Avoidable hospitalisation for diabetes mellitus among immigrants and natives: Results from the Italian Network for Longitudinal Metropolitan Studies. Nutr Metab Cardiovasc Dis 2020; 30:1535-1543. [PMID: 32611534 DOI: 10.1016/j.numecd.2020.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/08/2020] [Accepted: 05/04/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Italy has experienced a relevant increase in migration inflow over the last 20 years. Although the Italian Health Service is widely accessible, immigrants can face many barriers that limit their use of health services. Diabetes mellitus (DM) has a different prevalence across ethnic groups, but studies focusing on DM care among immigrants in Europe are scarce. This study aimed to compare the rates of avoidable hospitalisation (AH) between native and immigrant adults in Italy. METHODS AND RESULTS A multi-centre open cohort study including all 18- to 64-year-old residents in Turin, Venice, Reggio-Emilia, Modena, Bologna and Rome between 01/01/2001 and 31/12/2013-14 was conducted. Italian citizens were compared with immigrants from high migratory pressure countries who were further divided by their area of origin. We calculated age-, sex- and calendar year-adjusted rate ratios (RRs) and 95% confidence intervals (95% CIs) of AH for DM by citizenship using negative binomial regression models. The RRs were summarized using a random effects meta-analysis. The results showed higher AH rates among immigrant males (RR: 1.63, 95% CI: 1.16-2.23), whereas no significant difference was found for females (RR: 1.14, 95% CI: 0.65-1.99). Immigrants from Asia and Africa showed a higher risk than Italians, whereas those from Central-Eastern Europe and Central-Southern America did not show any increased risk. CONCLUSION Adult male immigrants were at higher risk of experiencing AH for DM than Italians, with differences by area of origin, suggesting that they may experience lower access to and lower quality of primary care for DM. These services should be improved to reduce disparities.
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Affiliation(s)
- Teresa Dalla Zuanna
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Loredan 18, 35131 Padova, Italy.
| | - Laura Cacciani
- Department of Epidemiology, Regional Health Service, Lazio Region, Rome, Italy
| | - Giulia Barbieri
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Loredan 18, 35131 Padova, Italy
| | - Elisa Ferracin
- Epidemiology Department, Local Health Unit TO3, Piedmont Region, Grugliasco, Turin, Italy
| | - Nicolas Zengarini
- Epidemiology Department, Local Health Unit TO3, Piedmont Region, Grugliasco, Turin, Italy
| | - Chiara Di Girolamo
- Regional Health and Social Care Agency, Emilia-Romagna Region, Bologna, Italy
| | - Nicola Caranci
- Regional Health and Social Care Agency, Emilia-Romagna Region, Bologna, Italy
| | - Alessio Petrelli
- National Institute for Health, Migration and Poverty (INMP), Rome, Italy
| | - Claudia Marino
- Department of Epidemiology, Regional Health Service, Lazio Region, Rome, Italy
| | - Nera Agabiti
- Department of Epidemiology, Regional Health Service, Lazio Region, Rome, Italy
| | - Cristina Canova
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Loredan 18, 35131 Padova, Italy
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Giorgi Rossi P, Djuric O, Navarra S, Rossi A, Di Napoli A, Frova L, Petrelli A. Geographic Inequalities in Breast Cancer in Italy: Trend Analysis of Mortality and Risk Factors. Int J Environ Res Public Health 2020; 17:ijerph17114165. [PMID: 32545263 PMCID: PMC7312287 DOI: 10.3390/ijerph17114165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/04/2020] [Accepted: 06/09/2020] [Indexed: 12/24/2022]
Abstract
We calculated time trends of standardised mortality rates and risk factors for breast cancer (BC) from 1990 to 2016 for all women resident in Italy. The age-standardised mortality rate in Italy decreased from 4.2 in 1990 to 3.2 (×100,000) in 2016. While participation in organised screening programmes and age-standardised fertility rates decreased in Italy, screening invitation coverage and mammography uptake, the prevalence of women who breastfed and mean age at birth increased. Although southern regions had favourable prevalence of protective risk factors in the 1990s, fertility rates decreased in southern regions and increased in northern regions, which in 2016 had a higher rate (1.28 vs. 1.32 child per woman) and a smaller increase in women who breastfed (+4% vs. +30%). In 2000, mammography screening uptake was lower in southern than in northern and central regions (28% vs. 52%). However, the increase in mammography uptake was higher in southern (203%) than in northern and central Italy (80%), reducing the gap. Participation in mammographic screening programmes decreased in southern Italy (−10%) but increased in the North (6.6%). Geographic differences in mortality and risk factor prevalence is diminishing, with the South losing all of its historical advantage in breast cancer mortality.
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Affiliation(s)
- Paolo Giorgi Rossi
- Servizio di Epidemiologia, Azienda Unità Sanitaria Locale—IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy;
| | - Olivera Djuric
- Servizio di Epidemiologia, Azienda Unità Sanitaria Locale—IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy;
- Center for Environmental, Nutritional and Genetic Epidemiology (CREAGEN), Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Università 4, 41121 Modena, Italy
- Correspondence: ; Tel.: +39-052-233-5278
| | - Simone Navarra
- National Institute of Statistics (Istat), Viale Liegi 13, 00198 Rome, Italy; (S.N.); (L.F.)
| | - Alessandra Rossi
- National Institute for Health, Migration and Poverty (INMP), Via di San Gallicano, 25/a, 00153 Rome, Italy; (A.R.); (A.D.N.); (A.P.)
| | - Anteo Di Napoli
- National Institute for Health, Migration and Poverty (INMP), Via di San Gallicano, 25/a, 00153 Rome, Italy; (A.R.); (A.D.N.); (A.P.)
| | - Luisa Frova
- National Institute of Statistics (Istat), Viale Liegi 13, 00198 Rome, Italy; (S.N.); (L.F.)
| | - Alessio Petrelli
- National Institute for Health, Migration and Poverty (INMP), Via di San Gallicano, 25/a, 00153 Rome, Italy; (A.R.); (A.D.N.); (A.P.)
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Petrelli A, Di Napoli A, Demuru E, Ventura M, Gnavi R, Di Minco L, Tamburini C, Mirisola C, Sebastiani G. Socioeconomic and citizenship inequalities in hospitalisation of the adult population in Italy. PLoS One 2020; 15:e0231564. [PMID: 32324771 PMCID: PMC7179888 DOI: 10.1371/journal.pone.0231564] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 03/26/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Higher levels of hospital admissions among people with lower socioeconomic level, including immigrants, have been observed in developed countries. In Europe, immigrants present a more frequent use of emergency services compared to the native population. The aim of our study was to evaluate the socioeconomic and citizenship differences in the hospitalisation of the adult population in Italy. METHODS The study was conducted using the database created by the record linkage between the National Health Interview Survey (2005) with the National Hospital Discharge Database (2005-2014). 79,341 individuals aged 18-64 years were included. The outcomes were acute hospital admissions, urgent admissions and length of stay (1-7 days, > = 8 days). Education level, occupational status, self-perceived economic resources and migratory status were considered as socioeconomic determinants. A multivariate proportional hazards model for recurrent events was used to estimate the risk of total hospital admissions. Logistic models were used to estimate the risk of urgent hospitalisation as well as of length of stay. RESULTS Low education level, the lack of employment and negative self-perceived economic resources were conditions associated with the risk of hospitalisation, a longer hospital stay and greater recourse to urgent hospitalisation. Foreigners had a lower risk of hospitalisation (HR = 0.75; 95% CI:0.68-0.83) but a higher risk of urgent hospitalisation (OR = 1.36; 95% CI:1.18-1.55) and more frequent hospitalisations with a length of stay of at least eight days (OR = 1.19; 95% CI:1.02-1.40). CONCLUSIONS To improve equity in access, effective primary, secondary and tertiary prevention strategies must be strengthened, as should access to appropriate levels of care.
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Affiliation(s)
- Alessio Petrelli
- National Institute for Health, Migration and Poverty (INMP), Rome, Italy
- * E-mail:
| | - Anteo Di Napoli
- National Institute for Health, Migration and Poverty (INMP), Rome, Italy
| | - Elena Demuru
- National Institute for Health, Migration and Poverty (INMP), Rome, Italy
| | - Martina Ventura
- National Institute for Health, Migration and Poverty (INMP), Rome, Italy
| | - Roberto Gnavi
- Epidemiology Unit, ASL TO3, Grugliasco, Turin, Italy
| | | | | | - Concetta Mirisola
- National Institute for Health, Migration and Poverty (INMP), Rome, Italy
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Petrelli A, Di Napoli A, Agabiti N, Barbieri G, Bardin A, Bargagli AM, Biggeri A, Bonvicini L, Broccoli S, Cacciani L, Canova C, Caranci N, Costa G, Dalla Zuanna T, Davoli M, Di Girolamo C, Ferracin E, Giorgi Rossi P, Grisotto L, Marino C, Pacelli B, Simonato L, Spadea T, Strippoli E, Zengarini N. [Immigrants' health and socioeconomic inequalities of overall population residing in Italy evaluated through the Italian network of Longitudinal Metropolitan Studies]. Epidemiol Prev 2020; 43:1-80. [PMID: 31744272 DOI: 10.19191/ep19.5-6.s1.112] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Describing and monitoring socioeconomic inequalities in health are the prerequisite for planning equity policies. In Italy, some cities have integrated personal information from the municipal registries with Census data and with data from healthcare information systems to set up Longitudinal Metropolitan Studies (LMS). Under the coordination of the Italian National Institute for Health, Migration, and Poverty (NIHMP), six cities in the LMS network have contributed to the present monograph: Turin, Venice, Reggio Emilia, Modena, Bologna, and Rome. MORTALITY RESULTS. Significant socioeconomic differences by level of education were seen in all the participating centres. People who live alone or in single-parent households are more likely to die, as are those living in a substandard dwelling. Immigrants resident in the six cities included in the study showed lower all-cause mortality than Italians (males: MRR 0.83; 95%CI 0.78-0.90 - females: MRR 0.70; 95%CI 0.64-0.77). Sub-Saharan Africans experienced a significant higher mortality than Italians (males: MRR 1.33; 95%CI 1.12-1.59 - females: MMR 1.69; 95%CI 1.31-2.17). Immigrants had a neonatal and post-neonatal mortality risk about 1.5 times higher than Italians (neonatal: OR 1.71; 95%CI 1.22-2.39 - post-neonatal: OR 1.63; 95%CI 1.03-2.57). A difference between Italians and immigrants was also observed for mortality in children aged 1-4 years, though less marked (OR 1.24; 95%CI 0.73-2.11). Excesses concerned particularly immigrants from North Africa and from sub-Saharan Africa as well as those residing in Italy for >5 years. HOSPITALISATION RESULTS. Hospitalisation rates are lower for immigrants than for Italians, except when due to infectious diseases, blood disorders, and, among women, for reasons linked to pregnancy and childbirth. Avoidable hospitalisation rates of adults from low migratory pressure Countries are lower than or equal to those of Italians. On the contrary, adults from low migratory pressure Countries show higher avoidable hospitalisation rates compared to Italians in every cohort, with the exception of Rome (RR 0.81; 95%CI 0.78-0.85), with RR ranging from 1.08 (95%CI 0.96-1.22) in Venice to 1.64 (95%CI 1.47-1.83) in Modena. CONCLUSIONS Maternal and child health is the most critical area of health for immigrant population. Considering the importance that the issue of health equity has taken on in the political agenda, the data presented in this volume are a great asset, particularly in light of the long recession and the social crisis that have impacted the Country.
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Affiliation(s)
- Alessio Petrelli
- Istituto nazionale per la promozione della salute delle popolazioni migranti e per il contrasto delle malattie della povertà (INMP), Roma;
| | - Anteo Di Napoli
- Istituto nazionale per la promozione della salute delle popolazioni migranti e per il contrasto delle malattie della povertà (INMP), Roma;
| | - Nera Agabiti
- Dipartimento di epidemiologia del Servizio sanitario regionale, Regione Lazio, ASL Roma 1, Roma
| | - Giulia Barbieri
- Dipartimento di scienze cardio-toraco-vascolari e sanità pubblica, Università degli Studi di Padova
| | - Andrea Bardin
- Dipartimento di scienze cardio-toraco-vascolari e sanità pubblica, Università degli Studi di Padova
| | - Anna Maria Bargagli
- Dipartimento di epidemiologia del Servizio sanitario regionale, Regione Lazio, ASL Roma 1, Roma
| | - Annibale Biggeri
- Dipartimento di statistica, informatica, applicazioni "G. Parenti", Università di Firenze, Firenze
| | - Laura Bonvicini
- Servizio di epidemiologia, Azienda unità sanitaria locale, IRCCS Reggio Emilia, Italia
| | - Serena Broccoli
- Servizio di epidemiologia, Azienda unità sanitaria locale, IRCCS Reggio Emilia, Italia
| | - Laura Cacciani
- Dipartimento di epidemiologia del Servizio sanitario regionale, Regione Lazio, ASL Roma 1, Roma
| | - Cristina Canova
- Dipartimento di scienze cardio-toraco-vascolari e sanità pubblica, Università degli Studi di Padova
| | - Nicola Caranci
- Agenzia sanitaria e sociale regionale, Regione Emilia-Romagna, Bologna
| | - Giuseppe Costa
- SC a DU Servizio sovrazonale di epidemiologia, ASL TO3 Piemonte, Grugliasco (TO).,Dipartimento di scienze cliniche e biologiche, Università di Torino, Torino
| | - Teresa Dalla Zuanna
- Dipartimento di scienze cardio-toraco-vascolari e sanità pubblica, Università degli Studi di Padova
| | - Marina Davoli
- Dipartimento di epidemiologia del Servizio sanitario regionale, Regione Lazio, ASL Roma 1, Roma
| | - Chiara Di Girolamo
- Agenzia sanitaria e sociale regionale, Regione Emilia-Romagna, Bologna.,Dipartimento di scienze mediche e chirurgiche, Alma Mater Studiorum, Università di Bologna, Bologna
| | - Elisa Ferracin
- SC a DU Servizio sovrazonale di epidemiologia, ASL TO3 Piemonte, Grugliasco (TO)
| | - Paolo Giorgi Rossi
- Servizio di epidemiologia, Azienda unità sanitaria locale, IRCCS Reggio Emilia, Italia
| | - Laura Grisotto
- Dipartimento di statistica, informatica, applicazioni "G. Parenti", Università di Firenze, Firenze
| | - Claudia Marino
- Dipartimento di epidemiologia del Servizio sanitario regionale, Regione Lazio, ASL Roma 1, Roma
| | - Barbara Pacelli
- Agenzia sanitaria e sociale regionale, Regione Emilia-Romagna, Bologna
| | - Lorenzo Simonato
- Dipartimento di scienze cardio-toraco-vascolari e sanità pubblica, Università degli Studi di Padova
| | - Teresa Spadea
- SC a DU Servizio sovrazonale di epidemiologia, ASL TO3 Piemonte, Grugliasco (TO)
| | - Elena Strippoli
- SC a DU Servizio sovrazonale di epidemiologia, ASL TO3 Piemonte, Grugliasco (TO)
| | - Nicolás Zengarini
- SC a DU Servizio sovrazonale di epidemiologia, ASL TO3 Piemonte, Grugliasco (TO)
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Petrelli A, Di Napoli A, Sebastiani G, Rossi A, Giorgi Rossi P, Demuru E, Costa G, Zengarini N, Alicandro G, Marchetti S, Marmot M, Frova L. Italian Atlas of mortality inequalities by education level. Epidemiol Prev 2019; 43:1-120. [PMID: 30808126 DOI: 10.19191/ep19.1.s1.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To evaluate the geographical and socioeconomic differences in mortality and in life expectancy in Italy; to evaluate the proportion of mortality in the population attributable to a medium-low education level through the use of maps and indicators. DESIGN Longitudinal design of the population enrolled in the 2011 Italian Census, following the population over time and registering any exit due to death or emigration. SETTING AND PARTICIPANTS The study used the database of the Italian National Institute of Statistics (Istat) developed by linking the 2011 Census with the Italian National Register of Causes of Death (2012-2014) for 35 groups of causes of death. Age, sex, residence, and education level information were collected from the Census. MAIN OUTCOME MEASURES Life expectancy at birth was calculated by sex, Italian region, and education level. For the population aged 30-89 years, the following items were developed by sex: 1. provincial maps showing, for each cause of death, the distribution in quintiles of smoothed standardized mortality ratio (SMR), adjusted for age and education level and estimated with Bayesian models for small areas (spatial conditional autoregressive model); 2. regional maps of population attributable fraction (PAF) for low and medium education levels, calculated starting from age-standardized mortality ratios; 3. tables illustrating for each region standardized mortality rates and standardized years of life lost rate by age (standardized YLL rate), and mortality rate ratios standardized by age (MMRs). RESULTS Males with a lower education level throughout Italy show a life expectancy at birth that is 3 years less than those with higher education; residents in Southern Italy lose an additional year in life expectancy, regardless of education level. Social inequalities in mortality are present in all regions, but are more marked in the poorer regions of Southern Italy. Geographical differences, taking into account the different population distributions in terms of age and education level, produce mortality differences for all causes: from -15% to +30% in women and from -13% to +26% in men, compared to the national average. Among the main groups of causes, the geographical differences are greater for cardiovascular diseases, respiratory diseases, and accidents, and lower for many tumour sites. A clear mortality gradient with an excess in Southern Italy can be seen for cardiovascular diseases: there are some areas where mortality for people with higher education level is higher than that for residents in Northern Italy with low education level. The gradient for "All tumours", instead, is from South to North, as it is for most single tumour sites. Population attributable fraction for low education level in Italy, taking into account the population distribution by age, is 13.4% in women and 18.3% in men. CONCLUSIONS The study highlighted important geographical differences in mortality, regardless of age and socioeconomic level, with a more significant impact in the poorer Southern regions, revealing a never-before-seen health advantage in the regions along the Adriatic coast. A lower education level explains a considerable proportion of mortality risk, although with differing effects by geographical area and cause of death. There are still mortality inequalities in Italy, therefore, representing a possible missed gain in health in our Country; these inequalities suggest a reassessment of priorities and definition of health targets. Forty years after the Italian National Health Service was instituted, the goal of health equity has not yet been fully achieved.
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Affiliation(s)
- Alessio Petrelli
- Istituto nazionale per la promozione della salute delle popolazioni migranti e il contrasto delle malattie della povertà (INMP), Roma, Italia.
| | - Anteo Di Napoli
- Istituto nazionale per la promozione della salute delle popolazioni migranti e il contrasto delle malattie della povertà (INMP), Roma, Italia
| | - Gabriella Sebastiani
- Direzione centrale per le statistiche sociali e il censimento della popolazione, Istituto nazionale di statistica (Istat), Roma, Italia
| | - Alessandro Rossi
- Istituto nazionale per la promozione della salute delle popolazioni migranti e il contrasto delle malattie della povertà (INMP), Roma, Italia
| | - Paolo Giorgi Rossi
- UOC Epidemiologia, Azienda unità sanitaria locale - IRCCS di Reggio Emilia, Reggio Emilia, Italia
| | - Elena Demuru
- Istituto nazionale per la promozione della salute delle popolazioni migranti e il contrasto delle malattie della povertà (INMP), Roma, Italia
| | - Giuseppe Costa
- UOC a DU Servizio sovrazonale di epidemiologia, ASL TO3 Piemonte, Grugliasco (TO), Italia
| | - Nicolás Zengarini
- UOC a DU Servizio sovrazonale di epidemiologia, ASL TO3 Piemonte, Grugliasco (TO), Italia
| | - Gianfranco Alicandro
- Direzione centrale per le statistiche sociali e il censimento della popolazione, Istituto nazionale di statistica (Istat), Roma, Italia
| | - Stefano Marchetti
- Direzione centrale per le statistiche sociali e il censimento della popolazione, Istituto nazionale di statistica (Istat), Roma, Italia
| | - Michael Marmot
- Institute of Health Equity, UCL Department of Epidemiology and Public Health, University College London, London, UK
| | - Luisa Frova
- Direzione centrale per le statistiche sociali e il censimento della popolazione, Istituto nazionale di statistica (Istat), Roma, Italia
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Petrelli A, Rosano A, Rossi A, Mirisola C, Cislaghi C. The geography and economics of forgoing medical examinations or therapeutic treatments in Italy during the economic crisis. BMC Public Health 2019; 19:1202. [PMID: 31477064 PMCID: PMC6720380 DOI: 10.1186/s12889-019-7502-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 08/15/2019] [Indexed: 01/02/2023] Open
Abstract
Background In Italy, the number of individuals who have forgone medical examinations or treatments for economic reasons is one of the highest in Europe. During the global economic crisis of 2008, the restrictive policies concerning access to healthcare and the quality of these services, which differs widely throughout the country, may have accentuated the territorial differences in unmet needs, thereby penalizing the more disadvantaged segments of the population. The study aimed at evaluating the geographical and socioeconomic differences, in particular the risk of poverty, that influence forgoing healthcare services in Italy. Methods Cross-sectional Italian data from the 2004–2015 European Survey on Income and Living Conditions (EU-SILC) were used. Hierarchical logistic models were tested, using as the outcome unmet needs for medical examinations or treatment in the preceding 12 months, and as risk factor the condition of being at risk of poverty. Age, sex, citizenship, educational level, presence of chronic or severely limiting diseases and self-perceived health were used as adjustment factors. Analyses were stratified over three time periods: pre-crisis (2004–2007), initial phase of the crisis (2008–2012) and second phase of the crisis (2013–2015). Results In Central Italy and particularly in Southern Italy, a marked increase (9.9% in 2013–2015) was seen in the overall rate of unmet needs as well as in that of unmet needs due to economic reasons. The probability of unmet needs was higher, and increased over time, for those at risk of poverty (aOR = 1.54 in 2004–07, aOR = 1.70 in 2008–12, aOR = 2.21 in 2013–15). Individuals with a low educational level, who had a chronic or severely limiting disease, who perceived their health as not good and immigrants had a higher risk of forgoing healthcare. The regions in Southern Italy had a significantly higher probability of unmet needs. Conclusions A strong association was found between the probability of forgoing medical examination or treatment and being at risk of poverty. Study results underline the need for healthcare policies aimed at facilitating access to healthcare services, particularly in the South, by developing a progressive mechanism of contribution to healthcare costs proportional to income and by guaranteeing free access to the poor. Electronic supplementary material The online version of this article (10.1186/s12889-019-7502-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alessio Petrelli
- National Institute for Health, Migration and Poverty (INMP), Rome, Italy.
| | - Aldo Rosano
- Italian National Institute of Health (ISS), Rome, Italy.,Agenzia Nazionale per i Servizi Sanitari Regionali (AGENAS), Rome, Italy
| | - Alessandra Rossi
- National Institute for Health, Migration and Poverty (INMP), Rome, Italy
| | - Concetta Mirisola
- National Institute for Health, Migration and Poverty (INMP), Rome, Italy
| | - Cesare Cislaghi
- Agenzia Nazionale per i Servizi Sanitari Regionali (AGENAS), Rome, Italy
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Di Meco E, Di Napoli A, Amato LM, Fortino A, Costanzo G, Rossi A, Mirisola C, Petrelli A. Infectious and dermatological diseases among arriving migrants on the Italian coasts. Eur J Public Health 2019; 28:910-916. [PMID: 30010744 DOI: 10.1093/eurpub/cky126] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Since 2008 Italy has been the destination of the 'central Mediterranean route', used by migrants to reach Europe. The aim of this study is to describe demographic characteristics and health problems of migrants at the time of arrival on the Italian coasts, focussing on dermatological and infectious diseases. Methods Cross-sectional study of data routinely collected (n = 6, 188) by the National Institute for Health Migration and Poverty (INMP) in the centres for migrants of Lampedusa and Trapani-Milo (2015-16). Logistic models were performed to identify factors associated with scabies, varicella and the occurrence of two or more not related diagnosis. Results The average age was 21.6 years; 83.5% of the patients were males. The most frequent countries of origin were Eritrea, Nigeria, and Somalia. The most frequent diagnosis was scabies (58% of patients), skin infections, pediculosis and dermatitis; respiratory infections and varicella were the most represented infectious diseases. The diagnosis of scabies was more probable among Somalis (OR: 11.60) and Eritreans (OR: 10.05); the diagnosis of varicella was more probable among Ghanaians (OR: 13.58) and Nigerians (OR: 9.79). Somalis (OR: 4.10) and Eritreans (OR: 3.32) were the patients more likely to receive two or more diagnosis. Conclusions The majority of the diseases affecting migrants is in most cases, related to the migration experience and is likely not to represent a major threat for public health. Up-to-date information regarding the burden of diseases is needed in order to identify the health needs of incoming migrants and to arrange the appropriate response in terms of health services provision.
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Affiliation(s)
- Eugenia Di Meco
- National Institute for Health Migration and Poverty (INMP), Rome, Italy
| | - Anteo Di Napoli
- National Institute for Health Migration and Poverty (INMP), Rome, Italy
| | | | - Antonio Fortino
- National Institute for Health Migration and Poverty (INMP), Rome, Italy
| | | | - Alessandra Rossi
- National Institute for Health Migration and Poverty (INMP), Rome, Italy
| | - Concetta Mirisola
- National Institute for Health Migration and Poverty (INMP), Rome, Italy
| | - Alessio Petrelli
- National Institute for Health Migration and Poverty (INMP), Rome, Italy
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Giorgi Rossi P, Petrelli A, Rossi A, Francovich L, Zappa M, Gargiulo L. [The inappropriateness in the use of female cancer screening tests in Italy: over- and under-utilization determinants]. Epidemiol Prev 2019; 43:35-47. [PMID: 31111711 DOI: 10.19191/ep19.1.p35.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES to identify the determinants of over and under-use of Pap test and mammography in the screening programme target population. DESIGN cross-sectional study. SETTING E PARTICIPANTS: we used data from the National Health interview conducted by the Italian National Institute of Statistics in 2012-2013 obtaining nation-wide representative samples of the female resident population aged 25-64 years (No. 32,831; target age of Pap test) and 50-69 years (No. 16,459; target age of mammography). MAIN OUTCOME MEASURES overall coverage: proportion of women in the target age with at least one test in lifetime; appropriate coverage: proportion of women reporting to have at least one or more tests following the first one with the recommended frequency (three and two years for Pap test and mammography, respectively); over-use: women reporting to repeat test at higher frequency; under-use: women reporting not having ever had a test or having test at longer intervals. For frequency outcomes, only women aged 28-64 years and 52-69 years were included for Pap test and mammography, respectively. RESULTS 11.9% of women have Pap test at the recommended frequency, 48.5% at shorter intervals, and 19.6% at longer intervals than recommended, while 20.0% never had a Pap test at all (39.6% under-use). 41.1% of women have a mammography at the recommended interval, 18.4% at shorter intervals, and 20.2% at longer intervals, while 20.3% never had a mammography at all. For both tests, in the North-East higher appropriate coverage and less over-use are observed, while in the South more under-use is highlighted. Young, foreigners, single, less educated, and unoccupied women have, at the same time, more over- and under-use for Pap test. Foreigner women reporting economic difficulties and single women have more mammography over and under-use. CONCLUSIONS Pap test and, in a minor measure, mammography over-use are relevant in Italy, while large part of the population is still not covered.
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Affiliation(s)
- Paolo Giorgi Rossi
- UOC epidemiologia, Azienda unità sanitaria locale - IRCCS di Reggio Emilia;
| | - Alessio Petrelli
- Istituto nazionale per la promozione della salute delle popolazioni migranti e il contrasto delle malattie della povertà (INMP), Roma
| | - Alessandra Rossi
- Istituto nazionale per la promozione della salute delle popolazioni migranti e il contrasto delle malattie della povertà (INMP), Roma
| | - Lisa Francovich
- Direzione centrale per le statistiche sociali e il censimento della popolazione, Istat, Roma
| | - Marco Zappa
- Osservatorio nazionale screening, Istituto per lo studio, la prevenzione e la rete oncologica (ISPRO), Firenze
| | - Lidia Gargiulo
- Direzione centrale per le statistiche sociali e il censimento della popolazione, Istat, Roma
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Fabiani M, Fano V, Spadea T, Piovesan C, Bianconi E, Rusciani R, Salamina G, Greco G, Ramigni M, Declich S, Petrelli A, Pezzotti P. Comparison of early childhood vaccination coverage and timeliness between children born to Italian women and those born to foreign women residing in Italy: A multi-centre retrospective cohort study. Vaccine 2019; 37:2179-2187. [PMID: 30902479 DOI: 10.1016/j.vaccine.2019.03.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/05/2019] [Accepted: 03/13/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Compared to hosting populations, immigrants are usually considered more vulnerable to communicable diseases, many of which are vaccine-preventable. This study aims to estimate vaccination coverage (VC) and timeliness in children born to women from high migratory pressure countries (HMPC) and to evaluate factors affecting differences with children born to Italian women or women from advanced development countries (ITA + ADC). METHODS We retrospectively analysed data of children born in 2009-2014 and resident in areas served by three local health units in the cities of Rome (n = 40,284), Turin (n = 49,600), and Treviso (n = 20,080). Data were retrieved through record-linkage of the population, vaccination, and birth registries. We used the Kaplan-Meier method to estimate VCs at different ages for the 3rd dose of vaccine against tetanus and the 1st dose of vaccines against measles and meningococcal group C. Factors affecting differences in VCs by citizenship were evaluated using log-binomial models. RESULTS In Rome, VCs at 2 years of age were consistently higher in children born to ITA + ADC women than in children born to HMPC women, while differences in VCs by citizenship varied according to antigen and birth-cohort in Turin and Treviso, respectively. Where differences were observed, these were only partially explained by the mother's socio-demographic characteristics, level of utilisation of health-services during pregnancy, and maternal, perinatal, and neonatal outcomes. Finally, we observed a reduction of VCs in recent birth cohorts (2012-14 vs. 2009-11), especially in children born to ITA + ADC women. CONCLUSIONS Differences in VCs by citizenship were not homogeneous and varied according to geographical context, antigen, and birth-cohort. These differences are likely to be also affected by informal barriers (e.g., linguistic and cultural barriers), which should be addressed in implementing strategies to increase vaccine uptake in foreign children. Moreover, our results suggest that effective strategies to promote vaccinations in the autochthonous population are also needed.
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Affiliation(s)
- Massimo Fabiani
- Infectious Diseases Department, Italian National Institute of Health (ISS), Viale Regina Elena 299, 00161 Rome, Italy.
| | - Valeria Fano
- Local Health Unit 2 (Asl RM2), Via Filippo Meda 35, 00157 Rome, Italy
| | - Teresa Spadea
- Epidemiology Unit, Local Health Unit 3 (Asl TO3), Via Sabaudia 164, 10095 Grugliasco, Turin, Italy
| | - Cinzia Piovesan
- Department of Prevention, Local Health Unit 2 (Ulss 2 Marca Trevigiana), Via S. Ambrogio di Fiera 37, 31100 Treviso, Italy
| | - Egisto Bianconi
- Local Health Unit 2 (Asl RM2), Via Filippo Meda 35, 00157 Rome, Italy
| | - Raffaella Rusciani
- Epidemiology Unit, Local Health Unit 3 (Asl TO3), Via Sabaudia 164, 10095 Grugliasco, Turin, Italy
| | - Giuseppe Salamina
- Local Health Unit (Asl Città di Torino), Via San Secondo 29, 10128 Turin, Italy
| | - Gregorio Greco
- Local Health Unit (Asl Città di Torino), Via San Secondo 29, 10128 Turin, Italy
| | - Mauro Ramigni
- Department of Prevention, Local Health Unit 2 (Ulss 2 Marca Trevigiana), Via S. Ambrogio di Fiera 37, 31100 Treviso, Italy
| | - Silvia Declich
- National Centre for Global Health, Italian National Institute of Health (ISS), Viale Regina Elena 299, 00161 Rome, Italy
| | - Alessio Petrelli
- National Institute for Health, Migration, and Poverty (INMP), Via di S. Gallicano 25, 00153 Rome, Italy
| | - Patrizio Pezzotti
- Infectious Diseases Department, Italian National Institute of Health (ISS), Viale Regina Elena 299, 00161 Rome, Italy
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Petrelli A, Giorgi Rossi P, Francovich L, Giordani B, Di Napoli A, Zappa M, Mirisola C, Gargiulo L. Geographical and socioeconomic differences in uptake of Pap test and mammography in Italy: results from the National Health Interview Survey. BMJ Open 2018; 8:e021653. [PMID: 30232106 PMCID: PMC6150150 DOI: 10.1136/bmjopen-2018-021653] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE The Italian National Health Service instituted cervical and breast cancer screening programmes in 1999; the local health authorities have a mandate to implement these screening programmes by inviting all women aged 25-64 years for a Pap test every 3 years (or for an Human Papilloma Virus (HPV) test every 5 years) and women aged 50-69 years for a mammography every 2 years. However, the implementation of screening programmes throughout the country is still incomplete. This study aims to: (1) describe cervical and breast cancer screening uptake and (2) evaluate geographical and individual socioeconomic difference in screening uptake. METHODS Data both from the Italian National Health Interview Survey (NHIS) conducted by the National Institute of Statistics in 2012-2013 and from the Italian National Centre for Screening Monitoring (INCSM) were used. The NHIS interviewed a national representative random sample of 32 831 women aged 25-64 years and of 16 459 women aged 50-69 years. Logistic multilevel models were used to estimate the effect of socioeconomic variables and behavioural factors (level 1) on screening uptake. Data on screening invitation coverage at the regional level, taken from INCSM, were used as ecological (level 2) covariates. RESULTS Total 3-year Pap test and 2-year mammography uptake were 62.1% and 56.4%, respectively; screening programmes accounted for 1/3 and 1/2 of total test uptake, respectively. Strong geographical differences were observed. Uptake was associated with high educational levels, healthy behaviours, being a former smoker and being Italian versus foreign national. Differences in uptake between Italian regions were mostly explained by the invitation coverage to screening programmes. CONCLUSIONS The uptake of both screening programmes in Italy is still under acceptable levels. Screening programme implementation has the potential to reduce the health inequalities gap between regions but only if uptake increases.
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Affiliation(s)
- Alessio Petrelli
- Epidemiology Unit, National Institute for Health, Migration and Poverty (INMP), Rome, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, AUSL Reggio Emilia, Reggio Emilia, Italy
- Epidemiology Unit, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Lisa Francovich
- Direzione centrale delle statistiche socio-demografiche e ambientale, National Institute of Statistics (Istat), Rome, Lazio, Italy
| | - Barbara Giordani
- Epidemiology Unit, Local Health Authority TO3, Grugliasco, Piemonte, Italy
| | - Anteo Di Napoli
- Epidemiology Unit, National Institute for Health, Migration and Poverty (INMP), Rome, Italy
| | - Marco Zappa
- Institute for Cancer Research and Prevention (ISPO), Italian National Screening Monitoring Centre, Florence, Italy
| | - Concetta Mirisola
- Epidemiology Unit, National Institute for Health, Migration and Poverty (INMP), Rome, Italy
| | - Lidia Gargiulo
- Direzione centrale delle statistiche socio-demografiche e ambientale, National Institute of Statistics (Istat), Rome, Lazio, Italy
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Petrelli A, Zengarini N, Demuru E, Giorgi Rossi P, Sebastiani G, Gaudio R, Costa G, Mirisola C, Alicandro G, Frova L. [Differences in mortality by educational level in Italy (2012-2014)]. Epidemiol Prev 2018; 42:288-300. [PMID: 30370730 DOI: 10.19191/ep18.5-6.p288.097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES to evaluate socioeconomic inequalities in mortality by educational level in Italy. DESIGN cohort study based on the record linkage between the 2012-2014 archives of mortality and the 2011 Italian population Census. SETTING AND PARTICIPANTS Italian population registered in the 2011 Census. MAIN OUTCOME MEASURES life expectancy by educational level, age-standardized mortality rates, mortality rate ratios (MRRs) for overall mortality, and 12 groups of causes of death. RESULTS life expectancy at birth was 80.3 years among men and 84.9 among women. High-educated men were expected to live 3 years longer than lower educated men, while the gap was narrower in women (1.5 years). Lower educated men had a higher mortality from any cause (MRR: 1.34; 95%CI 1.33-1.35) with larger differentials for lung, upper aerodigestive, and liver cancers, respiratory system diseases, AIDS and accidents. Socioeconomic inequalities were larger in the North-West of the Country for lung and liver cancer. Educational inequalities were smaller among women for all-cause mortality, but remarkably larger for circulatory system diseases (MRR: 1.40; 95%CI 1.38-1.42), particularly in the South (MRR: 1.46; 95%CI 1.42-1.50). CONCLUSIONS this study documented socioeconomic inequalities in mortality in Italy for many causes of death; some of them resulted heterogeneous by area of residence. Most of the inequalities can be counteracted with specific measures aimed to improve behavioural risk factors among less educated people.
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Affiliation(s)
- Alessio Petrelli
- Istituto nazionale per la promozione della salute delle popolazioni migranti e il contrasto delle malattie della povertà (INMP), Roma;
| | - Nicolás Zengarini
- UOC a DU servizio sovrazonale di epidemiologia, ASL TO3 Piemonte, Grugliasco (TO)
| | - Elena Demuru
- Istituto nazionale per la promozione della salute delle popolazioni migranti e il contrasto delle malattie della povertà (INMP), Roma
| | - Paolo Giorgi Rossi
- UOC epidemiologia, Azienda unità sanitaria locale - IRCCS di Reggio Emilia
| | - Gabriella Sebastiani
- Direzione centrale per le statistiche sociali e il censimento della popolazione, Istituto nazionale di statistica (Istat), Roma
| | - Raffaella Gaudio
- Istituto nazionale per la promozione della salute delle popolazioni migranti e il contrasto delle malattie della povertà (INMP), Roma
| | - Giuseppe Costa
- UOC a DU servizio sovrazonale di epidemiologia, ASL TO3 Piemonte, Grugliasco (TO)
| | - Concetta Mirisola
- Istituto nazionale per la promozione della salute delle popolazioni migranti e il contrasto delle malattie della povertà (INMP), Roma
| | - Gianfranco Alicandro
- Direzione centrale per le statistiche sociali e il censimento della popolazione, Istituto nazionale di statistica (Istat), Roma
| | - Luisa Frova
- Direzione centrale per le statistiche sociali e il censimento della popolazione, Istituto nazionale di statistica (Istat), Roma
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Padovese V, Franco G, Valenzano M, Pecoraro L, Cammilli M, Petrelli A. Skin cancer risk assessment in dark skinned immigrants: the role of social determinants and ethnicity. Ethn Health 2018; 23:649-658. [PMID: 28277022 DOI: 10.1080/13557858.2017.1294657] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Dark-skinned people have a lower incidence rate of skin cancer, in particular melanoma, which is detected at more advanced stages leading to poorer prognoses and long-term outcomes compared to whites. The gap in survival is due to some difficulty in melanoma detection, lack of attention from doctors and awareness by patients. This study aims to assess skin cancer risk awareness in dark-skinned immigrants and to determine the influence of socioeconomic factors and ethnic origin on behaviors. DESIGN This is a cross-sectional health facility based study carried out in a 12-month period. A semi-structured questionnaire to assess skin cancer risk awareness and a dermatological examination was offered to dark-skinned immigrants consecutively attending the dermatology department of the National Institute for Health, Migration and Poverty in Rome. RESULTS 147 dark-skinned immigrants were enrolled, of which 54.4% were males, coming from Africa (53.1%). They were mainly young, aged 18-34 (56.5%). The level of education and length of stay in Italy was significantly related to the awareness about skin cancer: people with a high educational level (OR: 8.1 95% CI: 3.2-23.4) or immigrated more than 4 years before the interview (OR: 2.1 95% CI: 1.0-4.4) have a greater knowledge about skin cancer. CONCLUSIONS Education level is the strongest predictive factor of skin cancer awareness, whereas cultural behaviours and personal experience of sunburns are the main factors determining sunlight avoidance. Health promotion programs targeting immigrants must consider cultural differences related to ethnicity and country of origin, and adopt a transcultural approach.
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Affiliation(s)
- Valeska Padovese
- a Department of Dermatology , National Institute for Health, Migration and Poverty (INMP) , Rome , Italy
| | - Gennaro Franco
- a Department of Dermatology , National Institute for Health, Migration and Poverty (INMP) , Rome , Italy
| | - Mariacarla Valenzano
- a Department of Dermatology , National Institute for Health, Migration and Poverty (INMP) , Rome , Italy
| | - Laura Pecoraro
- a Department of Dermatology , National Institute for Health, Migration and Poverty (INMP) , Rome , Italy
| | - Marina Cammilli
- a Department of Dermatology , National Institute for Health, Migration and Poverty (INMP) , Rome , Italy
| | - Alessio Petrelli
- a Department of Dermatology , National Institute for Health, Migration and Poverty (INMP) , Rome , Italy
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Dalla Zuanna T, Spadea T, Milana M, Petrelli A, Cacciani L, Simonato L, Canova C. Avoidable hospitalization among migrants and ethnic minority groups: a systematic review. Eur J Public Health 2018; 27:861-868. [PMID: 28957490 DOI: 10.1093/eurpub/ckx113] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background The numbers of migrants living in Europe are growing rapidly, and has become essential to assess their access to primary health care (PHC). Avoidable Hospitalization (AH) rates can reflect differences across migrant and ethnic minority groups in the performance of PHC. We aimed to conduct a systematic review of all published studies on AH comparing separately migrants with natives or different racial/ethnic groups, in Europe and elsewhere. Methods We ran a systematic search for original articles indexed in primary electronic databases on AH among migrants or ethnic minorities. Studies presenting AH rates and/or rate ratios between at least two different ethnic minority groups or between migrants and natives were included. Results Of the 35 papers considered in the review, 28 (80%) were conducted in the United States, 4 in New Zealand, 2 in Australia, 1 in Singapore, and none in Europe. Most of the studies (91%) used a cross-sectional design. The exposure variable was defined in almost all articles by ethnicity, race, or a combination of the two; country of birth was only used in one Australian study. Most of the studies found significant differences in overall AH rates, with minorities (mainly Black and Hispanics) showing higher rates than non-Hispanic Whites. Conclusions AH has been used, mostly in the US, to compare different racial/ethnic groups, while it has never been used in Europe to assess migrants' access to PHC. Studies comparing AH rates between migrants and natives in European settings can be helpful in filling this lack of evidence.
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Affiliation(s)
- Teresa Dalla Zuanna
- Department of Cardiac, Thoracic and Vascular Sciences, and Public Health, University of Padova, Padova, Italy
| | - Teresa Spadea
- Epidemiology Unit, Regione Piemonte, Grugliasco (TO) ASL TO3, Italy
| | - Marzio Milana
- Department of Cardiac, Thoracic and Vascular Sciences, and Public Health, University of Padova, Padova, Italy
| | - Alessio Petrelli
- National Institute for Health, Migration and Poverty (INMP), Rome, Italy
| | - Laura Cacciani
- Lazio Regional Health Service, Department of Epidemiology, Rome, Italy
| | - Lorenzo Simonato
- Department of Cardiac, Thoracic and Vascular Sciences, and Public Health, University of Padova, Padova, Italy
| | - Cristina Canova
- Department of Molecular Medicine, University of Padova, Padova, Italy
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Petrelli A, Di Napoli A, Rossi A, Spizzichino D, Costanzo G, Perez M. [Overweight and obesity among adult immigrant populations resident in Italy]. Epidemiol Prev 2018; 41:26-32. [PMID: 28929724 DOI: 10.19191/ep17.3-4s1.p026.062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES to evaluate sociodemographic and behavioural factors associated with overweight and obesity among immigrant population in Italy. DESIGN cross-sectional study on the representative sample of foreign population resident in Italy of the Italian National Institute of Statistics (Istat) survey "Social conditions and integration of foreign citizens in Italy", carried out in 2011-2012. SETTING AND PARTICIPANTS the study was conducted on a subsample of 15,195 foreigners aged 18-64 years, corresponding to an estimate of 2,986,202 foreign citizens among the resident population in Italy. MAIN OUTCOME MEASURES study outcome is the presence of overweight and obesity, conditions identified according to WHO criteria, namely body mass index (BMI) values ≥25 kg/m2 and ≥30 kg/m2, respectively. BMI was calculated based on weight (expressed in kg) and height (expressed in cm) information collected through the questionnaire. A multivariate log-binomial model was used to evaluate association between overweight/obesity and the following factors: gender, age, origin, length of stay in Italy, occupational status, presence of Italians in the household, educational level, dietary, smoking habits. RESULTS among foreigners in Italy, 30.9% is overweight (40.3% among men and 23.2% among women) and 7.5% is obese (no differences were found between males and females). The multivariate log-binomial model shows lower probability of being overweight/obese among women (PRR: 0.65) and among families with at least one Italian person (PRR: 0.80); probability increases with age: 35-45 years show a PRR of 1.48; 46-55 years a PRR of 1.73; 56-64 years a PRR of 1.77. The probability is higher if the length of stay in Italy is between 5 and 10 years (PRR: 1.11) or longer than 11 years (PRR: 1.09); it is higher also among not employed (PRR: 1.05) and less educated people (PRR: 1.06). If compared to European people, probability is lower among people who come from Sub-Saharan Africa (PRR: 0.89) and Central-Western Asia (PRR: 0.93), whereas it is higher among people from the Americas (PRR: 1.08). CONCLUSIONS overweight/obesity prevalence among immigrants has the same dimensions as for Italians. This is a worrying result, also considering the increasing demographic weight of second-generation immigrants. Multifactorial public health interventions in each community are advisable, both acting on dietary habits and on the promotion of physical activity, even trough culturally oriented messages.
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Affiliation(s)
- Alessio Petrelli
- Istituto nazionale per la promozione della salute delle popolazioni migranti e per il contrasto delle malattie della povertà (INMP), Roma.
| | - Anteo Di Napoli
- Istituto nazionale per la promozione della salute delle popolazioni migranti e per il contrasto delle malattie della povertà (INMP), Roma
| | - Alessandra Rossi
- Istituto nazionale per la promozione della salute delle popolazioni migranti e per il contrasto delle malattie della povertà (INMP), Roma
| | | | - Gianfranco Costanzo
- Istituto nazionale per la promozione della salute delle popolazioni migranti e per il contrasto delle malattie della povertà (INMP), Roma
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Fabiani M, Di Napoli A, Riccardo F, Gargiulo L, Declich S, Petrelli A. [Differences in influenza vaccination coverage among subgroups of adult immigrants residing in Italy at risk for complications (2012-2013)]. Epidemiol Prev 2018; 41:50-56. [PMID: 28929727 DOI: 10.19191/ep17.3-4s1.p050.065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES to evaluate differences in influenza vaccination coverage (IVC) in immigrants at risk for influenza-related complications, according to their area of origin and length of stay in Italy. DESIGN cross-sectional survey conducted on the sample of foreign citizens included in the survey on health conditions and use of health services of the Italian resident population (Italian national institute of statistics, 2012-2013). SETTING AND PARTICIPANTS analysis conducted on 885 foreign adult citizens (≥18 years) at risk for influenza-related complications (elderly residents ≥65 years and residents with specific chronic diseases). MAIN OUTCOME MEASURES vaccination coverage ratios (VCR) comparison between long-term immigrants (≥10 years) and recent immigrants (<10 years), and between non-African and African immigrants, adjusted by demographic and socioeconomic characteristics and level of health services utilization. RESULTS IVC among immigrants was 15.6%, significantly higher in long-term immigrants (18.3%) compared to recent immigrants (10.2%) (VCR: 1.79; 95%CI 1.21-2.66), and in non-African immigrants (17.1%) compared to African immigrants (9.4%) (VCR: 1.82; 95%CI 1.04-3.17). After adjusting on the basis of demographic and socioeconomic characteristics and for level of health services utilization between the compared subgroups, the difference in IVC according to the length of stay was greatly reduced (VCR: 1.41; 95%CI 0.94- 2.10), while IVC difference reduction according to area of origin was less relevant (VCR: 1.66; 95%CI 0.95-2.91). CONCLUSIONS demographic and socioeconomic characteristics and level of health services utilization explained part of the difference in IVC between the compared subgroups, particularly between long-term and recent immigrants. The difference in IVC between African immigrants and immigrants from other areas remained quite pronounced even after adjusting on the basis of these factors. This suggests that IVC, especially in African immigrants, is affected by other informal barriers, such as cultural and linguistic barriers, that need to be addressed when planning effective immunization access strategies.
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Affiliation(s)
- Massimo Fabiani
- Centro nazionale di epidemiologia, sorveglianza e promozione della salute (CNESPS), Istituto superiore di sanità, Roma.
| | - Anteo Di Napoli
- Istituto nazionale per la promozione della salute delle popolazioni migranti e per il contrasto delle malattie della povertà (INMP), Roma
| | - Flavia Riccardo
- Centro nazionale di epidemiologia, sorveglianza e promozione della salute (CNESPS), Istituto superiore di sanità, Roma
| | | | - Silvia Declich
- Centro nazionale di epidemiologia, sorveglianza e promozione della salute (CNESPS), Istituto superiore di sanità, Roma
| | - Alessio Petrelli
- Istituto nazionale per la promozione della salute delle popolazioni migranti e per il contrasto delle malattie della povertà (INMP), Roma
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Di Napoli A, Gatta R, Rossi A, Perez M, Costanzo G, Mirisola C, Petrelli A. [Perceived discrimination at work for being an immigrant: a study on self-perceived mental health status among immigrants in Italy]. Epidemiol Prev 2018; 41:33-40. [PMID: 28929725 DOI: 10.19191/ep17.3-4s1.p033.063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND exposure to discrimination is widely understood as a social determinant of psychophysical health and a contributing factor to health inequities among social groups. Few studies exist, particularly in Italy, about the effects of discrimination among immigrants at workplace. OBJECTIVES to analyse the association between perceived discrimination at work for being an immigrant and mental health status among immigrants in Italy. SETTING AND PARTICIPANTS a sub-sample of 12,408 immigrants residing in Italy was analysed. MAIN OUTCOME MEASURES data came from the survey "Social conditions and integration of foreign citizens in Italy", carried out in 2011-2012 by the Italian National Institute of Statistics (Istat). Self-perceived mental health status was measured through mental component summary (MCS) of SF-12 questionnaire, assuming as worse health status MCS score distribution ≤1st quartile. In order to evaluate the probability of poor health status, a multivariate log-binomial model was performed assuming: discrimination at work for being an immigrant as determinant variable; age, gender, educational level, employment status, area of origin, residence in Italy, length of stay in Italy, self-perceived loneliness and satisfaction about life as potential confounding variables. RESULTS among immigrants, 15.8% referred discrimination at his/her workplace in Italy for being an immigrant. Higher probability of poor mental health status was observed for immigrants who referred discrimination at workplace (Prevalence Rate Ratio - PRR: 1.16) who arrived in Italy since at least 5 years (PRR: 1.14), for not employed subjects (PRR: 1.31), and for people from the Americas (PRR: 1.14). Lower probability of poor mental health status was found in immigrants from Western- Central Asia (PRR: 0.83) and Eastern-Pacific Asia (PRR: 0.79). Compared to immigrants residing in North-Eastern Italy, higher probability of worse mental health status was observed in people who resided in Northern-Western (PRR: 1.30), Central (PRR: 1.26), and Southern (PRR: 1.15) Italian regions. CONCLUSIONS our findings confirm that discrimination at workplace for being an immigrant is a risk factor for self-perceived mental health among immigrants in Italy, suggesting that an overall public health response is essential in addition to work-based interventions. Improving working conditions, promoting organisational strategies to support coping behaviours, and challenging discrimination can improve mental health status of immigrants.
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Affiliation(s)
- Anteo Di Napoli
- Istituto nazionale per la promozione della salute delle popolazioni migranti e per il contrasto delle malattie della povertà (INMP), Roma.
| | - Rosaria Gatta
- Istituto nazionale per la promozione della salute delle popolazioni migranti e per il contrasto delle malattie della povertà (INMP), Roma
| | - Alessandra Rossi
- Istituto nazionale per la promozione della salute delle popolazioni migranti e per il contrasto delle malattie della povertà (INMP), Roma
| | | | - Gianfranco Costanzo
- Istituto nazionale per la promozione della salute delle popolazioni migranti e per il contrasto delle malattie della povertà (INMP), Roma
| | - Concetta Mirisola
- Istituto nazionale per la promozione della salute delle popolazioni migranti e per il contrasto delle malattie della povertà (INMP), Roma
| | - Alessio Petrelli
- Istituto nazionale per la promozione della salute delle popolazioni migranti e per il contrasto delle malattie della povertà (INMP), Roma
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Di Napoli A, Perez M, Rossi A, Spizzichino D, Iannucci L, Gargiulo L, Panaccione D, Mirisola C, Petrelli A. [Factors associated to medical visits: comparison among Italians and immigrants resident in Italy]. Epidemiol Prev 2018; 41:41-49. [PMID: 28929726 DOI: 10.19191/ep17.3-4s1.p041.064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES to evaluate the role of factors potentially associated with the use of medical visits by the immigrant population living in Italy, making a comparison with the Italian population. DESIGN cross-sectional study based on the representative sample of the population residing in Italy considered in the Survey "Health and use of health services" conducted by the Italian National Institute of Statistics (Istat) in 2013. SETTING AND PARTICIPANTS the study was conducted on a sample of citizens aged 18-64 years (72,476 individuals) representing a population of 37,290,440 residents in Italy (33.9 million Italians and 3,390,440 foreigners) in 2013. MAIN OUTCOME MEASURES an indicator on the use of medical visits has been used as an outcome, based on people who had replied affirmatively to the question: «In the last four weeks, have you been examined by the family doctor, by the pediatrician, or by medical specialists, as an eye doctor, dentist, etc.?». Starting from this outcome, the question «Can you indicate the main reason of the visits made in the last 4 weeks?» was used to build two additional outcome variables for separately evaluating the use of medical examinations for "diseases or disorders" from the use of medical examination for "health check in the absence of diseases or disorders". For each outcome, a logistic regression model was fitted, considering as independent variables information related to socioeconomic status and to the respondent's health condition. RESULTS 21.4% of foreigners (18-64 years) living in Italy used medical visits during the four weeks before the interview, a percentage lower than the one recorded among Italian citizens (27.0%). Taking into account the socioeconomic characteristics, lifestyle and health status of respondents, the results of logistic regression models showed that foreigners have a lower probability than Italians to make a medical examination, both for visits motivated by any health problems (OR: 0.80; 95%CI 0.73-0.87), and in case of medical examination carried out for preventive purposes (OR: 0.72; 95%CI 0.64-0.82). CONCLUSION the more the time living in the host Country increases, the more immigrants residing in Italy tend to have the same health problems of the most disadvantaged groups of the autochthonous population, maybe beacuse of the deterioration of the so-called "healthy immigrant effect". In this context, they should be considered as more vulnerable in terms of health, and special attention must be paid to prevention. The lower use of medical visits highlights inequities in access to services. In order to reduce health inequalities, barriers that affect equitable access to health care should be removed, taking into account the heterogeneity of these sub-groups, characterized by different cultures and attitudes towards the health system.
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Affiliation(s)
- Anteo Di Napoli
- Istituto nazionale per la promozione della salute delle popolazioni migranti e per il contrasto delle malattie della povertà (INMP), Roma.
| | | | - Alessandra Rossi
- Istituto nazionale per la promozione della salute delle popolazioni migranti e per il contrasto delle malattie della povertà (INMP), Roma
| | | | | | | | | | - Concetta Mirisola
- Istituto nazionale per la promozione della salute delle popolazioni migranti e per il contrasto delle malattie della povertà (INMP), Roma
| | - Alessio Petrelli
- Istituto nazionale per la promozione della salute delle popolazioni migranti e per il contrasto delle malattie della povertà (INMP), Roma
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Francovich L, Di Napoli A, Giorgi Rossi P, Gargiulo L, Giordani B, Petrelli A. [Cervical and breast cancer screening among immigrant women resident in Italy]. Epidemiol Prev 2018; 41:18-25. [PMID: 28929723 DOI: 10.19191/ep17.3-4s1.p018.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES to compare Pap test and mammography uptake in 2005 and 2013 between Italian and immigrant women residing in Italy and to evaluate factors associated with probability of being up-to-date with screening testing in immigrant women. DESIGN cross-sectional study based on data of "Multipurpose survey on health and use of health services" conducted in 2005 and 2013 by the Italian National Institute of Statistics (Istat). SETTING AND PARTICIPANTS the analysis includes the interviews of women included in the target age group for Pap test (25-64 years: No. 32,831) and mammography (50- 69 years: No. 16,459). Women resident in Italy with foreign citizenship are defined as "immigrants". MAIN OUTCOME MEASURES standardized prevalence rates of women self-reporting having had a Pap test and a mammography in the absence of symptoms "at least once in a lifetime"; standardized prevalence ratio of up-to-date test uptake according to recommendation, i.e., in the last three years for Pap test and two years for mammography. A logistic regression model has been built to evaluate the association between up-to-date test uptake and demographic, socioeconomic, behavioural, and health service utilization factors in immigrant women. RESULTS prevalence of Pap test and mammography uptake was lower in immigrants, both in 2005 and 2013. This difference reduced in 2013 due to a stronger increase in immigrants than in Italians, except for mammography. The increase in Pap test uptake among immigrant women was stronger in North-Eastern (+26,4%) and Central Italy (+26,4%), while in Southern Italy and in the Islands the increase was stronger among Italian women. Test uptake in immigrants increases with longer length of stay in Italy for both tests. Among immigrants (No. 2,601), Pap test uptake was higher in women who: had a preventive examination in the previous month (OR: 2.13); have an Italian partner (OR: 1.72); have been staying in Italy for more than 13 years; are graduated (OR: 1.87); perceive their economic resources as adequate or optimal (OR: 1.39); come from the Americas (68% more if compared to Africans). As regards mammography uptake in immigrants (No. 636), associated factors are: having had a preventive examination in the previous month (OR: 3.35); having high educational level (OR: 2.51); perceiving economic resources as adequate or optimal (OR: 1.75). CONCLUSION this study shows that there is a lower screening uptake in immigrant women, as observed in other studies conducted both in Italy and in industrialized Countries, even with longer history of immigration. In the South of Italy, the uptake is very low also for Italian women, with prevalence lower than immigrants in Northern Italy. This phenomenon suggests that high accessibility to screening facilities is effective in increasing uptake in both Italian and immigrant women. The decreasing trend in differences with longer lengths of stay, the improvement in 2013 compared to 2005, and the advantage of women with Italian partners suggest a positive effect of integration on preventive behaviours, even if there are differences between immigrants' areas of origin.
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Affiliation(s)
| | - Anteo Di Napoli
- Istituto nazionale per la promozione della salute delle popolazioni migranti e per il contrasto delle malattie della povertà (INMP), Roma
| | - Paolo Giorgi Rossi
- UOC epidemiologia AUSL Reggio-Emilia.,IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia
| | | | | | - Alessio Petrelli
- Istituto nazionale per la promozione della salute delle popolazioni migranti e per il contrasto delle malattie della povertà (INMP), Roma
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Caranci N, Di Girolamo C, Giorgi Rossi P, Spadea T, Pacelli B, Broccoli S, Ballotari P, Costa G, Zengarini N, Agabiti N, Bargagli AM, Cacciani L, Canova C, Cestari L, Biggeri A, Grisotto L, Terni G, Costanzo G, Mirisola C, Petrelli A. Cohort profile: the Italian Network of Longitudinal Metropolitan Studies (IN-LiMeS), a multicentre cohort for socioeconomic inequalities in health monitoring. BMJ Open 2018; 8:e020572. [PMID: 29678981 PMCID: PMC5914711 DOI: 10.1136/bmjopen-2017-020572] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 01/25/2018] [Accepted: 02/21/2018] [Indexed: 11/21/2022] Open
Abstract
PURPOSE The Italian Network of Longitudinal Metropolitan Studies (IN-LiMeS) is a system of integrated data on health outcomes, demographic and socioeconomic information, and represents a powerful tool to study health inequalities. PARTICIPANTS IN-LiMeS is a multicentre and multipurpose pool of metropolitan population cohorts enrolled in nine Italian cities: Turin, Venice, Reggio Emilia, Modena, Bologna, Florence, Leghorn, Prato and Rome. Data come from record linkage of municipal population registries, the 2001 population census, mortality registers and hospital discharge archives. Depending on the source of enrolment, cohorts can be closed or open. The census-based closed cohort design includes subjects resident in any of the nine cities at the 2001 census day; 4 466 655 individuals were enrolled in 2001 in the nine closed cohorts. The open cohort design includes subjects resident in 2001 or subsequently registered by birth or immigration until the latest available follow-up (currently 31 December 2013). The open cohort design is available for Turin, Venice, Reggio Emilia, Modena, Bologna, Prato and Rome. Detailed socioeconomic data are available for subjects enrolled in the census-based cohorts; information on demographic characteristics, education and citizenship is available from population registries. FINDINGS TO DATE The first IN-LiMeS application was the study of differentials in mortality between immigrants and Italians. Either using a closed cohort design (nine cities) or an open one (Turin and Reggio Emilia), individuals from high migration pressure countries generally showed a lower mortality risk. However, a certain heterogeneity between the nine cities was noted, especially among men, and an excess mortality risk was reported for some macroareas of origin and specific causes of death. FUTURE PLANS We are currently working on the linkage of the 2011 population census data, the expansion of geographical coverage and the implementation of the open design in all the participating cohorts.
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Affiliation(s)
- Nicola Caranci
- Regional Health and Social Care Agency, Emilia-Romagna Region, Bologna, Italy
| | - Chiara Di Girolamo
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale and Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico - IRCCS, Reggio Emilia, Italy
| | | | - Barbara Pacelli
- Regional Health and Social Care Agency, Emilia-Romagna Region, Bologna, Italy
| | - Serena Broccoli
- Epidemiology Unit, Azienda Unità Sanitaria Locale and Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico - IRCCS, Reggio Emilia, Italy
| | - Paola Ballotari
- Epidemiology Unit, Azienda Unità Sanitaria Locale and Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico - IRCCS, Reggio Emilia, Italy
| | - Giuseppe Costa
- Epidemiology Unit, ASL TO3, Turin, Italy
- Department of Clinical and Biological Science, University of Turin, Turin, Italy
| | | | - Nera Agabiti
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | | | - Laura Cacciani
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Cristina Canova
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | - Laura Cestari
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | - Annibale Biggeri
- Department of Statistics, Computer Science and Applications ’G. Parenti', University of Florence, Florence, Italy
| | - Laura Grisotto
- Department of Statistics, Computer Science and Applications ’G. Parenti', University of Florence, Florence, Italy
| | - Gianna Terni
- Department of Statistics, Computer Science and Applications ’G. Parenti', University of Florence, Florence, Italy
| | | | - Concetta Mirisola
- National Institute for Health, Migration and Poverty (INMP), Rome, Italy
| | - Alessio Petrelli
- National Institute for Health, Migration and Poverty (INMP), Rome, Italy
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Petrelli A, Di Napoli A, Rossi A, Gargiulo L, Mirisola C, Costanzo G. [Self-perceived health status among immigrants in Italy]. Epidemiol Prev 2017; 41:11-17. [PMID: 28929722 DOI: 10.19191/ep17.3-4s1.p011.060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES to evaluate self-perceived health status of immigrants in Italy. DESIGN cross-sectional study based on the representative national samples of the multipurpose surveys "Health conditions and use of health services" conducted in 2005 and 2013 by the Italian National Institute of Statistics (Istat). SETTING AND PARTICIPANTS the study was conducted on the age group of 18-64: No. 80,661 in 2005, among which 3.2% were immigrants, and No. 72,476 in 2013, among which 7.1% were immigrants. MAIN OUTCOME MEASURES prevalence rate ratios (PRR) calculated through log-binomial regression models, stratified by survey edition and gender, by evaluating the association between the Physical Component Score (PCS), the Mental Component Score (MCS), and the overall health index and citizenship. Adjustment for the following confounding factors was performed: age, educational level, working condition, perceived economic resources, body mass index (BMI). RESULTS in 2005, immigrants had a lower probability of poor-perceived physical health, both among men (PRR: 0.79; 95%CI 0.70-0.89) and women (PRR: 0.89; 95%CI 0.82- 0.97), compared to Italians. In 2013, the perceived health advantage of immigrants was reduced for both genders (PRR males: 0.87; 95%CI 0.80-0.95; PRR females: 0.94; 95%CI 0.88-0.99). In the considered period, the prevalence of people with worse mental health conditions increases, with lower PRR among immigrants, compared to Italians. Higher probability of «NOT good» overall perceived health was also observed among immigrants residing in Italy for at least 10 years (PRR men: 1.24; PRR women: 1.15) and among immigrants men from America (PRR: 1.35). CONCLUSIONS from 2005 to 2013, immigrants seemed to maintain a better perception of health status than Italians. Nevertheless, study results show a decrease in self-perceived health, particularly mental health, in the considered period - apart from demographic, socioeconomic, and lifestyle factors - as well as a worse overall self-perceived health status among immigrants who stayed in Italy longer. Such results lead to suppose that the "healthy migrant effect" tends to disappear over time, maybe due to the world financial crisis. Unemployment increases and lower income also made the access to medical care more difficult, particularly among the most fragile population groups, including migrants. In this context, it is essential to promote health policies supporting equity of access to healthy lifestyles and effective health services, which are fundamental to reduce health inequalities.
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Affiliation(s)
- Alessio Petrelli
- Istituto nazionale per la promozione della salute delle popolazioni migranti e per il contrasto delle malattie della povertà (INMP), Roma.
| | - Anteo Di Napoli
- Istituto nazionale per la promozione della salute delle popolazioni migranti e per il contrasto delle malattie della povertà (INMP), Roma
| | - Alessandra Rossi
- Istituto nazionale per la promozione della salute delle popolazioni migranti e per il contrasto delle malattie della povertà (INMP), Roma
| | | | - Concetta Mirisola
- Istituto nazionale per la promozione della salute delle popolazioni migranti e per il contrasto delle malattie della povertà (INMP), Roma
| | - Gianfranco Costanzo
- Istituto nazionale per la promozione della salute delle popolazioni migranti e per il contrasto delle malattie della povertà (INMP), Roma
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