Sociodemographic profile, health-related behaviours and experiences of healthcare access in Italian transgender and gender diverse adult population

PURPOSE

Information on the general health of transgender and gender diverse (TGD) individuals continues to be lacking. To bridge this gap, the National Institute of Health in Italy together with the National Office against Racial Discriminations, clinical centres, and TGD organizations carried out a cross-sectional study to define the sociodemographic profile, health-related behaviours, and experiences of healthcare access in Italian TGD adult population.

METHODS

A national survey was conducted by Computer-Assisted Web Interviewing (CAWI) technique. Collected data were compared within the TGD subgroups and between TGD people and the Italian general population (IGP).

RESULTS

TGD respondents were 959: 65% assigned female at birth (AFAB) and 35% assigned male at birth (AMAB). 91.8% and 8.2% were binary and non-binary TGD respondents, respectively. More than 20% of the TGD population reported to be unemployed with the highest rate detectable in AMAB and non-binary people. Cigarette smoking and binge drinking were higher in the TGD population compared with IGP (p < 0.05), affecting TGD subgroups differently. A significant lower percentage of AFAB TGD people reported having had screening for cervical and breast cancer in comparison with AFAB IGP (p < 0.0001, in both cases). Over 40% was the percentage of AFAB and non-binary TGD people accessing healthcare who felt discriminated against because of their gender identity.

CONCLUSIONS

Our results are a first step towards a better understanding of the health needs of TGD people in Italy in order to plan the best policy choices for a more inclusive public health.

The willingness to be vaccinated against SARS-CoV-2 in the Italian population

Background

Italy was one of the earliest countries to experience a severe Covid-19 epidemic and vaccination is essential to controll it. The willingness to be vaccinated against Covid-19 was investigated by the Italian ongoing ;surveillance systems PASSI (18-69yy) and PASSI d'Argento (65+) with a Covid module added in August 2020.

Methods

To measure the prevalence of hesitancy and refusal to receive the COVID-19 vaccine, we used a sample collected between August and December 2020, before starting the Covid-19 vaccination campaign. Sample was appropriately weighted to take into account the regional number and the composition by gender and age. Using a multinomial regression model, a specfic analysis on elderly data were provided to examine the association between demographic and medical characteristics and Covid-19 attitudes.

Results

Among adults, 67% answered to be likely accepting the vaccine (one half not hesitating at all and the other half very likely in any way); younger individuals, aged 18-34, are highly incline (76%). On older sample, 55% would accept vaccination and 16% would likely refuse; the remaining 29% were categorized as hesitant. Compared with the acceptance group, the hesitancy group identified several risk factors in common with the refusal group, including not having gotten a flu vaccine during the previous flu season (hesitancy: RRR=2.0; 95% CI 1.4-2.9, refusal: RRR=12.1; 95%CI 7.6-19.37) and lower risk of having had a death from Covid-19 among family or friends (hesitancy: RRR=4.8; 95%CI 2.0-11.4, refusal: RRR=15.4; 95%CI 3.7-64.5). Hesitancy group has also lesser awareness and experience with the disease, a lower perception of being personally at risk and lower trust in the ability of health units to manage the pandemic situation.

Conclusions

Results show the importance of establishing and maintaining ongoing contact among the preventive services, primary care providers and the population since trust is difficult to establish during an emergency.

Key messages

On of the most important finding for public health prevention efforts was the importance of influenza vaccine in predicting COVID. Having an agile system that can monitor changing attitudes will be important to altering the messaging and identifying changes in the characteristics of those hesitant or unwilling to be vaccinated.

Impact of COVID-19 on economic and working conditions in Italy. Data from PASSI and PASSI d’Argento

Background

Having affected multiple life aspects globally, the COVID-19 pandemic will generate long-term consequences on productive sector and economy. The two Italian population-based surveillance systems PASSI (18-69yy) and PASSI d'Argento (65+) have annexed a COVID-module to the standard questionnaires' sections to investigate also changes of economic and working conditions related to the COVID-19 crisis.

Methods

We analysed data on a sample of 2,613 PASSI and 2,288 PASSI d'Argento interviews, collected between August and December 2020.

Results

Among adults, 34% refers a worsening of their financial resources because of the COVID-19 crisis: above all if socially deprived people, with many difficulties (52%) or with a low educational level (41%). Despite keeping up working, 31% of employed people worked less due to the COVID crisis, with a lower wage; 5.5% lost the job and a certain number had to give it up. The worsening of economic resources correlates to changes in working conditions due to the pandemic crisis, but the latter did not fully determine the former. Economic losses are more frequent among people in search of employment (52% vs 35% of occupied or 28% of inactive), those who lost their job (76%) or, despite keeping up working, earn less (66%), but interest also individuals who have not undergone changes per the working condition and volume (19%). The association between worsened economic resources and social disadvantage (low education and economic difficulties) is significant, even adjusting for job or wage loss. Even among older persons, a lower but non-negligible quota (16%) declares economic worsening due to the pandemic-related crisis. The percentage triples (29%) on difficulty making ends meet.

Conclusions

Since the analysis of preliminary findings, it emerges how the impact of this crisis is and will not be the same to all, but will emphasize inequalities, at the expense of the most vulnerable individuals, at any age.

Key messages

In Italy, the COVID-19 pandemic has affected the main social determinants of people health because it has worsened economic and working conditions.

This crisis is emphasizing health inequalities, at the expense of the most vulnerable individuals, at any age.

Health-related lifestyles: how they have changed after the COVID-19 pandemic occurring in Italy

Background

The COVID-19 pandemic has fully affected the global community and will generate long-term consequences on social and individual life overall.

Methods

Since their start, the two Italian population-based surveillance systems PASSI (18-69yy) and PASSI d'Argento (65+) have investigated health-related lifestyles. The continuous monthly data collection allows observation of changes in the short, medium and long terms. We compared prevalence of tobacco and alcohol use, physical activity, PA, or inactivity, PI, before and after March 2020, to evaluate temporal trends with particular concern to changes due to the pandemic.

Results

Sedentariness has been growing among inactive adults but in pandemic time, we observed a 10% significant reduction compared to 2019, due to a significant increase of spare time PA from 42% (2019) to 45% (2020) and a reduction of spare time PI from 42% to 39%. Despite a stable trend, elderly increased significantly PI, from 40% (2019) to 43% (2020). PI goes from 46% to 52% among Southern residents and from 45% to 53% in poorly educated people. Since 2008, at-risk alcohol consumption gradually increased in adults because of binge-drinking and between meals modalities. In 2018, a tendency inversion started and finds confirmation during the pandemic: binge-drinking decreases significantly from dal 9.5% (2019) to 8.2% (2020), between meals from 9.4% to 8.6%. During the pandemic, elderly increase alcohol consumption significantly, from 39% (2019) to 45% (2020), attributable to changes in moderate use by women: 17% in 2019 vs. 25% in 2020 overall; from 20% to 30% in highly educated and from 15% to 21% in poorly educated. It seems the pandemic did not change smoking percentages.

Conclusions

Monitoring the impact of the COVID-19 pandemic is crucial to understand strategies for tackling behavioural risk factors for noncommunicable diseases that, even in pandemic, represent the main burden to disability and deaths in Italy.

Key messages

Monitoring the impact of the COVID-19 pandemic is crucial to understand strategies for tackling behavioural risk factors for noncommunicable diseases. Having an ongoing Behavioral Risk Factor Surveillance System is an opportunity to misure and evaluate the impact of a shock as Covid-19 pandemic.

Measuring Health Literacy in Tuscany through the Italian risk factor surveillance system (PASSI)

Background

Health literacy (HL) can be defined as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. A module to measure HL has been implemented in Tuscany since 2017 within the Italian risk factor surveillance system (PASSI). Here, we aimed to assess HL levels and their relations with social determinants and health behaviours.

Methods

During 2017-2018, a representative sample (N &gt; 7000, aged 18 to 69 years) of the Tuscan population was interviewed in PASSI. HL was measured using the Italian version of the short-short form (HLS-EU-Q6) of the HLS-EU-Q47. Multivariate analysis was performed to investigate associations between HL, social determinants and selected health behaviours (diet and physical activity).

Results

61% of the interviewees had an adequate HL level, 30% problematic and 9% inadequate. In the multivariate analysis, the odds of inadequate HL level increased for all social determinants except gender and loneliness. The strongest association was observed for foreign citizenship (OR 3.38, 95% CI 2.63-4.34) followed by financial problems (OR 2.10, 95% CI 1.73-2.55), low education (OR 1.91, 95% CI 1.58-2.32), being aged 50-69 years (OR 1.51, 95% CI 1.18-1.94) and unemployment (OR 1.42, 95% CI 1.17-1.72). With regard to health behaviours, subjects with inadequate HL level had the lowest odds of engaging in regular physical activity (OR 0.59, 95% CI 0.49-0.71) and one of the lowest odds of eating at least three portions of fruit and vegetables (OR 0.79, 95% CI 0.65-0.95).

Conclusions

Our findings suggest that HL is strongly associated with social determinants and has major influence on health behaviours. Our study is still ongoing, with the next step being to build a conceptual model to depicting the effect of HL as a mediator of the association between social determinants and health behaviours.

Key messages

Health Literacy is strongly associated with social determinants. Health Literacy has major influence on health behaviours.

Flu vaccination among health workers in Italy: results from the nationwide surveillance PASSI 2015-18

Background

Influenza causes a significant health and socio-economic burden every year. Healthcare workers (HCWs) are at higher risk of exposure to respiratory pathogens than general population, including seasonal influenza virus, with potential threats to their health and patients' safety. We aimed to estimate the adherence to flu vaccination of health workers in 2015-2018 seasons in Italy.

Methods

We analyzed data collected between 2015 and 2018 from the Italian Behavioral Risk Factor Surveillance System (PASSI). PASSI collects data on health behaviors in the adults (18-64 years) through telephonic administration of standardized questionnaires to a representative sample of Italian population. The answers related to flu vaccination refer to the vaccination campaign preceding the interview

Results

Preliminary data show that overall 11.9% (CI 10.3% - 13.7%) of HCWs reported to have been vaccinated vs 7.2% (CI 6.9% - 7.5%) of the total population sample. Physicians showed a higher overall adherence compared to other healthcare professionals (22.4% [CI 18% - 27.5%] vs 9% [CI 7.4% - 10.9%], respectively). Differences of adherence were found also across age groups: 18.3% [CI 15% - 22.2%] of respondents between 50-64 years reported to have received a vaccination compared to 10% (CI 7.9% - 12.5%) and 4.3% (CI 2.8% - 6.4%) of 35-49 years and 18-34 years age groups, respectively. The annual influenza vaccination coverage for people working in healthcare has increased over the years (9.8% in 2015 vs 14.1% in 2018).

Conclusions

Although coverage rates are increasing over time, adherence to influenza vaccination is still too low, especially among younger HCWs and non-medical HCWs. Strategic actions, such as local and national programs to increase self-awareness of being an at-high-risk category for contracting and transmitting infections and/or mandatory vaccination, should be adopted to sharply achieve an optimal coverage rate for HCWs.

Key messages

Adherence to seasonal influenza vaccination is still very low among Italian HCWs. A participatory attitude towards vaccination for HCWs should be pursued. Monitoring and reporting process should be improved to provide further detailed evidence for adopting targeted programs.

Profiling biopsychosocial health of cancer-diagnosed elderly in Italy by Passi d’Argento, 2016-2017

Background

PASSI d'Argento (PdA) is an Italian population-based surveillance system, coordinated by the Istituto Superiore di Sanità (ISS) and carried out by the Local Health Units (LHUs). PdA monitors wide-ranged health related-behaviours in the elderly (65+) living in Italy as per the three pillars of the “Active Healthy Ageing” framework: Health, Participation, Security.

Methods

The PdA sample is randomly selected from the LHU lists, stratified by sex and age. 22,811 records have been collected in 2016-2017 on a representative sample of residents aged over65, not being hospitalised, in long-term care, in a nursing home or prison.

Results

3,019 respondents resulted cancer-diagnosed elderly (CDE) reporting cancer diagnosis or confirmation, leukaemia and lymphomas included (annual average prevalence of 12.8%, Confidence Intervals 95%: 12.1-13.4%; one million and 729 thousand people). CDE refer: poorer health conditions (22%) than Chronic Elderly Patients (CEP; 18%) and Healthy Elderly (HE; 5%), sight impairment (12%), hearing loss (15%) and chewing problems (14%). CDE (10%) and CEP (11%) are more prone to fall than HE do (6%). Disability accounts for 21% in CDE and CEP vs. 12% in HE. A multivariate analysis confirms a compromised psychophysical health profile in CDE vs. HE, and vs. CEP. CDE behave still unhealthily, are insufficiently advised by health professionals, do not comply with the seasonal flu vaccination [Health]. CDE face increased risk for isolation or cognitive decline: they experience lower social connectedness (17%) than CEP (20%) and HE (28%) [Participation], and perceive higher neighbourhood insecurity (19%) than how CEP (17%) and HE (13%) do [Security].

Conclusions

PdA data on the poor biopsychosocial health profile of CDE highlight to what extent healthy behaviours and prevention can ameliorate their quality of life PdA calls for global action strategies in Italy, which aim at taking complete charge of CDE and also CEP.

Key messages

In Italy, elderly cancer survivors show poor biopsychosocial health profile and overall quality of life. By modifying behaviours, elderly suffering from any cancer or chronic disease can age healthily.

Diabetes: awareness and management. Data of Passi and Passi d’Argento surveillance in Lazio, Italy

Background

Diabetes is a health emergency: in Italy over 3 million people are diabetics. In Lazio region a high percentage of population is affected by diabetes. Data are collected from two Italian population surveillance systems, Passi during 2015-18 and Passi d'Argento (PdA) during 2016-2018; this trasversal study was conducted to investigate diabetes awareness and clinical management in Lazio.

Methods

Passi and PdA collect representative data providing a telephone interview with a standardized questionnaire to a representing sample (18-69 and over 65 aged respectively), randomly selected and sex-and-age stratified. In both questionnaires a diabetes section assesses diagnosis, knowledge of HbA1c, health setting and number of annual checks. Data refer to whom affirm to be diagnosed with diabetes. Results are shown by prevalence and 95% CI.

Results

Diabetes prevalence grows with age, it does not reach 1% in people under 50 years, it is 9% for the age group 50-69 years and 20% in over 75. Serious economic difficulties and low education level are related to higher prevalence. Among diabetics, 18.7% (15.42-22.46) from Passi and 24.2% (20.29- 28.61) from PdA ignore HbA1c. About clinical management, 1.5% (0.73-2.90) in Passi do not receive any care from doctor; the whole sample of PdA receives medical care. Most of the respondents in both surveillance are managed by diabetes care team (43.76% in Passi - 39.87% in PdA), reporting to receive care about three times a year on average. No significant differences are observed between economic and education levels.

Conclusions

High percentage of diabetics, not knowing HbA1c, are not aware about disease. Patient empowerment is necessary to gain control over disease and increases capacity to act on it. Health education should be improved and diagnostic and therapeutic pathways, recently introduced in Lazio Region, should be better structured. Population surveillances allow to plan and evaluate programs and interventions.

Key messages

Fight the lack of awareness with patient empowerment to gain control over diabetes. Population surveillances are valuable tools to plan and evaluate programs and interventions in Public Health.