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Diseguaglianze

  • Chiara Marinacci1

  1. Ministero della Salute, Dipartimento della programmazione e dell'ordinamento del Servizio sanitario nazionale, Direzione Generale della Programmazione Sanitaria.
Chiara Marinacci -

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Ricerca bibliografica periodo dal 16 agosto 2012 al 31 ottobre

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Stringa: ((((((("socioeconomic factors"[MeSH Terms] OR "social class"[MeSH Terms]) OR "educational status"[MeSH Terms]) OR inequalities[Title/Abstract]) OR inequities[Title/Abstract]) OR socioeconomic[Title/Abstract]) OR socio-economic[Title/Abstract]) OR disparities[Title/Abstract]) AND ("italy"[MeSH Terms] OR "italy"[All Fields]) AND ("2012/08/16"[PDAT] : "2012/10/31"[PDAT])
1. Federico B, Falese L, Marandola D, Capelli G. Socioeconomic differences in sport and physical activity among Italian adults. J Sports Sci. 2012 Oct 29. [Epub ahead of print]
University of Cassino , Department of Health and Sport Sciences , via S , Angelo (Folcara) , Cassino (FR) , 03043 , Italy.

Abstract
We aimed to assess the extent of socioeconomic differences in sport and physical activity among Italian adults. A secondary data analysis of a multipurpose survey carried out by the National Institute of Statistics in 2006 in Italy was performed. We found marked differences in the practice of physical activity and sport by socioeconomic position. Subjects with a higher educational level were more likely to be physically active, practising more frequently both sport and physical activity. The Odds Ratio (OR) of regular physical activity for the highest educated compared to the lowest educated males was 1.70 (95% Confidence Interval [CI]: 1.38, 2.08), and the OR of sport participation was 2.03 (95% CI: 1.51, 2.72). Among females, the corresponding ORs were 1.32 (95% CI: 1.08, 1.63) and 2.26 (95% CI: 1.51, 3.38). Similar differences in physical activity and sport were found in relation to occupation and material conditions. Almost all sports were more frequently practised by subjects of higher socioeconomic status. Socioeconomic differences in sport and physical activity may derive from economic or cultural barriers. Policies to reduce inequalities and ensure access to sport independently of socioeconomic position are strongly needed.

2. Malaguarnera M, Vacante M, Frazzetto PM, Motta M. What is the frailty in elderly? Value and significance of the multidimensional assessments. Arch Gerontol Geriatr. 2012 Oct 20. pii: S0167-4943(11)00282-2. doi: 10.1016/j.archger.2011.09.017. [Epub ahead of print]
Research Center "The Great Senescence", University of Catania, Cannizzaro Hospital, Via Messina 829, I-95125 Catania, Italy. Abstract
Authors perform a critical revision of the concept of frailty in elderly going back to its first indication (1978). It is a particular phenotypic condition, characterized by advanced age, clinically unstable polypathologies in evolution, with cognitive disturbances, often very severe, loss of auto sufficiency and the critical socio-economic conditions. The diagnostic validity, both in the definition of the deficits and in the evaluation of the declines in the fundamental functions should be underlined. The first ones are needed particularly for the epidemiological and population studies, and the second one, at the individual level. Today, first of all in the geriatric field, the method of multidimensional evaluation (MDE) is the first choice for the early diagnosis of "elderly frailty" (EF), in order to determine the biological, functional, cognitive and clinical aspects of the elderly subjects, and also for the application of adequate programs of intervention at the sanitary-assistential-social levels.
3. De Lorenzo S, Tiberi S. Tuberculosis a re-emerging disease. Intern Emerg Med. 2012 Oct;7 Suppl 3:185-7. doi: 10.1007/s11739-012-0822-9.
Department of Phithisiology and Pulmonology, Morelli Hospital, AOVV, via E.Zubiani 33, 23035, Sondalo (SO), Italy, sfdelore@virgilio.it. Abstract
Two billion people, nearly one-third of the population worldwide, are infected by M. tuberculosis. Since 2008, the number of foreign TB cases in Italy has overtaken native cases. Even though TB prevalently affects elderly Italian natives, the diagnosis of the disease in these subjects is difficult and frequently delayed because of the low index of suspicion due to loss of clinical experience. Moreover, the large use of TNF inhibitors has created a new risk group for the disease, highlighting the need for tougher screening practices to reduce new cases of severe TB. Immigration from high-incidence countries like Romania has increased the number of cases of multi-drug resistant TB. These cases are usually difficult to treat because of fewer treatment options and also difficulty in managing patients with adverse socioeconomic conditions such as homelessness. It is mandatory that young doctors acquire experience in the diagnosis and treatment of TB, a disease that is not so infrequent as it was a decade or two ago.
4. Bruno G, Spadea T, Picariello R, Gruden G, Barutta F, Cerutti F, Cavallo-Perin P, Costa G, Gnavi R; Piedmont Study Group for Diabetes Epidemiology. Early Life Socioeconomic Indicators and Risk of Type 1 Diabetes in Children and Young Adults. J Pediatr. 2012 Oct 17. pii: S0022-3476(12)01024-4. doi: 10.1016/j.jpeds.2012.09.010. [Epub ahead of print]
Department of Medical Sciences, University of Turin, Turin, Italy. Electronic address: graziella.bruno@unito.it. Abstract
OBJECTIVE: To examine the potential role of 2 early-life socioeconomic indicators, parental education, and crowding index, on risk of type 1 diabetes (T1DM) in patients up to age 29 years to test heterogeneity by age at onset according to the hygiene hypothesis. STUDY DESIGN: The study base was 330 950 individuals born from 1967 to 2006 who resided in the city of Turin at any time between 1984 and 2007. Data on their early life socioeconomic position were derived from the Turin Longitudinal Study; 414 incident cases of T1DM up to age 29 years were derived from the Turin T1DM registry. RESULTS: Socioeconomic indicators had opposing effects on risk of T1DM in different age at onset subgroups. In a Poisson regression model that included both socioeconomic indicators, there was a 3-fold greater risk of T1DM (relative risk 2.91, 95% CI 0.99-8.56) in children age 0-3 years at diagnosis living in crowded houses. In the 4- to 14-year subgroup, a low parental educational level had a protective effect (relative risk 0.50, 95% CI 0.29-0.84), and the effect of crowding nearly disappeared. In the 15- to 29-year subgroup, neither crowding nor parental educational level was clearly associated with the incidence of T1DM. CONCLUSIONS: We provide evidence of heterogeneity by age at onset of the association between early-life socioeconomic indicators and the risk of T1DM. This finding is consistent with the hypothesis that infectious agents in the perinatal period may increase the risk, whereas in the following years they may become protective factors (hygiene hypothesis).
5. Barbadoro P, Chiatti C, D'Errico MM, Di Stanislao F, Prospero E. Caesarean Delivery in South Italy: Women without Choice. A Cross Sectional Survey. PLoS One. 2012;7(9):e43906. doi: 10.1371/journal.pone.0043906. Epub 2012 Sep 17.
Department of Biomedical Sciences, Università Politecnica delle Marche, Ancona, Italy. Abstract
BACKGROUND: In spite of the World Health Organization's recommendations to maintain caesarean delivery (CD) between 5% and 15% of total births, the rates of CD continue to rise in countries with routine access to medical services. As in Italy CD rate reached 38% in 2008, the highest at EU level, we evaluated socioeconomic and clinical correlates of "elective" and "non programmed" CD in the Country. We performed a stratified analysis in order to verify whether the effect of such correlates differed among women with an "a priori" preference for natural and caesarean delivery respectively. METHODS AND FINDINGS: We analyzed cross-sectional data from the Italian National Statistics Institute (ISTAT) survey on health condition. Socio-demographic variables, information on maternal care services use and health conditions during pregnancy, as well as maternal preferences on delivery, were available for a representative sample of 2,474 primiparous women. After an initial bivariate analysis, we used logistic regressions to evaluate factors associated to the study outcomes. Overall CD accounted for 35.5% of the total births in our sample (CI 33.6-37.4%); moreover, 30.7% (CI 28.6-32.6%) of women preferring natural delivery actually delivered with a CD. Elective CD rate is higher among women over 35 years (22.9%, CI 18.8-27.4%), and those living in the South (26.2%, CI 23.0-29.6%). The multivariate analysis showed that, even adjusting for several confounders, women in the South, receiving care in the private sector had higher chances of CD, also in case of preference for natural delivery. CONCLUSION: Policy interventions are required to reduce the rate of undesired CD, e.g. increasing women knowledge regarding delivery in order to favour aware choices. An effective strategy to reduce CD rate should address the Southern Regions, as women here appear to have a very limited control over the delivery, in spite of a widespread preference for natural delivery.

Commento a cura di C. Marinacci:
L’indagine mette in luce un’elevata quota di ricorso al cesareo (35.5%) su un campione nazionale di quasi 2500 primipare, seppure l’87,4% di queste avrebbe preferito il parto naturale. In generale, la probabilità di un cesareo di elezione risulta significativamente minore tra le donne di classe sociale più bassa, più elevata al crescere dell’età e più che raddoppiata tra le donne del sud o che partoriscono in una struttura privata, pur tenendo conto di fattori di rischio materni e indicatori di decorso fisiologico della gravidanza e accrescimento fetale. Selezionando solo le oltre 2000 donne che avrebbero preferito il parto naturale, il rischio di cesareo di elezione si conferma più elevato al crescere dell’età e al sud, evidenziando come la scelta delle modalità del parto sia, per alcune aree del paese, slegata dalle preferenze materne a parità di fattori clinici.

6. Quaglia A, Lillini R, Mamo C, Ivaldi E, Vercelli M; SEIH (Socio-Economic Indicators, Health) Working Group Socio-economic inequalities: A review of methodological issues and the relationships with cancer survival. Crit Rev Oncol Hematol. 2012 Sep 19. pii: S1040-8428(12)00173-4. doi: 10.1016/j.critrevonc.2012.08.007. [Epub ahead of print]
U.O.S. Epidemiologia Descrittiva (Registro Tumori), IRCCS Azienda Ospedaliera Universitaria San Martino-IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy. Electronic address: alberto.quaglia@istge.it Abstract
During the past few decades, many studies on socio-economic factors and health outcomes have been developed using various methodologies with differing approaches. A bibliographic research in MEDLINE/PubMed and SCOPUS was carried out for the period 2000-2011 to describe the influence of socio-economic status (SES) on cancer survival, in particular with reference to the outcome of European research results and the results of some cases of other Western studies. This review is divided into two sections: the first describing the different approaches of the study on individuals and populations of the concept of "social class" as well as methods used to measure the association between deprivation and health (i.e. ecological level studies, deprivation indexes, etc.); and the second discussing the association between socio-economic factors and cancer survival, describing the roles of various determinants of differences in survival, such as clinical and pathological prognostic factors, together with consideration of diagnosis and treatment and some patients' characteristics.
7. Buja A, Boemo DG, Furlan P, Bertoncello C, Casale P, Baldovin T, Marcolongo A, Baldo V. Tackling inequalities: are secondary prevention therapies for reducing post-infarction mortality used without disparities? Eur J Prev Cardiol. 2012 Sep 28. [Epub ahead of print]
University of Padua, Padua, Italy. Abstract
Background: Mortality due to coronary heart disease has been declining as a result of better clinical patient management, including secondary prevention with the aid of effective drugs. The clinical challenge remains how to improve adherence to evidence-based cardiac care for all patients who can benefit from it. The present study aimed to assess the effectiveness of drug use after acute myocardial infarction (AMI) in reducing total medium-term mortality and to establish whether there are disparities in prescribing all therapies of demonstrated effectiveness.Design: We conducted a retrospective cohort study between 2002 and 2009 using a record linkage database, considering 1327 patients discharged after AMI.Methods: Cox's regression models were used for the survival analysis with time-dependent variables. Logistic regression analyses were performed to investigate the inequalities in the actual use of therapies found significantly associated with a lower mortality in the survival analyses.Results: Therapies independently associated with a lower all-cause mortality risk were antiplatelet drugs, beta-blockers, angiotensin-converting enzyme inhibitors, and statins. Gender-related differences in prescriptions were seen for statins and antiplatelet drugs; age-related differences emerged for all drugs. Associated chronic obstructive pulmonary disease reduced the likelihood of patients taking the effective treatments.Conclusion: The present study revealed disparities in the use of treatments for the secondary prevention of coronary heart disease unjustifiable on the strength of clinical evidence.
8. Sacerdote C, Baldi I, Bertetto O, Di Cuonzo D, Farina E, Pagano E, Rosato R, Senore C, Merletti F, Ciccone G. Hospital factors and patient characteristics in the treatment of colorectal cancer: a population based study. BMC Public Health. 2012 Sep 12;12(1):775. [Epub ahead of print]
Abstract
ABSTRACT: BACKGROUND: The present study focuses on the analysis of social, clinical and hospital characteristics that can lead to disparities in the management and outcome of care. To that end, indicators of the quality of initial treatment delivered to newly-diagnosed colorectal cancer patients in a North-Western Region of Italy, were investigated using administrative data. METHODS: The cohort includes all incident colorectal cancer patients (N = 24,187) selected by a validated algorithm from the Piedmont Hospital Discharge Record system over an 8-year period (2000--2007).Three indicators of quality of care in this population-based cohort were evaluated: the proportion of preoperative radiotherapy (RT) and of abdominoperineal (AP) resection in rectal cancer patients, and the proportion of postoperative in-hospital mortality in colorectal cancer patients. RESULTS: Among rectal cancers, older patients were less likely to have preoperative RT, and more likely to receive an AP resection compared to younger patients. The probability of undergoing preoperative RT and AP resection was reduced in females compared to males (odds ratio (OR) 0.77, 95% confidence interval (CI) 0.64-0.93 and OR 0.78, 95%CI 0.69-0.89, respectively). However, there was a trend of increasing RT over time (p for trend <0.01). The probability of undergoing AP resection was increased in less-educated patients and in hospitals with a low caseload. A higher risk of postoperative in-hospital mortality was found among colorectal cancer patients who were older, male, (female versus male OR 0.71, 95%CI 0.60-0.84), unmarried (OR 1.32, 95%CI 1.09-1.59) or with unknown marital status. CONCLUSIONS: The study provides evidence of the importance of social, clinical and hospital characteristics on the equity and quality of care in a Southern European country with an open-access public health care system.
9. Petrelli A, De Luca G, Landriscina T, Costa G. Socioeconomic differences in waiting times for elective surgery: a population-based retrospective study. BMC Health Serv Res. 2012 Aug 21;12(1):268. [Epub ahead of print]
Abstract
BACKGROUND: Widespread literature on inequity in healthcare access and utilization has been published, but research on socioeconomic differences in waiting times is sparse and the evidence is fragmentary and controversial. The objective of the present study is the analysis of the relationship between individual socioeconomic level and waiting times for in-hospital elective surgery. METHODS: We retrospectively studied the waiting times experienced by patients registered on hospital waiting lists for 6 important surgical procedures by using the Hospital Discharge Database (HDD) of the Piedmont Region (4,000,000 inhabitants in the North West of Italy) from 2006 to 2008. The surgical procedures analyzed were: coronary artery by-pass (CABG), angioplasty, coronarography, endarterectomy, hip replacement and cholecystectomy. Cox regression models were estimated to study the relationship between waiting times and educational level taking into account the confounding effect of the following factors: sex, age, comorbidity, registration period, and Local Health Authorities (LHA) as a proxy of supply. RESULTS: Median waiting times for low educational level were higher than for high educational level for all the selected procedures. Differences were particularly high for endarterectomy and hip replacement. For all considered procedures, except CABG, an inverse gradient between waiting times and educational level was observed: the conditional probabilities of undergoing surgery were lower among individuals with a low to middle level education than for individuals with a higher level of education after adjustment for sex, age, comorbidities, registration period, and LHAs. For most procedures the effect decreases over the follow up period. CONCLUSIONS: The results of the study show evidence of inequalities in access to elective surgery in Italy. Implementation of policies aimed to promote national information initiatives that guarantee wider access to those with low socio-economic status is strongly recommended.

Commento a cura di C. Marinacci:
Lo studio si basa sull’analisi dei tempi d’attesa per importanti procedure chirurgiche erogate in ambito ospedaliero, in un periodo antecedente importanti provvedimenti come l’emanazione del Piano Nazionale di Governo delle Liste d’Attesa per il triennio 2010-2012. I risultati evidenziano, per il periodo 2006-2008, un’associazione tra bassa istruzione e tempi d’attesa più elevati per angioplastica, coronarografia, endoarterectomia carotidea, protesi d’anca e colecistectomia, che persiste pur tenendo conto di indicatori demografici, di comorbidità e di offerta. Oltre che noto determinante della domanda di alcune di queste prestazioni, l’istruzione sembra evidentemente influire sulle reti di informazione disponibili, sulle modalità di orientamento nell’offerta e sulle capacità di negoziazione dei tempi d’attesa. Sarà interessante conoscere l’impatto dei provvedimenti nazionali e locali sulla persistenza delle associazioni osservate.

10. Vercelli M, Lillini R, Capocaccia R, Quaglia A; SEIH (Socio-Economic Indicators and Health) Working Group & AIRTUM contributors. Use of SERTS (Socio-Economic, health Resources and Technologic Supplies) models to estimate cancer survival at provincial geographical level. Cancer Epidemiol. 2012 Aug 17. [Epub ahead of print]
Liguria Region Cancer Registry, Descriptive Epidemiology Unit, IRCCS Azienda Ospedaliera Universitaria San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy; Department of Health Sciences, University of Genoa, Italy.
Abstract
AIM: The main aim of this work is to compute expected cancer survival for Italian provinces by Socio-Economic and health Resources and Technologic Supplies (SERTS) models, based on demographic, socioeconomic variables and information describing the health care system (SEH). METHODS: Five-year age-standardised relative survival rates by gender for 11 cancer sites and all cancers combined of patients diagnosed in 1995-1999, were obtained from the Italian Association of Cancer Registries (CRs) database. The SEH variables describe at provincial level macro-economy, demography, labour market, health resources in 1995-2005. A principal components factor analysis was applied to the SEH variables to control their strong mutual correlation. For every considered cancer site, linear regression models were estimated considering the 5-RS% as dependent variable and the principal components factors of the SEH variables as independent variables. RESULTS: The model composition was correlated to the characteristics of take in charge of patients. SEH factors were correlated with the observed survival for all cancer combined and colon-rectum in both sexes, prostate, kidney and non Hodgkin's lymphomas in men, breast, corpus uteri and melanoma in women (R(2) from 40% to 85%). In the provinces without any CR the survival was very similar with that of neighbouring provinces with analogous social, economic and health characteristics. CONCLUSIONS: The SERTS models allowed us to interpret the survival outcome of oncologic patients with respect to the role of the socio-economic and health related system characteristics, stressing how the peculiarities of the take in charge at the province level could address the decisions regarding the allocation of resources.

10. Dallolio L, Di Gregori V, Lenzi J, Franchino G, Calugi S, Domenighetti G, Fantini MP. Socio-economic factors associated with infant mortality in Italy: an ecological study. Int J Equity Health. 2012 Aug 16;11(1):45. [Epub ahead of print]

Abstract
INTRODUCTION: One issue that continues to attract the attention of public health researchers is the possible relationship in high-income countries between income, income inequality and infant mortality (IM). The aim of this study was to assess the associations between IM and major socio-economic determinants in Italy. METHODS: Associations between infant mortality rates in the 20 Italian regions (2006-2008) and the Gini index of income inequality, mean household income, percentage of women with at least 8 years of education, and percentage of unemployed aged 15-64 years were assessed using Pearson correlation coefficients. Univariate linear regression and multiple stepwise linear regression analyses were performed to determine the magnitude and direction of the effect of the four socio-economic variables on IM. RESULTS: The Gini index and the total unemployment rate showed a positive strong correlation with IM (r=0.70; p<0.001 and r=0.84; p<0.001 respectively), mean household income showed a strong negative correlation (r=-0.78; p<0.001), while female educational attainment presented a weak negative correlation (r=-0.45; p<0.05). Using a multiple stepwise linear regression model, only unemployment rate was independently associated with IM (b=0.15, p<0.001). CONCLUSIONS: In Italy, a high-income country where health care is universally available, variations in IM were strongly associated with relative and absolute income and unemployment rate. These results suggest that in Italy IM is not only related to income distribution, as demonstrated for other developed countries, but also to economic factors such as absolute income and unemployment. In order to reduce IM and the existing inequalities, the challenge for Italian decision makers is to promote economic growth and enhance employment levels.

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