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  • 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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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 ("2013/06/16"[PDAT] : "2013/08/31"[PDAT])
1. Braggion M, Campostrini S, Bertin G. Socio-economic differences in healthcare access from a welfare system perspective, Italy: 2007-2010. Health Promot Int. 2013 Aug 9. [Epub ahead of print]
Department of Economics, Ca' Foscari University Venice, San Giobbe, Cannaregio 873, Venice 30121, Italy.

Abstract Inequalities between poorer and wealthier people in accessing healthcare services have been widely studied, but the mechanisms generating them are still to be fully understood. Among these, there is still a lack of evidence of relationships between health prevention/health promotion policies, welfare systems and social differences. We analysed 68 201 females from the PASSI Italian surveillance system for the years 2007-2010. The prevalence of women undergoing Pap testing was used as an example of access to preventive services. An odds ratio gradient was found with regard to different welfare system clusters: the probability of undergoing a screening test is higher for more advanced welfare systems. A strong association was found between having received a letter from the local health unit and having undergone the screening test. Significant differences still exist between high- and low-income women and their access to Italian preventive public services. As we expected, social determinants play an important role in health disparities, as these are also strongly influenced by typologies of welfare systems and by health policies.

2. Rossi MC, Cristofaro MR, Gentile S, Lucisano G, Manicardi V, Mulas MF, Napoli A, Nicolucci A, Pellegrini F, Suraci C, Giorda C; on behalf of the AMD Annals Study Group. Sex Disparities in the Quality of Diabetes Care: Biological and Cultural Factors May Play a Different Role for Different Outcomes: A cross-sectional observational study from the AMD Annals initiative. Diabetes Care. 2013 Jul 8. [Epub ahead of print]
Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, S. Maria Imbaro (CH), Chieti, Abruzzo, Italy.

Abstract OBJECTIVE To investigate the quality of type 2 diabetes care according to sex.RESEARCH DESIGN AND METHODSClinical data collected during the year 2009 were extracted from electronic medical records; quality-of-care indicators were evaluated. Multilevel logistic regression analysis was applied to estimate the likelihood of women versus men to be monitored for selected parameters, to reach clinical outcomes, and to be treated with specific classes of drugs. The intercenter variability in the proportion of men and women achieving the targets was also investigated.RESULTSOverall, 415,294 patients from 236 diabetes outpatient centers were evaluated, of whom 188,125 (45.3%) were women and 227,169 (54.7%) were men. Women were 14% more likely than men to have HbA1c >9.0% in spite of insulin treatment (odds ratio 1.14 [95% CI 1.10-1.17]), 42% more likely to have LDL cholesterol (LDL-C) ≥130 mg/dL (1.42 [1.38-1.46]) in spite of lipid-lowering treatment, and 50% more likely to have BMI ≥30 kg/m(2) (1.50 [1.50-1.54]). Women were less likely to be monitored for foot and eye complications. In 99% of centers, the percentage of men reaching the LDL-C target was higher than in women, the proportion of patients reaching the HbA1c target was in favor of men in 80% of the centers, and no differences emerged for blood pressure.CONCLUSIONSWomen show a poorer quality of diabetes care than men. The attainment of the LDL-C target seems to be mainly related to pathophysiological factors, whereas patient and physician attitudes can play an important role in other process measures and outcomes.

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