Health inequalities, before and after Covid. The Imp Monograph

The volume brings together literature reviews, original scientific contributions or revisions of the most recent scientific publications on the subject of health inequalities, with particular reference to those that the Covid-19 epidemic has accentuated (such as lists of waiting for non-emergency health care) or determined (such as access to swabs for the diagnosis of Covid-19), in the context of the most severe economic recession since the time of the world conflicts. VOLUME.

28 FEB – The monograph “Socio-economic and territorial health inequalities in Italy: methodological notes and recent evidence also in the light of the Covid-19 epidemic”, Fourth issue of the NIHMP Epidemiology Notebooks series.

“The Covid-19 pandemic has contributed to accentuating socio-economic and territorial health inequalities in Italy,” he says. Alessio PetrelliDirector of the UOC of Epidemiology of the National Institute for the promotion of the health of migrant populations and the fight against diseases of poverty.

The volume brings together literature reviews, original scientific contributions or revisions of the most recent scientific publications on the subject of health inequalities, with particular reference to those that the Covid-19 epidemic has accentuated (such as lists of waiting for non-emergency health care) or determined (such as access to swabs for the diagnosis of Covid-19), in the context of the most severe economic recession since the time of the world conflicts.

The monograph aims to document and enrich the content of the ECM training course “Socio-economic and territorial inequalities in health in Italy: methodological advice and recent evidence also in the light of the Covid-19 epidemic” organized on 14-15 October 2021 by INMP UOC Epidemiology. The course was delivered by epidemiologists from national research organizations (INMP, ISS, ISTAT, AIFA) and regional epidemiological centers with greater experience in the field of health inequalities (ASSR Emilia-ASL, AUSL Reggio Emilia, ASL Turin 3).

Impact of the pandemic on the immigrant population

The main results presented in the monograph include those that emerged from the interregional project promoted and coordinated by INMP with Piedmont, Lombardy, Veneto, Emilia-Romagna, Tuscany, Lazio, Sicily, which evaluated the impact of the pandemic on the immigrant population. The results of the project will be analytically documented in a monographic issue of Epidemiology & Prevention future.

Regarding the diagnostic test for SARS-CoV2, the results of the project show a greater use of the test and a higher rate of positivity among Italians, compared to foreigners, in 2020. Hospitalization (both in the Covid wards and in intensive care) showed higher crude rates among Italians (reflecting the real workload of the health system) and higher age-standardized rates among foreigners (reflecting the risk of deterioration of the ‘health). These results are consistent with those presented in one of the two ISS studies presented, in which a delay in the median date of diagnosis of approximately two weeks was also observed in the epidemic curves of foreign citizens, compared to Italian citizens, especially for those who come from countries with a low development index.

Territorial and socio-economic differences

The other ISS study revealed an increase in the incidence of COVID-19 in the most deprived municipalities during and after the confinement.
ISTAT’s contribution showed an increase in health inequalities that occurred in the areas most affected by the pandemic (North-West) during the most intense phases of the spread of the virus, between March and April and between October and December 2020 , the gap in mortality rates between the highly educated (higher) population and the low-educated (less educated) population increased significantly, especially among women.
Impact on care “outside Covid-19”

Results from the Mimico-19 project documented the strong impact on the health system of the Covid-19 pandemic, which caused a postponement of deferred benefits, discouraging non-urgent demand, as well as a self-limitation of demand related to the fear of while the capacity for timely and appropriate treatment in time-dependent ways, after access to the hospital, remained unchanged.

Risk and prognostic factors

The results observed in the Reggio Emilia cohort confirm male sex, age, the presence of previous pathologies (diabetes and obesity) as risk and prognostic factors, especially for prognosis; to underline the strong excess incidence associated with dementia, probably due to the spread of the epidemic in residences for the elderly observed throughout northern Italy.

Mental health effects

The appearance or aggravation of reactive psychopathological symptoms (“traumatic” reactions, anxio-depressive, sleeping and eating disorders) have also been documented. An interregional collaborative project coordinated by the INMP has just been launched in this area of ​​health.

Other socio-economic differences not directly related to Covid-19

The volume of Quaderni di Epidemiologia also presents a contribution drawn from the Atlas of social inequalities in the face of drug use for the treatment of the main chronic diseases of AIFA, which shows how socio-economic position is strongly correlated with drug use.
Finally, with regard to professional issues, the results available in the literature indicate that both physical and psychosocial factors play an important role in determining social inequalities in the occurrence of mental disorders, cardiovascular diseases and musculoskeletal disorders. , among the pathologies most responsible for disability. .

February 28, 2022
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