Prevalence of chronic diseases by immigrant status and disparities in chronic disease management in immigrants: a population-based cohort study, Valore Project

BackgroundFor chronic conditions, disparities can take effect cumulatively at various times as the disease progresses, even when care is provided. The aim of this study was to quantify the prevalence of diabetes, congestive heart failure (CHF) and coronary heart disease (CHD) in adults by citizenship, and to compare the performance of primary care services in managing these chronic conditions, again by citizenship.MethodsThis is a population-based retrospective cohort study on 1,948,622 people aged 16 years or more residing in Italy. A multilevel regression model was applied to analyze adherence to care processes using explanatory variables at both patient and district level.ResultsThe age-adjusted prevalence of diabetes was found higher among immigrants from high migratory pressure countries (HMPC) than among Italians, while the age-adjusted prevalence of CHD and CHF was higher for Italians than for HMPC immigrants or those from highly-developed countries (HDC). Our results indicate lower levels in all quality management indicators for citizens from HMPC than for Italians, for all the chronic conditions considered. Patients from HDC did not differ from Italian in their adherence to disease management schemes.ConclusionThis study revealed a different prevalence of chronic diseases by citizenship, implying a different burden of primary care by citizenship. Our findings show that more effort is needed to guarantee migrant-sensitive primary health care.

[1]  A. Nicolucci,et al.  Impact of a chronic care model based on patient empowerment on the management of Type 2 diabetes: effects of the SINERGIA programme , 2011, Diabetic medicine : a journal of the British Diabetic Association.

[2]  G. Costa,et al.  The Impact of Adherence to Screening Guidelines and of Diabetes Clinics Referral on Morbidity and Mortality in Diabetes , 2012, PloS one.

[3]  R. Bhopal,et al.  Large-scale epidemiological data on cardiovascular diseases and diabetes in migrant and ethnic minority groups in Europe. , 2009, European journal of public health.

[4]  L. Elliott.  Closing the health and equalities gap: an international perspective. , 2005 .

[5]  Spyridon S Marinopoulos,et al.  The Charlson comorbidity index is adapted to predict costs of chronic disease in primary care patients. , 2008, Journal of clinical epidemiology.

[6]  M. Harris,et al.  Diabetes in America: Epidemiology and Scope of the Problem , 1998, Diabetes Care.

[7]  B. Starfield,et al.  Contribution of primary care to health systems and health. , 2005, The Milbank quarterly.

[8]  R. Rumbaut.  Paradoxes (and Orthodoxies) of Assimilation , 1997 .

[9]  Brent A. Langellier,et al.  Immigration Disparities in Cardiovascular Disease Risk Factor Awareness , 2011, Journal of Immigrant and Minority Health.

[10]  J. Nolan,et al.  Globalization, immigration and diabetes self-management: an empirical study amongst immigrants with type 2 diabetes mellitus in Ireland. , 2009, QJM : monthly journal of the Association of Physicians.

[11]  B. Rechel,et al.  Monitoring migrant health in Europe: a narrative review of data collection practices. , 2012, Health policy.

[12]  S. Greenfield,et al.  Selecting indicators for the quality of diabetes care at the health systems level in OECD countries. , 2006, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[13]  Carlo Devillanova.  Immigrants ’ access to health care services in Italy : New evidence from survey data * , 2012 .

[14]  Nancy M Albert,et al.  Association between performance measures and clinical outcomes for patients hospitalized with heart failure. , 2007, JAMA.

[15]  Richard H Glazier,et al.  A Systematic Review of Interventions to Improve Diabetes Care in Socially Disadvantaged Populations A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances. DOI: 10.2337/dc05-1942 , 2006, Diabetes Care.

[16]  Martijn J Schuemie,et al.  Chronic disease prevalence from Italian administrative databases in the VALORE project: a validation through comparison of population estimates with general practice databases and national survey , 2013, BMC Public Health.

[17]  D. Petitti,et al.  Evaluation of the effect of performance monitoring and feedback on care process, utilization, and outcome. , 2000, Diabetes care.

[18]  Johan P Mackenbach,et al.  Ethnic differences in mortality, end-stage complications, and quality of care among diabetic patients: a review. , 2005, Diabetes care.

[19]  J. Mainz.  Defining and classifying clinical indicators for quality improvement. , 2003, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[20]  A. Zaslavsky,et al.  Racial disparities in the quality of care for enrollees in medicare managed care. , 2002, JAMA.

[21]  C. Patel.  A discussion paper , 2010 .

[22]  Walter Ricciardi,et al.  Italy: health system review. , 2014, Health systems in transition.