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Istituto Superiore di Sanità
EpiCentro - L'epidemiologia per la sanità pubblica
Istituto Superiore di Sanità - EpiCentro


The Immigrant Population and their Health Care Needs in the Local Health Authority of Treviso (Veneto Region, Italy)

Giuseppe Battistella1 , Antonio Carlini1 and Leila Giuanuzzi Savelli2

1Health Observatory of the Local Health Authority 9, Treviso

2Department of Prevention, Local Health Authority 9, Treviso

 

To analyze the health problems correlated with immigration, to define priorities, and to plan in a coherent manner for emerging health needs, the Local Health Authority 9 of Treviso in the Veneto Region of Northern Italy conducted a study of the epidemiologic and demographic characteristics of the immigrant population served by the Authority. The health services delivered to this population, and their expressed health needs.

 

In this study, immigrants were identified among persons who had had at least one contact with the health system and were subsequently registered on the patient lists of the Authority. The study was conducted through record linkage of a series of local and regional databases, using each individual’s unique health ID number to perform the linkage. The databases, which covered varying periods of time, included:

  • Demographic reports for the Communes served by the Authority (as of 31/12/01)

  • The Authority’s mortality register (1996-99)

  • Exemptions from co-payment for certain diseases and conditions from the computer records of the Authority (1/10/02)

  • Prescription and specialty clinic visit records (1999-2001)

  • Computerized hospital discharge records, including hospitalizations in private structures contracted the health system and admissions in other hospitals within and outside the Treviso area (1997-2001)

  • Visits to the emergency room of the regional hospital “Cà Foncello” of Treviso (1985-2001).

During 1995-2002, 31,467 immigrants came in contact with the health care system and were registered in the patient rolls; they were from 154 different countries. For analytic purposes, the population was divided into two broad groups: those born in Western Europe and North America (13%) and those born elsewhere (87%). In the first group, 26% were considered residents of the Treviso area; the residents were older (44 years) than the non-residents (36 years). In the second, group, by contrast, 77% were considered residents, with a mean age of 29 years versus 32 years for the non-residents.

 

As of October 1 2002, the number of foreign-born residents living in the communes of the Authority was 15,180; 80% had been assigned a general practitioner (Table).  The resident immigrants were not uniformly distributed among the communes; the percentage of foreign residents varied from 1.7% to 9% of the total population of the communes. The accuracy of such analyses is limited, however, by the lack of inclusion of illegal immigrants and by the high mobility of the immigrant population.

 

Among immigrants registered with the health system, the percentage with exemptions from co-payment for chronic illnesses was 2.6%; this compared with a percentage of 16.5% among the Italian-born population. In particular, among those 15-44 years, who represent 72% of the immigrant population, the prevalences were 2% and 4.7%, respectively, suggesting that on the whole immigrants are a relatively healthy population. The most common exemptions were for diabetes and hypertension; only 0.6% were exempted for one of the three chronic infectious diseases eligible for exemption (HIV, TB, and viral hepatitis). 

 

Based on the analysis of the use of drugs, it would also appear that few of the immigrants suffer from infectious diseases commonly associated with immigration (TB, malaria, protozoal infection. During the 3-year period 1999-2001, the mean annual consumption of drugs for the treatment of these conditions represented only 3% of the total prescriptions. Instead, antibiotics accounted for 23% of the prescribed drugs, with antacids, contraceptives, and anti-hypertensives each accounting for an additional 8%. It should be noted, however, that these figures may under-estimate actual use since some programs, such as the TB program, directly supply drugs and since patients may purchase drugs outside the national health care system.

 

Data on access to the emergency room demonstrated a disproportionate number of trauma cases, with immigrants account for 25% of visits for injuries resulting from violence, 15% of workplace injuries, and 10% of traffic-related injuries. Data on hospitalization also demonstrated serious trauma to be the leading cause of male admissions, while for females, the leading causes were related to pregnancy and reproductive health.

 

To further evaluate reproductive outcomes in the immigrant population, we examined data on immigrants from those countries contributing more than 50 women 15-49 years of age. There were a total of 80 hospitalizations each year for induced abortion; the ratio between hospitalizations for abortions and deliveries was 51.7% versus 17.1% for those born in Italy. The rate of abortion estimated in 2001 differed by country of origin, from 0 to 70.8 per 10000 women. There were also considerable variations in the fertility rate from 0 to 128.6 per 1000 women 15-49 years. There was a weak correlation (r-square = 0.24; p =0.02) between abortion and fertility rate.

 

Dental problems emerged as the most common specialty visit. Excluding laboratory exams, 22% of the total cost of the leading 20 categories of specialty services was for dental procedures.

 

During 1996-99, there were 342 deaths among persons born outside Italy (2.5% of total deaths). Among women, most deaths occurred in those 65 years and over (80%), while in men, 28% occurred among those 15-44 years and 22j% in those 45-64. Overall, the leading cause of death was ischemic heart disease, although in males, violence was also an important cause of death; Thoracic, abdominal, and pelvic trauma was the second leading cause of death in men, and trauma, fractures, injuries, and burns accounted for2/3 of deaths among young adult males.

 

The primary problem of health care delivery was determined to be the loss of access to the health care system for various reasons. The number of people affected by loss of access has risen from 197 in 1997 to 584 in 2001; for 2002, this figure is estimated at approximately 900 cases.

 

Editorial Note

Salvatore Geraci, Director of Caritas, Rome

 

Compared with other regions, he Veneto region has experienced the greatest increase in immigrants in recent years. In 1991, there were 43,000 (6.6% of the national total); 11 years later, the number was three times as great, with an estimated 154,000 by the end of 2002 (10.2% of the national total), of whom 27,000 arrived between 2001 and 2002. As a result, the region now has the third highest number of immigrants after Lombardy (regional capital, Milan) and Lazio (regional capital, Rome). In addition, data on the “legalization” of immigrants confirms that the region, which is enjoying considerable economic growth, is also becoming home to an increasing number of immigrants. A total of 61,418 immigrants in Veneto have asked to have their status in Italy legalized, representing 8.7% of all applications in Italy. Within Veneto, Treviso has the third-largest number of immigrants and is experiencing the greatest increases. In the light of these considerations, it is therefore noteworthy that this article provides a timely picture of the health needs using existing data sources, even though certain issues remain to be resolved in the data collection systems (for example, the distinction between legal and non-legal immigrants, foreigners temporarily present but not resident).

 

With respect to access to services, the authors underline the problem of those who lose their coverage under the health care system. This is related to maintaining their stay permit (which is based on national policies which at the moment are particularly weak), which is essential for maintaining health coverage. It should be noted, however, that even those who do not have a stay permit are still entitled to essential and urgent care, both outpatient and hospital-based, to continuity of care, and to preventive services. This requires organizational efforts, with careful attention to the networking between the hospital and peripheral services, specific training of personnel in order to guarantee basic services for those who do not have stay permits and are therefore not eligible to be assigned to a general practitioner.