title: Prevalence of chronic diseases by immigrant status and disparities in chronic disease management in immigrants: a population-based cohort study, Valore Project.
abstract: BACKGROUND
  For 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.
  
  
  METHODS
  This 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.
  
  
  RESULTS
  The 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.
  
  
  CONCLUSIONS
  This 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.
authors.affiliation: Department of Molecular Medicine, Laboratory for Public Health and Population Studies, University of Padova, Via Loredan 18, Padova 35128, Italy. alessandra.buja@unipd.it
authors.forename: Alessandra
authors.initials: A
authors.lastname: Buja
authors.forename: Rosa
authors.initials: R
authors.lastname: Gini
authors.forename: Modesta
authors.initials: M
authors.lastname: Visca
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Damiani
authors.forename: Bruno
authors.initials: B
authors.lastname: Federico
authors.forename: Paolo
authors.initials: P
authors.lastname: Francesconi
authors.forename: Daniele
authors.initials: D
authors.lastname: Donato
authors.forename: Alessandro
authors.initials: A
authors.lastname: Marini
authors.forename: Andrea
authors.initials: A
authors.lastname: Donatini
authors.forename: Salvatore
authors.initials: S
authors.lastname: Brugaletta
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Baldo
authors.forename: Mariadonata
authors.initials: M
authors.lastname: Bellentani
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease / Q000453:epidemiology* / Q000628:therapy; D003327:Coronary Disease / Q000453:epidemiology / Q000628:therapy; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000628:therapy; D054242:Emigrants and Immigrants / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology*; D006333:Heart Failure / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D015995:Prevalence; D011320:Primary Health Care / Q000592:standards; D019984:Quality Indicators, Health Care / Q000592:standards; D012189:Retrospective Studies; D055815:Young Adult