Under-treatment of migrants with diabetes in a universalistic health care system: the ARNO Observatory.
OBJECTIVE
To assess whereas prevalence, treatment and direct costs of drug-treated diabetes were similar in migrants and in people of Italian citizenship under the universalistic Italian health care system.


RESULTS
Drug-treated diabetic individuals were identified in the population-based multiregional ARNO Observatory on the basis of 2010 prescriptions. Migrants were identified by the country-of-birth code on the fiscal identification code. Diabetes prevalence was calculated for Italians (n = 7,328,383) and migrants (n = 527,965). To assess the odds of migrants of having diabetes compared to Italians, we individually matched all migrants to Italians for major confounders (age, sex and place of residence). Finally, all migrants with diabetes were individually matched for confounders to Italians with diabetes to compare prescriptions, hospitalization rates, services use and direct costs for the National Health System. We identified 368,797 subjects with diabetes among Italians and 10,336 among migrants, giving prevalence of 5.03% and 1.96%, respectively. Migrants with diabetes were younger than Italians (52 ± 13 years vs. 68 ± 14 years, P < 0.001); after matching, their risk of disease was higher (odds ratio, 1.55, 95% confidence interval, 1.50-1.60). The total cost was 27% lower in migrants, due to lower cost of drugs (-29%), hospital admission (-27%) and health services (-22%). The number of packages/treated person-year of all glucose-lowering drugs was also lower in migrants (-15%) (P < 0.001).


CONCLUSIONS
Compared to subjects of Italian ancestry, migrants to Italy show a higher risk of diabetes but less intense treatment. Inequalities in health care use are likely and are maintained also in a universalistic system.
Unit of Metabolic Diseases and Clinical Dietetics, "Alma Mater Studiorum" University, Bologna, Italy; Italian Diabetes Society, Rome, Italy. Electronic address: giulio.marchesini@unibo.it.
G
G
Marchesini
CINECA Interuniversity Consortium, Bologna, Italy.
D
D
Bernardi
Section of Metabolic Diseases and Diabetes, Department of Endocrinology and Metabolism, University of Pisa, Pisa, Italy; Italian Diabetes Society, Rome, Italy.
R
R
Miccoli
CINECA Interuniversity Consortium, Bologna, Italy.
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E
Rossi
Department of Clinical and Experimental Medicine, "Federico II" University, Naples, Italy; Italian Diabetes Society, Rome, Italy.
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O
Vaccaro
CINECA Interuniversity Consortium, Bologna, Italy.
M
M
De Rosa
Section of Endocrinology, Diabetes & Metabolism, Department of Medicine, University of Verona, Verona, Italy; Italian Diabetes Society, Rome, Italy.
E
E
Bonora
Department of Medical Sciences, University of Turin, Turin, Italy; Italian Diabetes Society, Rome, Italy.
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G
Bruno
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003695:Delivery of Health Care / Q000191:economics / Q000208:ethnology; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics / Q000208:ethnology; D016527:Drug Costs; D054242:Emigrants and Immigrants; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000208:ethnology; D017721:Hospital Costs; D006801:Humans; D007004:Hypoglycemic Agents / Q000191:economics / Q000627:therapeutic use*; D007223:Infant; D007231:Infant, Newborn; D007558:Italy / Q000453:epidemiology; D016015:Logistic Models; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics; D016017:Odds Ratio; D015995:Prevalence; D012042:Registries; D012111:Residence Characteristics; D012307:Risk Factors; D055815:Young Adult
D007004:Hypoglycemic Agents
Cost; Diabetes; Health care system; Migrants; Treatment