title: Systematic age-related differences in chronic disease management in a population-based cohort study: a new paradigm of primary care is required.
abstract: BACKGROUND
  Our interest in chronic conditions is due to the fact that, worldwide, chronic diseases have overtaken infectious diseases as the leading cause of death and disability, so their management represents an important challenge for health systems. The aim of this study was to compare the performance of primary health care services in managing diabetes, congestive heart failure (CHF) and coronary heart disease (CHD), by age group.
  
  
  METHODS
  This population-based retrospective cohort study was conducted in Italy, enrolling 1,948,622 residents ≥ 16 years old. A multilevel regression model was applied to analyze compliance to care processes with explanatory variables at both patient and district level, using age group as an independent variable, and adjusting for sex, citizenship, disease duration, and Charlson index on the first level, and for District Health Unit on the second level.
  
  
  RESULTS
  The quality of chronic disease management showed an inverted U-shaped relationship with age. In particular, our findings indicate lower levels for young adults (16-44 year-olds), adults (45-64), and oldest old (+85) than for patients aged 65-74 in almost all quality indicators of CHD, CHF and diabetes management. Young adults (16-44 y), adults (45-64 y), the very old (75-84 y) and the oldest old (+85 y) patients with CHD, CHF and diabetes are less likely than 65-74 year-old patients to be monitored and treated using evidence-based therapies, with the exceptions of echocardiographic monitoring for CHF in young adult patients, and renal monitoring for CHF and diabetes in the very old.
  
  
  CONCLUSIONS
  Our study shows that more effort is needed to ensure that primary health care systems are sensitive to chronic conditions in the young and in the very elderly.
authors.affiliation: Laboratory of Public Health and Population Studies, Section Public Health, Dipartimento di Medicina Molecolare, Università di Padova, Padova, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Buja
authors.affiliation: Istituto di Sanità pubblica, Facoltà di Medicina, Università Cattolica Sacro Cuore di Roma, Roma, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Damiani
authors.affiliation: Osservatorio di Epidemiologia, Agenzia Regionale di Sanità della Toscana, Firenze, Italy.
authors.forename: Rosa
authors.initials: R
authors.lastname: Gini
authors.affiliation: Sezione OSS - Organizzazione Servizi Sanitari, Agenas, Agenzia Nazionale per i Servizi Sanitari, Roma, Italy.
authors.forename: Modesta
authors.initials: M
authors.lastname: Visca
authors.affiliation: Dipartimento di Scienze Umane, Sociali e della Salute, Università degli Studi di Cassino e del Lazio Meridionale, Cassino, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Federico
authors.affiliation: ULSS 16 Padova, Regione Veneto, Padova, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Donato
authors.affiliation: Osservatorio di Epidemiologia, Agenzia Regionale di Sanità della Toscana, Firenze, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Francesconi
authors.affiliation: Zona Territoriale Senigallia, Regione Marche, Ancona, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Marini
authors.affiliation: Regione Emilia Romagna, Bologna, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Donatini
authors.affiliation: ASP 7 Ragusa, Regione Sicilia, Ragusa, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Brugaletta
authors.affiliation: Laboratory of Public Health and Population Studies, Dipartimento di Medicina Molecolare, Università di Padova, Padova, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Baldo
authors.affiliation: Sezione OSS - Organizzazione Servizi Sanitari, Agenas, Agenzia Nazionale per i Servizi Sanitari, Roma, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Donata Bellentani
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000453:epidemiology*; D003327:Coronary Disease / Q000453:epidemiology; D003695:Delivery of Health Care; D003920:Diabetes Mellitus / Q000453:epidemiology; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011159:Population Surveillance; D011320:Primary Health Care; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D055815:Young Adult