title: Differences in diabetes prevalence and inequalities in disease management and glycaemic control by immigrant status: a population-based study (Italy).
abstract: BACKGROUND
  The diabetes prevalence increases at an alarming rate around the world and understanding disparities in occurrence, care management, and health outcomes may be a starting point towards achieving more effective strategies to prevent and manage it. The aims of this study are to compare immigrants and Italians in terms of the differences in diabetes prevalence and to evaluate inequalities in disease management and glycaemic control by using information included in Reggio Emilia diabetes register.
  
  
  METHODS
  We retrieved from the diabetes register subjects aged 20-74 on December 31(st), 2009. Using citizenship, we created three main groups: Italy, High Developed Countries (HDC), and High Migration Pressure Countries (HMPC). These were split into sub-regions of origin. We calculated age-adjusted prevalence by gender and sub-region. Using logistic regression model, we analyzed the association between area of origin and following indicators: 1) not being in care of diabetes clinics; 2) not having glycated haemoglobin (HbA1c) test in 2010; 3) among those tested, having a HbA1c value > = 9% (75 mmol/mol).
  
  
  RESULTS
  We found 15,889 Italian and 1,295 HMPC citizens with diabetes. HMPC citizens had higher age-adjusted prevalence of diabetes than Italians (females 5.0% vs 3.6%; males 6.5% vs 5.5%). The excess was mostly due to a strong excess in immigrants from Southern Asia (females 9.7%, males 10.2%) and Northern Africa (females 9.3%, males 5.9%). HMPC citizens were cared for by diabetes clinics in a similar proportion than Italians (OR: 1.08; 95% CI: 0.93-1.25), but had a greater odds of not being tested for HbA1c (OR: 1.51; 95% CI: 1.34-1.71), as well as of having HbA1c values equal to or over 9% (OR: 2.06; 95% CI: 1.80-3.14). The outcomes were poorer in HMPC females for the first two outcomes, while there was no difference for the HbA1c values (Wald test for heterogeneity p = 0.0850; p = 0.0156; p = 0.6635, respectively).
  
  
  CONCLUSIONS
  Our findings highlight the need for gender-oriented actions for prevention and early diagnosis of the diabetes to contrast the higher risk in Northern Africans and Southern Asians. Further studies are required to determine whether the protocols in use are adequate for different immigrant groups.
authors.affiliation: Servizio Interaziendale di Epidemiologia, Local Health Authority, Via Amendola 2, Reggio Emilia, Italy. paola.ballotari@ausl.re.it.|IRCCS, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy. paola.ballotari@ausl.re.it.
authors.forename: Paola
authors.initials: P
authors.lastname: Ballotari
authors.affiliation: Servizio Interaziendale di Epidemiologia, Local Health Authority, Via Amendola 2, Reggio Emilia, Italy. stefania.caroli@ausl.re.it.|IRCCS, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy. stefania.caroli@ausl.re.it.
authors.forename: Stefania
authors.initials: S
authors.lastname: Caroli
authors.affiliation: Servizio Interaziendale di Epidemiologia, Local Health Authority, Via Amendola 2, Reggio Emilia, Italy. francy.ferr80@gmail.com.|IRCCS, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy. francy.ferr80@gmail.com.
authors.forename: Francesca
authors.initials: F
authors.lastname: Ferrari
authors.affiliation: IRCCS, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy. gabriele.romani@ausl.re.it.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Romani
authors.affiliation: Primary Health Care, Local Health Authority, Reggio Emilia, Italy. marina.greci@ausl.re.it.
authors.forename: Greci
authors.initials: G
authors.lastname: Marina
authors.affiliation: Research and Innovation Unit, Local Health Authority, Reggio Emilia, Italy. antonio.chiarenza@ausl.re.it.
authors.forename: Antonio
authors.initials: A
authors.lastname: Chiarenza
authors.affiliation: Department of Internal Medicine, Hospital of Montecchio, Local Health Authority, Reggio Emilia, Italy. valeria.manicardi@ausl.re.it.
authors.forename: Valeria
authors.initials: V
authors.lastname: Manicardi
authors.affiliation: Servizio Interaziendale di Epidemiologia, Local Health Authority, Via Amendola 2, Reggio Emilia, Italy. paolo.giorgirossi@ausl.re.it.|IRCCS, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy. paolo.giorgirossi@ausl.re.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Giorgi Rossi
mesh_terms: D000328:Adult; D000352:Africa, Northern / Q000208:ethnology; D000367:Age Factors; D000368:Aged; D001208:Asia / Q000208:ethnology; D001786:Blood Glucose; D003920:Diabetes Mellitus / Q000208:ethnology* / Q000628:therapy*; D019468:Disease Management; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006301:Health Services Needs and Demand; D006801:Humans; D007558:Italy / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012737:Sex Factors
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin