title: Health inequalities: an analysis of hospitalizations with respect to migrant status, gender and geographical area.
abstract: BACKGROUND
  The quality of care includes several aspects which may be influenced by social-economic status. This study analyzes hospitalizations for several conditions, such as chronic diseases, cancer and appendectomy, in Italians and immigrant people living in Italy with the aim to evaluate possible inequalities in the quality of health care services due to migrant status, gender and geographical macro-areas (Northern, Central, Southern Italy).
  
  
  METHODS
  The data source of hospital discharges for stroke, myocardial infarction, chronic liver disease, cervical cancer, mastectomy and appendectomy was the Ministry of Health. ICD 9 codes were used for data collection. Crude and standardized hospitalization rates per 100.000 were calculated. Italian resident population and an estimate of immigrants living in Italy were used as denominators while standardization was done with respect to the European population. The data we used covers the 2006-2008 period.
  
  
  RESULTS
  Immigrants showed significantly higher hospitalization rates for stroke, cervical cancer and appendectomy and significantly lower hospitalization rates for chronic liver diseases and mastectomy. Males showed significantly higher hospitalization rates than females for myocardial infarction, chronic liver diseases and appendectomy. Notwithstanding, differences related to migrant status and gender varied according to geographical macro-area. With respect to that, Southern Italy showed significantly higher hospitalization rates for stroke, myocardial infarction and chronic liver diseases and significantly lower hospitalization rates for mastectomy and appendectomy.
  
  
  CONCLUSIONS
  The results of this study may reflect inequalities in the quality of health care, in particular in primary and secondary prevention, access to specialized care and inappropriateness, due to migrant status and gender. Also, differences between macro-areas suggest heterogeneities in the integration policies and the promotion of immigrants' health. Research should be endorsed in this field in order to further describe inequalities and their reasons and in the light of supporting policies development.
authors.affiliation: Department of Public Health, Università Cattolica del Sacro Cuore, L.go Francesco Vito 1, 00168, Rome, Italy. chiara.dewaure@rm.unicatt.it.
authors.forename: Chiara
authors.initials: C
authors.lastname: de Waure
authors.affiliation: Department of Public Health, Università Cattolica del Sacro Cuore, L.go Francesco Vito 1, 00168, Rome, Italy. bruno_stefania@rm.unicatt.it.
authors.forename: Stefania
authors.initials: S
authors.lastname: Bruno
authors.affiliation: Department of Public Health, Università Cattolica del Sacro Cuore, L.go Francesco Vito 1, 00168, Rome, Italy. giuseppefuria87@libero.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Furia
authors.affiliation: Consiglio Nazionale dell'Economia e del Lavoro, Rome, Italy. luca.disciullo@dossierimmigrazione.it.
authors.forename: Luca
authors.initials: L
authors.lastname: Di Sciullo
authors.affiliation: Department of Public Health, Università Cattolica del Sacro Cuore, L.go Francesco Vito 1, 00168, Rome, Italy. serena_car@tiscali.it.
authors.forename: Serena
authors.initials: S
authors.lastname: Carovillano
authors.affiliation: Department of Public Health, Università Cattolica del Sacro Cuore, L.go Francesco Vito 1, 00168, Rome, Italy. marialucia.specchia@rm.unicatt.it.
authors.forename: Maria Lucia
authors.initials: ML
authors.lastname: Specchia
authors.affiliation: Area sanitaria Caritas di Roma, Rome, Italy. s.geraci@areasanitaria.it.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Geraci
authors.affiliation: Department of Public Health, Università Cattolica del Sacro Cuore, L.go Francesco Vito 1, 00168, Rome, Italy. wricciardi@rm.unicatt.it.
authors.forename: Walter
authors.initials: W
authors.lastname: Ricciardi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D054242:Emigrants and Immigrants; D005260:Female; D062306:Geography, Medical; D054624:Health Status Disparities; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data / Q000639:trends; D017678:Sex Distribution