title: The burden of chronic noncommunicable diseases in undocumented migrants: a 1-year survey of drugs dispensation by a non-governmental organization in Italy.
abstract: OBJECTIVE
  This study was carried out with two objectives. The first one was to have an insight into the prevalence of chronic noncommunicable diseases (CNCD) in undocumented migrants, and the second one was to evaluate if differences existed among different ethnic groups.
  
  
  METHODS
  The study is based on the collection of data on drug dispensation by a non-governmental organization (NGO) providing free medical assistance to undocumented migrants in Milan, Italy. All the prescriptions to adult subjects from January 1 to December 31 2014 (total 8438) were recorded and analyzed. All the data available for the patients receiving prescriptions (age, gender and country of birth) were also collected in anonymous form. Ethical approval for the study was given by the Ethics Committee of the NGO.
  
  
  METHODS
  Drugs were grouped according to the anatomical therapeutic chemical (ATC) classification and their quantities expressed as daily defined doses (DDDs)/1000 patients/day. The 56 ATC levels were divided into three groups according to their use for acute, chronic, or both acute and chronic diseases. The statistical analysis of drug dispensation was performed for the whole population and for the five ethnic groups into which it had been divided.
  
  
  RESULTS
  Prescription of medicines for chronic conditions was significantly greater than for acute (154.2 ± 45.9 vs 51.3 ± 18.4 DDD/1000 patients/day, P < 0.02) and for both acute and chronic conditions (57.9 ± 12.8 DDD/1000 patients/day, P < 0.02). Five ATC classes accounted for 60% of all chronic prescriptions. They were differently distributed among the five ethnic groups (e.g., Asians required more antihypertensives and antidiabetics, East Europeans required more lipid modifying drugs, antihypertensives and antithrombotics).
  
  
  CONCLUSIONS
  Our data show an important use of medicines for chronic diseases in a population of undocumented migrants. Though with some limitations, this could be an indicator of a high prevalence of CNCD in this population, with significant differences among different ethnic groups. This situation should be considered when planning health interventions, also in consideration of the fact that it could have an impact on European Health Services in a short time.
authors.affiliation: Istituti Clinici Zucchi, Carate, Italy; Department of Clinical Sciences and Community Health, University of Milan, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Fiorini
authors.affiliation: Department of Medicine and Surgery, University of Milano-Bicocca, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Cerri
authors.affiliation: Department of Clinical Sciences and Community Health, University of Milan, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Bini
authors.affiliation: Department of Clinical Sciences and Community Health, University of Milan, Italy.
authors.forename: A E
authors.initials: AE
authors.lastname: Rigamonti
authors.affiliation: Department of Internal Medicine, Fondazione IRCCS San Matteo, University of Pavia, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Perlini
authors.affiliation: IRCCS - Istituto Auxologico Italiano, Experimental Laboratory for Auxo-endocrinological Research, Milan, Verbania, Italy.
authors.forename: N
authors.initials: N
authors.lastname: Marazzi
authors.affiliation: IRCCS - Istituto Auxologico Italiano, Experimental Laboratory for Auxo-endocrinological Research, Milan, Verbania, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Sartorio
authors.affiliation: Department of Clinical Sciences and Community Health, University of Milan, Italy. Electronic address: silvano.cella@unimi.it.
authors.forename: S G
authors.initials: SG
authors.lastname: Cella
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease / Q000188:drug therapy / Q000453:epidemiology*; D017281:Cost of Illness; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009938:Organizations; D010604:Pharmacy; D015995:Prevalence; D011795:Surveys and Questionnaires; D000069756:Undocumented Immigrants / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: ATC classification of drugs; Chronic noncommunicable diseases; Daily defined dose; Migrants health; Pharmacoepidemiology; Undocumented migrants