Il Libro Bianco del Diabete in Basilicata. 1° Report 2013

The Basilicata Region was analyzed and compared to the Italian context and to the national benchmarks in terms of demographic situation, epidemiology and burden of diabetes mellitus, exposure to major risk factors and volume and cost of inpatient and outpatient services provided to citizens of the region for the same pathology. The demographic situation has been described as the analysis of the population structure and its evolution over time is of vital importance for the design and programming of health and social services. For the same purpose, a definition of the burden of diabetes mellitus in the Basilicata Region has been conducted. Exposure to almost all major risk factors can be modified by health policies and the “empowerment” of the population (a process of social action through which communities develop competence over their lives, in order to improve equity and quality of life). Knowing the distribution of exposure to these risk factors in the population is therefore essential to the planning of such policies and the identification of the primary objectives. In order to identify those objectives, body weight distribution, physical activity habits, dietary patterns, and high blood pressure incidence in the Basilicata region resident population were analyzed. The number of hospitalizations for diabetes and the use of outpatient and day hospital services were analyzed as they may be indicative of the appropriateness of care provided, which is inevitably reflected on the public spending. Only the most recent data available were used. All data come from institutional sources (Italian National Institute of Statistics - ISTAT; Health for All Database; Basilicata region databases). The Basilicata Region has a population of 577,562 inhabitants (0.97% of the entire Italian population). The population is declining (-3.3 percentage points from 2002). The male/female ratio is 0.96; women predominate especially among the older age groups. The population is aging significantly. Aging is mainly due to the very low birth rate: in Basilicata, a birth rate of 1.70 (Italy: 2.14) and a mortality rate of 2.24 (Italy: 2.34) were observed in 2011. The aging index (the number of persons 65 years old or over per hundred persons under the age of 15) in Basilicata is 154.2 (Italy: 148.6). The two provinces are quite different from the point of view of the distribution of residents in urban centers. Sixty-five percent of the population lives in the province of Potenza, where only 39.4% of the population lives in the 7 municipalities with more than 10,000 inhabitants. The rest of the population of the Potenza province lives in 93 towns, mostly very small (less than 2,000 inhabitants). Instead, in the province of Matera 57.8% of the population lives in the 5 municipalities with more than 10,000 inhabitants and the rest of the population is divided among 26 other municipalities. The prevalence of diabetes mellitus in the Basilicata Region has been increasing in the recent years and was estimated at 6.9% in 2012 (Italy: 5.5%). In Italy, the region with the lowest prevalence of diabetes is the autonomous province of Bolzano (3.2%), while the region with the highest prevalence is the Abruzzo region (7.4%). The standardized mortality rate for diabetes in the Basilicata Region in 2009 (most recent data) amounted to 35.6 per 100,000 for males (Italy: 33.5) and 38.3 per 100,000 for females (Italy: 39.2). The standardized mortality rate increases with age: in patients over 65 is equal to 163.7 per 100,000 for males (Italy: 155.6) and 252.3 per 100,000 for females (Italy: 256.5). There were no deaths due to diabetes in the age group 0-34 in 2009. With regard to risk factors, 49.2% of the Basilicata population is in excess of bodyweight (Italy: 45.8%; benchmark - autonomous province of Bolzano: 39.8%) and 13.1% of the population is obese (Italy: 10.0%; benchmark - autonomous province of Bolzano: 6.4%). In the 6-17 age group, fact of major concern, 32.9% of residents are in excess weight (Italy: 27.2%; benchmark, Trentino - Alto Adige: 18.3%). Much as 48.4% of the population of the region is sedentary (do not practice any sport or physical activity. Italy: 39.8%; benchmark - autonomous province of Trento: 13.5%) and only 16.3% of the population practice at least one sport on a continuous basis (Italy: 21.9%; benchmark - autonomous province of Trento: 31.9%). Dietary habits do not differ very much from the rest of the country, as the main meal is lunch, eaten mostly at home, and the breakfast is generally adequate. However, some foods associated with hypertension, hypercholesterolemia and hyperglycemia (and thus to diabetes mellitus) are consumed by a greater proportion of the population in the region compared to the rest of Italy (cold cuts several times a week: 65.3 vs. 62.0%; eggs several times a week: 62.8 vs. 56.8%; snack foods several times a week: 30.9 vs. 25.6%), or in any case in rather high quantities (cheese at least once a day: 19.5 vs. 23.6%; pork meat several times a week: 48.2 vs. 46.5%; bovine meats several times a week: 68.7 vs. 69.8%; carbonated drinks at least once a day: 11.5 vs. 13.8%; wine, customarily: 48.3 vs. 53.3%; beer, customarily: 42.8 vs. 46.2%). The consumption of vegetables is very limited: only 27.4% of the Basilicata population consumes vegetables at least once a day (Italy: 51.4%) and only 4.7% of the population has at least 5 portions of fruits and vegetables a day (Italy: 4.9%). Hypertension affected 16.4% of the Italian population in 2012. Similarly, in the Basilicata region 16.8% of the population suffers from hypertension (benchmark - autonomous province of Bolzano: 12.5%). In the 2009-2011 period, 6,138 residents in the Basilicata region were hospitalized with a principal diagnosis of diabetes mellitus (ICD-9-CM 250.0-250.9). Of these hospitalizations, 5,315 (87%) were carried out in the region. In total, 19,790 days of hospitalization with a principal diagnosis of diabetes mellitus were reported, of which 16,946 (86%) in the region. The average number of days of hospitalization for diabetes was 3.2 days. The principal diagnosis reported more frequently in cases of hospitalization for diabetes, according to the ICD9-CM codes, is classified as diabetes/hyperglycemia (250.0), equivalent to 69.9% of the total. The other most frequent causes of hospitalization for diabetes were eye disorders (250.5, 8.9% of the total), renal disorders (250.4, 7.9% of the total) and angiopathy/gangrene (250.7, 6.7% of the total). In 2010, in the Basilicata region, it was observed a standardized rate of hospital discharges for diabetes mellitus in the main or secondary diagnosis of 116.6 per 10,000, (Italy: 77.0; benchmark - Veneto region: 43.0). Thirteen percent of hospitalizations for diabetes mellitus of citizens residing in the Basilicata region actually occurred in other regions. Hospital discharges after lower limb amputation in Basilicata (11.9 per 100,000) are less frequent than in the rest of Italy (13.3 per 100,000), but differ much from the value of the benchmark region (Valle d’Aosta: 3.0 per 100,000). Males are much more prone to amputation of the lower limb compared to females (19.5 vs. 6.4 per 100,000), and this is especially true for major amputations (6.7 vs. 0.6 per 100,000). With regard to the economic burden, the Basilicata region spent an average of € 580 for each hospitalization in the region and € 1,546 for each hospitalization outside the region in the period 2009-2011. The global spending for diabetes mellitus hospitalizations was € 4,358,529. Concerning outpatient services, in the 2009-2011 period the following services were offered to diabetics residing in Basilicata: 15,344 visits to the neurologist, with expenditure amounting to € 322,251, of which € 5,244 for visits outside the region (1.6%); 80,318 eye examinations, with expenditure amounting to € 1,445,954 of which € 41,889 for visits outside the region (2.9%); 88,775 outpatient services at the hemodialysis departments, at a cost of € 14,868,662, of which € 233,122 for services outside the region (1.6%). Globally, the region spent € 5,262,989 for outpatient services related to diabetes mellitus, of which € 5,238,816 for examinations in the region (99.5% of the total) and € 24,173 in other regions (0.5%).