Against the backdrop of population aging, dementia is an increasingly relevant issue for population health. Education plays a key role in this regard, influencing the risk of developing dementia and serving as a crucial dimension in health disparities among older adults. While many studies indicate a protective effect of more years of education on the risk of dementia, the extent to which education shapes inequalities beyond the onset of the disease remains underexplored. In this study, we analyze educational differences in the risk of developing disease and in healthcare utilization among people living with dementia. Regarding the latter, we focus on the risk of first hospitalization after dementia identification. The analysis is conducted in the Lazio Region (Italy) between 2012 and 2022. We use the Lazio Longitudinal Study, combining 2011 Census data (resident population aged 50–90) and information from regional healthcare administrative databases through record linkage. We estimate Kaplan-Meier survival curves by level of education for dementia identification among disease-free individuals, and cumulative hazard functions for the risk of first subsequent hospitalization among patients identified as incident cases. Combining population-comprehensive data sources, our study contributes to current knowledge by offering novel evidence on the educational gradient in dementia incidence and healthcare utilization in Italy.

INTRODUCTION In Italy, it was estimated that approximately 1,200,000 people were living with dementia in 2018 (1). International reports from the Lancet Commission indicate that intensive interventions targeting modifiable risk factors, such as diabetes mellitus, hypertension, obesity, physical inactivity, depression, smoking, and low educational attainment, could prevent or delay up to 35% of dementia cases worldwide. In Italy, a 20% reduction in these seven risk factors could lead to a 6.4% decrease in Alzheimer’s dementia cases (2,3,4,5). OBJECTIVES The PREV-ITA-DEM project, a large-scale study funded in 2022 by the Italian Ministry of Health under the National Recovery and Resilience Plan (PNRR-MAD-2022-12375822), aimed to estimate the incidence of dementia in relation to risk factors such as diabetes, hypertension, and depression. The study adopted a population-based approach using data from Healthcare Utilization Databases (including Pharmaceuticals, Exemptions, Hospitalizations, Population Registry, and Mortality) with the goal of supporting prevention efforts. MATERIALS E METHODS This retrospective cohort study involved three distinct cohorts, each exposed to one of the three risk factors of interest: hypertension, diabetes, and depression. The reference population included the adult population (aged ≥ 50 years) living in and receiving healthcare in the metropolitan area of Turin, in Bologna Local Health Authority (AUSL), and in Lazio region. Exposure cohorts were defined between January 1, 2011, and December 31, 2020, using a 4-years look-back period (2007–2010) to identify only incident cases. Follow-up, with a maximum duration of 12 years, started on January 1, 2011, and ended at the earliest occurrence of one of the following events: dementia diagnosis, migration, death, or the end of the study period (December 31, 2022). A methodological approach based on a Common Data Model (CDM) was adopted, with a shared operational protocol, harmonized database structures, and a common script applied locally by each participating center, in compliance with data privacy regulations established by the Italian Data Protection Authority. A record linkage procedure of regional administrative health data flows was executed to generate the three studied cohorts. Quantitative variables were synthesized through means and standard deviations, while categorical variables were reported as absolute and relative frequencies. Incidence rates for dementia and the exposures (hypertension, diabetes, depression) were calculated based on the number of incident cases per person-time, also accounting for censored individuals (due to death or migration). The risk of dementia associated with each exposure was estimated using Cox proportional hazards models, both univariate and multivariate (adjusted for key confounders), with time-dependent exposures. Results were expressed as Hazard ratios (HRs) and 95% confidence intervals (95% CIs). Data were analysed using Stata and SAS software, with a p-value <0.05 for statistical significance. RESULTS During the follow-up period, dementia incident cases after a diagnosis of depression added up to 4,161 (12.3%) in Bologna, 15,412 (9.4%) in Lazio, and 6,775 (8.5%) in Turin. Regarding diabetes, the number of individuals who developed dementia was 1,163 (4.1%) in Bologna, 6,854 (3.6%) in Lazio, and 1,917 (2.1%) in Turin. Finally, for hypertension, dementia incident cases during follow-up amounted to 6,729 (3.8%) in Bologna, 13,018 (1.0%) in Lazio, and 3,321 (1.5%) in Turin. Univariate analysis showed a positive association between depression and the risk of dementia in Bologna (HR: 6.0; 95% CI: 5.6–6.4), Lazio (HR: 5.06; 95% CI: 4.88–5.25), and Turin (HR: 7.56; 95% CI: 7.21–7.94). Diabetes was also significantly associated with dementia across all three studied areas: Bologna (HR: 2.2; 95% CI: 1.9–2.4), Lazio (HR: 1.8; 95% CI: 1.7–1.9), and Turin (HR: 2.4; 95% CI: 2.2–2.7). Hypertension showed a positive association in Bologna (HR: 1.5; 95% CI: 1.4–1.6) and Lazio (HR: 1.06; 95% CI: 1.0–1.1), while an inverse association was observed in Turin (HR: 0.94; 95% CI: 0.89–0.98). After adjusting for sex, age, and Charlson Comorbidity Index, depression was strongly associated with an increased risk of dementia across all areas: Turin (HR: 6.0; 95% CI: 5.7–6.2), Bologna (HR: 2.8; 95% CI: 2.6–2.9), and Lazio (HR: 2.58; 95% CI: 2.49–2.68). Diabetes showed a significant association only in Turin (HR: 1.7; 95% CI: 1.5–1.8) and Bologna (HR: 1.1; 95% CI: 1.02–1.3), whereas the association was not confirmed in Lazio (HR: 0.98; 95% CI: 0.93–1.03). Hypertension was inversely associated with dementia in all areas: Turin (HR: 0.9; 95% CI: 0.9–1.0), Bologna (HR: 0.63; 95% CI: 0.60–0.66), and Lazio (HR: 0.80; 95% CI: 0.78–0.82). CONCLUSIONS These preliminary findings underscore the importance of prevention strategies focused on the early management of psychiatric and metabolic risk factors in the adult population, suggesting potential benefits in reducing the incidence of dementia. INTRODUCTION In Italy, it was estimated that approximately 1,200,000 people were living with dementia in 2018 (1). International reports from the Lancet Commission indicate that intensive interventions targeting modifiable risk factors, such as diabetes mellitus, hypertension, obesity, physical inactivity, depression, smoking, and low educational attainment, could prevent or delay up to 35% of dementia cases worldwide. In Italy, a 20% reduction in these seven risk factors could lead to a 6.4% decrease in Alzheimer’s dementia cases (2,3,4,5). OBJECTIVES The PREV-ITA-DEM project, a large-scale study funded in 2022 by the Italian Ministry of Health under the National Recovery and Resilience Plan (PNRR-MAD-2022-12375822), aimed to estimate the incidence of dementia in relation to risk factors such as diabetes, hypertension, and depression. The study adopted a population-based approach using data from Healthcare Utilization Databases (including Pharmaceuticals, Exemptions, Hospitalizations, Population Registry, and Mortality) with the goal of supporting prevention efforts. MATERIALS E METHODS This retrospective cohort study involved three distinct cohorts, each exposed to one of the three risk factors of interest: hypertension, diabetes, and depression. The reference population included the adult population (aged ≥ 50 years) living in and receiving healthcare in the metropolitan area of Turin, in Bologna Local Health Authority (AUSL), and in Lazio region. Exposure cohorts were defined between January 1, 2011, and December 31, 2020, using a 4-years look-back period (2007–2010) to identify only incident cases. Follow-up, with a maximum duration of 12 years, started on January 1, 2011, and ended at the earliest occurrence of one of the following events: dementia diagnosis, migration, death, or the end of the study period (December 31, 2022). A methodological approach based on a Common Data Model (CDM) was adopted, with a shared operational protocol, harmonized database structures, and a common script applied locally by each participating center, in compliance with data privacy regulations established by the Italian Data Protection Authority. A record linkage procedure of regional administrative health data flows was executed to generate the three studied cohorts. Quantitative variables were synthesized through means and standard deviations, while categorical variables were reported as absolute and relative frequencies. Incidence rates for dementia and the exposures (hypertension, diabetes, depression) were calculated based on the number of incident cases per person-time, also accounting for censored individuals (due to death or migration). The risk of dementia associated with each exposure was estimated using Cox proportional hazards models, both univariate and multivariate (adjusted for key confounders), with time-dependent exposures. Results were expressed as Hazard ratios (HRs) and 95% confidence intervals (95% CIs). Data were analysed using Stata and SAS software, with a p-value <0.05 for statistical significance. RESULTS During the follow-up period, dementia incident cases after a diagnosis of depression added up to 4,161 (12.3%) in Bologna, 15,412 (9.4%) in Lazio, and 6,775 (8.5%) in Turin. Regarding diabetes, the number of individuals who developed dementia was 1,163 (4.1%) in Bologna, 6,854 (3.6%) in Lazio, and 1,917 (2.1%) in Turin. Finally, for hypertension, dementia incident cases during follow-up amounted to 6,729 (3.8%) in Bologna, 13,018 (1.0%) in Lazio, and 3,321 (1.5%) in Turin. Univariate analysis showed a positive association between depression and the risk of dementia in Bologna (HR: 6.0; 95% CI: 5.6–6.4), Lazio (HR: 5.06; 95% CI: 4.88–5.25), and Turin (HR: 7.56; 95% CI: 7.21–7.94). Diabetes was also significantly associated with dementia across all three studied areas: Bologna (HR: 2.2; 95% CI: 1.9–2.4), Lazio (HR: 1.8; 95% CI: 1.7–1.9), and Turin (HR: 2.4; 95% CI: 2.2–2.7). Hypertension showed a positive association in Bologna (HR: 1.5; 95% CI: 1.4–1.6) and Lazio (HR: 1.06; 95% CI: 1.0–1.1), while an inverse association was observed in Turin (HR: 0.94; 95% CI: 0.89–0.98). After adjusting for sex, age, and Charlson Comorbidity Index, depression was strongly associated with an increased risk of dementia across all areas: Turin (HR: 6.0; 95% CI: 5.7–6.2), Bologna (HR: 2.8; 95% CI: 2.6–2.9), and Lazio (HR: 2.58; 95% CI: 2.49–2.68). Diabetes showed a significant association only in Turin (HR: 1.7; 95% CI: 1.5–1.8) and Bologna (HR: 1.1; 95% CI: 1.02–1.3), whereas the association was not confirmed in Lazio (HR: 0.98; 95% CI: 0.93–1.03). Hypertension was inversely associated with dementia in all areas: Turin (HR: 0.9; 95% CI: 0.9–1.0), Bologna (HR: 0.63; 95% CI: 0.60–0.66), and Lazio (HR: 0.80; 95% CI: 0.78–0.82). CONCLUSIONS These preliminary findings underscore the importance of prevention strategies focused on the early management of psychiatric and metabolic risk factors in the adult population, suggesting potential benefits in reducing the incidence of dementia.

INTRODUCTION:We aimed to evaluate the diagnostic stability of a large spectrum of psychiatric diagnoses in adolescents and young adult patients attending specialised facilities in the Lazio Region (Italy). METHODS:A total of 3871 subjects (11-35 years) at their first hospitalisation with a psychiatric diagnosis were selected and followed up for 10 years on subsequent hospital admissions to psychiatric care. RESULTS:A total of 1145 patients were readmitted to a hospital for a psychiatric disorder in the following 10 years. Among these subjects, the concordance between the first and last diagnosis was 57.8% with a weighted kappa of 0.47 (95% CI: 0.42-0.51); the repeated stability (the same diagnosis in at least 75% of admissions) was 31.2%. The diagnostic categories with the highest values of prospective concordance and kappa were schizophrenia spectrum and other functional psychoses (70%, kappa 0.53), substance use disorders (54%, kappa 0.57), and eating disorders (80.9%, kappa 0.76). CONCLUSIONS:In a population study, the stability over time of the first psychiatric diagnosis in a hospital varied according to the specific diagnostic categories, and overall, it was lower than previously reported. The trajectories were disorder-specific, and the stability was influenced by several factors, including the individuals' characteristics, the disorder's severity, and the diagnostic setting.

BackgroundAlzheimer's disease and other dementias are major causes of disability and death among older adults. With an increasing number of older migrants in Italy, dementia prevalence in this group is expected to rise. However, little is known about their health outcomes.ObjectiveThis study aimed to analyze mortality in migrants with dementia in Lazio, Italy, as part of the ImmiDem project (GR-2021-12372081).MethodsA cohort study was conducted on individuals aged ≥50 with dementia living in Lazio as of December 31, 2018, who were followed for 5 years. Migratory status was defined by country of birth: native Italians, migrants from High Migratory Pressure Countries (HMPCs), or Highly Developed Countries (HDCs). Age-standardized mortality proportion was calculated by migratory status, and time-to-event analysis was performed using Cox regression models.ResultsAs of December 31, 2018, 38,380 individuals with dementia lived in Lazio, with 2.1% born in HMPCs and 0.9% in HDCs. The age-standardized mortality proportion was lower in migrants born in HPMCs (30.7%; 95% CI: 26.4-35.8) than among natives (36.8%; 95% CI: 35.4-38.4). The age- and sex-adjusted hazard ratio (HR) confirmed lower mortality in migrants (HMPCs HR = 0.91, 95% CI:0.82-1; HDCs HR = 0.79, 95% CI:0.68-0.91) than natives.ConclusionsMigrants with dementia showed lower mortality than Italians, possibly due to health advantages, salmon bias, or migration dynamics. However, these findings may not accurately reflect better health status. Potential underdiagnosis of dementia and the use of country of birth as a proxy for migratory status may have influenced results and should be considered in future research.

While educational disparities in dementia incidence are well-known, whether and to what extent they persist beyond dementia onset is less explored. In this study, we investigated educational disparities in the risk of dementia diagnosis in administrative health records (dementia incidence) and subsequent healthcare utilization among dementia patients. We analysed the Lazio Region Longitudinal Study (Italy) from 2012 to 2022. We applied Cox regression to investigate disparities in dementia incidence and three subsequent healthcare utilization outcomes (all-cause hospitalizations, potentially preventable hospitalizations, and emergency visits). In a cohort of dementia-free 50-90-year-olds (907 453 men and 1 083 538 women), we found strong and age-patterned disparities in dementia incidence. Compared to highly-educated, the incidence in low-educated men and women was higher, especially at ages 50-64 (HR = 2.09, 95 % CI: 1.69-2.58 and HR = 2.17; 95 % CI: 1.71-2.74). In the follow-up of 27 158 men and 40 797 women incident dementia cases, low-educated had higher risk of all-cause hospitalizations (HR = 1.24; 95 % CI: 1.16-1.32 and HR = 1.18; 95 % CI: 1.09-1.27), potentially-preventable hospitalizations (HR = 1.27; 95 % CI: 1.17-1.37 and HR = 1.19; 95 % CI: 1.08-1.31) and emergency visits (HR = 1.33; 95 % CI: 1.26-1.41 and HR = 1.27; 95 % CI: 1.18-1.35). Disparities in hospitalization are reduced after adjusting for health conditions pre-existing dementia identification, less so those in emergency visits. Overall, disparities in dementia incidence persisted to a lesser extent in subsequent healthcare utilization and were mostly accounted by pre-existing health conditions.

to estimate Amyotrophic Lateral Sclerosis (ALS) incidence and prevalence in three Italian Regions (Lazio, Tuscany, and Umbria), using health administrative databases.

OBJECTIVES:to estimate Amyotrophic Lateral Sclerosis (ALS) incidence and prevalence in three Italian Regions (Lazio, Tuscany, and Umbria), using health administrative databases. DESIGN:retrospective population-based study. SETTING AND PARTICIPANTS:ALS patients residing in Lazio, Umbria, and Tuscany were identified through an algorithm based on three different administrative databases: hospital discharge records, exemptions from health care co-payment, and emergency departments (study period 2014-2019). Crude, age- and gender-specific prevalence were calculated on 31.12.2019 and incidence rates of ALS were standardised by region, year, and gender between 2014-2019. Using a clinical dataset available in the Lazio Region, the proportion of individuals residing in the region correctly identified as ALS cases by the algorithm were calculated. MAIN OUTCOMES MEASURES:prevalence and incidence rates. RESULTS:a total of 1,031 ALS patients (>=18 years) were identified: 408 cases in Tuscany, 546 in Lazio, and 77 in Umbria. ALS standardised prevalence (per 100,000) was similar among regions: 12.31 in Tuscany, 11.52 in Lazio, and 9.90 in Umbria. The 5-year crude rates were higher in men, and in people aged 65-79 years. Among 310 patients included in the clinical dataset, 263 (84.8%) were correctly identified by the algorithm based on health administrative databases. CONCLUSIONS:ALS prevalence and incidence in three Central Italy Regions are rather similar, but slightly higher than those previously reported. This finding is plausible, given that previous results relate to at least ten years ago and evidenced increasing trends. Overall, the results of this paper encourage the use of administrative data to produce occurrence estimates, useful to both epidemiological surveillance and research and healthcare policies.

Abstract Background Dementia is a major cause of disability and death among older people. Older migrants living in Italy are increasing and the prevalence of dementia is expected to rise in this population. Nevertheless, there is lack of real-world information concerning their health outcomes. The aim of this work was to analyse mortality in migrants with dementia living in Lazio, Italy (IMMIDEM project, GR-2021-12372081) Methods In a retrospective cohort study, people with dementia aged ≥50 living in Lazio on 31st December 2018 were selected using Health Information Systems (HIS) and followed-up for 5 years. The migrant status was defined according to the Country of birth as native Italians, people from High Migratory Pressure Countries (HMPC) or Highly Developed Countries (HDC). Age-standardized mortality rate (SMR) was estimated overall and by migrant status. Time to event analysis was performed using Kaplan-Meier curves, log-rank tests, and multivariate Cox regression. Results On 31st December 2018, 38,835 individuals with dementia were living in Lazio, 2.1% from HMPC and 0.9% from HDC. Natives and HDC were older than HPMC, while migrants showed a higher proportion of female. The SMR was lower in migrants from HPMC (42.2%; CI95% 37.0%-48.1%) and from HDC (33.2%; CI95% 25.4%-43.4%) than among natives (52.4%; CI95% 50.7%-54.1%). The age-adjusted mortality hazard ratio (HR) was lower in migrants (HDCs HR = 0.76, CI95%:0.66-0.89; HMPC HR = 0.88, CI95%:0.80-0.97) than natives. Conclusions The study showed a lower mortality rate among migrants with dementia compared to native Italians. Under-diagnosis, the “salmon bias”, and the “‘healthy migrant effect” could explain this apparent paradox, consistently with available literature. In addition, following-up migrants in the HIS may be difficult and underestimation may occur. Enhancing the comprehension of this phenomenon could allow the formulation of more effective, diversity-sensitive policies and practices for the management of dementia. Key messages • The mortality rate among migrants with dementia was found lower than that among native Italians. • Understanding the morbidity and mortality patterns in migrants with dementia is important to develop practice to adequately respond to their health needs and diversity-sensitive polices.

BACKGROUND:Entering dialysis is a critical moment in patients' healthcare journey, and little is known about drug therapy around it. A study funded by the Italian Medicines Agency offered the opportunity to leverage data from the Lazio Regional Dialysis and Transplant Registry (RRDTL) and perform an observational study on drug use patterns before and after initiating chronic dialysis. METHODS:Individuals initiating dialysis in 2016-2020 were identified from RRDTL, excluding patients with prior renal transplantation, stopping dialysis early, or dying within 12 months. Use of study drugs, predefined by clinicians, in the two years around the index date was retrieved from the drug claims register and described by semester. For each drug group, proportions of users (min 2 claims in 6 months) by semester, and intensity of treatment in terms of Defined Daily Doses (DDDs) for cardiovascular and antidiabetic agents were compared across semesters, stratifying by sex and age. RESULTS:In our cohort of 3,882 patients we observed a general increase in drug use after initiating dialysis, with the mean number rising from 5.5 to 6.2. Cardiovascular agents accounted for the highest proportions, along with proton pump inhibitors and antithrombotics over all semesters. Dialysis-specific therapies showed the most evident increase, in particular anti-anaemics (iron 4-fold, erythropoietins almost 2-fold), anti-parathyroids (6-fold), and chelating agents (4-fold). Use of cardiovascular and antidiabetic drugs was characterised by significant variations in terms of patterns and intensity, with some differences between sexes and age groups. CONCLUSIONS:Entering dialysis is associated with increased use of specific drugs and goes along with adaptations of chronic therapies.

Abstract Background and Aims In 2010, 2.6 million people received Kidney Replacement Treatment (KRT) worldwide. Hemodialysis (HD) is the most commonly used KRT. HD patients have a consistent risk of death. The impact of Educational Level (Edl) on the mortality in HD patients is unclear. This study aims to analyse the association between the Edls and mortality in incident chronic HD patients using the Lazio Regional Dialysis and Transplant Registry. Method A cohort of incident HD patients between 2008 and 2022 was selected. Patients under 18 years old and with a follow-up period shorter than 91 days were excluded. All patients were characterized by sociodemographic and clinical characteristics at the incident date and were followed from the incident date until the earliest of the following dates: death, transplantation, renal function recovery or end of the study (one or three years after initiation). One-year and three-year Crude Mortality Rates*100 Person Years (CMR*100PY) overall and by Edal (low: up to primary school, medium: secondary school, high: university degree and more) were calculated. Cumulative survival estimates at one year and three years since starting HD, were presented as Kaplan-Meier curves by EdL and compared using the log-rank test. Crude and adjusted Hazard Ratios (HR) and respective 95% Confidence Intervals (95% CI) of the association between EdL and one and three-year mortality were calculated using univariate and multivariate Cox regression models (reference category: low EdL). Sociodemographic and clinical characteristics were considered potential confounders or effect modifiers in the adjusted Cox regression models. Results The cohort counted 9,776; 33.5% had a low EdL, 30.7% had a medium, and 35.8% had a high EdL. The mean age decreased with increasing EdL (73 and 65 in low and high EdL, respectively) as the proportion of females (43.0% and 26.0% in low and high EdL, respectively). During the first year of HD, 1,683 deaths occurred, and 3,827 occurred within three years. One-year CMR*100PY were 24.1 (95% CI 22.4-26.0) in low EdL, 17.4 (95% CI: 15.9-19.0) in medium EdL and 15.0 (95% CI: 13.8-16.4) in high ED. The corresponding three-year CMR were 22.7 (95% CI 21.6-23.8), 17.4 (95% CI 16.4-18.4) and 15.1 (95% CI 14.2-16.0). One-year survivals estimates were 78.0% in low EdL, 83.8% in medium and 85.8% in high EdL (log-rank test: p-value < 0.001). The three-years survival estimates were 51.0% in low EdL, 59.3% in medium EdL and 63.7% in high EdL (log-rank test: p-value < 0.001). In one-year mortality the crude HRs were 0.72 (95% CI: 0.64–0.81) and 0.62 (95% CI: 0.55–0.70) of medium and high EdL vs. low EdL respectively; the corresponding adjusted HRs were 0.93 (95% CI: 0.83–1.06) and 0.92 (95% CI: 0.81–1.04) (Fig. 1). Similar results were obtained for three-year mortality: crude HRs were 0.77 (95% CI: 0.71–0.83) and 0.66 (95% CI: 0.62–0.72); adjusted HRs were 0.99 (95% CI: 0.92–1.08) and 0.97 (95% CI: 0.89–1.06), respectively (Fig. 2).). Conclusion Based on the present study, high educational level does not appear to be associated with lower mortality risk at either one-year or three-years. Hemodialysis patients are constantly monitored by National Health Service; this probably cancels the effect of low educational level on mortality. Although EdL is a strong indicator of socioeconomic position, it does not capture all dimensions of disadvantage. The mechanisms that underline the poor prognosis in Haemodialysis patients are complex and further investigations are needed.

Introduction Mental healthcare provision is undergoing substantial reconfiguration in many regions of the world. Such changes require a broad evidence-based approach incorporating epidemiological data and information of local needs. Objectives To estimate the prevalence of schizophrenia spectrum disorders (SSDs) in the Lazio region and its geographical distribution using the regional health information systems (HIS). Methods Cases of SSDs (15-64-year-old) were identified using an algorithm based on data from the hospital discharge registry [ICD IX CM: 295, 297, 298 (excl. 298.0)] and the ticket exemption database [code 044], between 2006 and 2019. Crude, and age- and gender-specific prevalence estimates on December 31, 2019, were calculated. To compare prevalence between different areas within the region, we calculated age- and gender-adjusted prevalence rates Results A total of 18,371 cases were identified. Crude prevalence rate was 4.29/1,000 (95% CI 4.29-4.30) and 5.93/1,000 (95% CI 5.92-5.949 for women and men, respectively. An increase in the prevalence rate by age was observed in both genders. The age- and gender-adjusted prevalence rate was 5.03/1,000 (95 % CI 4.96-5.10), with significant differences within the region, ranging from 4.25/1,000 in the province of Viterbo to 5.42/1,000 in the city of Rome and 6.02/1000 in the province of Frosinone. Conclusions Our results showed that the overall prevalence of SSDs among adults in the Lazio region is similar to estimates published in prior reviews, but an uneven regional geographical distribution was observed. While possible underestimation must be considered, HIS represents a valuable source of information useful for epidemiological surveillance and healthcare planning. Disclosure No significant relationships.

BACKGROUND:. In the last decades some studies observed a moderate progressive decrease in short-term mortality in incident hemodialysis patients. The aim of the study is to analyse the mortality trends in patients starting hemodialysis using the Lazio Regional Dialysis and Transplant Registry. METHODS:. Patients who started chronic hemodialysis between 2008 and 2016 were included. Annual 1-year and 3-year Crude Mortality Rate*100 Person Years (CMR*100PY) overall, by gender and age classes were calculated. Cumulative survival estimates at 1 year and 3 years since the date of starting hemodialysis were presented as Kaplan-Meier curves for the three periods and compared using the log-rank test. The association between periods of incidence in hemodialysis and 1-year and 3-year mortality were investigated by means of unadjusted and adjusted Cox regression models. Potential determinants of both mortality outcomes were also investigated. RESULTS:. Among 6,997 hemodialysis patients (64.5% males, 66.1% over 65 years old) 923 died within 1 year and 2,253 within 3 years form incidence; CMR*100PY were 14.1 (95%CI: 13.2-15.0) and 13.7 (95%CI: 13.2-14.3), respectively; both remained unchanged over the years. Even after stratification by gender and age classes no significant changes emerged. Kaplan-Meier mortality curves did not show any statistically significant differences in survival at 1 year and 3 years from hemodialysis incidence across periods. No statistically significant associations were found between periods and 1-year and 3-year mortality. Factors associated with a greater increase in mortality are: being over 65 years, born in Italy, not being self-sufficient, having systemic versus undetermined nephropathy, having heart disease, peripheral vascular disease, cancer, liver disease, dementia and psychiatric illness, and receiving dialysis by catheter rather than fistula. CONCLUSIONS:. The study shows that the mortality rate in patients with end-stage renal disease starting hemodialysis in the Lazio region was stable over 9 years.

In tackling social inequalities in health, the first step is to analyze and understand the territory, especially in urban contexts. In this sense, the Municipality of Rome represents an interesting case study due to its peculiar urban and social stratification. The large territory over which it extends is characterized by various types of urban patterns, from the dense city of the most central areas to the dispersed city that extends in all directions. The public housing projects built in the last sixty years are part of this complex urban system. The Local Health Unit Roma 1 is developing its own Health Equity Plan. Starting from this and from previous analysis carried out in the area of the Local Health Unit Rome 1 (comprising six municipalities, for an area of over 500 km2 and a population exceeding one million inhabitants), an observational study was carried out with the aim of identifying any inequalities in the use of second-level services. These were measured in terms of hospitalization and access to the Emergency Department and the resident population in the Public Building areas, delimited in Rome by the Zoning Plans. The study shows that there are significant differences for many of the areas analyzed, which could lead to inequalities in access to health services, especially those of primary health care. Analyzing these results in the light of the evolution of the urban fabric of the city, also in accordance with the field experience of the Local Health Unit operators, should guarantee a better understanding of the phenomenon with a view to providing epidemiological support to health planning.

The urban context of the city of Rome is the result of an urban but also socio-economic stratification. From the frenetic development of the central areas at the end of the nineteenth century, up to the building speculation of the first half of the twentieth century and throughout the sixties, Rome today is characterized by highly urbanized areas, and dispersed nuclei of cities in an area of over 1200 km2. Municipalities XIII and XIV constitute in this a real representative cross section of the Roman context. The dense fabric of the more central historical periphery becomes gradually more rarefied, re-aggregating around the GRA motorway ring, and then dispersing again into the countryside to the north. Within this fabric there are areas of Public Residential Housing (PRH), built between the 40 and 70 s, which still today constitute, in the perception of the population, real “urban islands”. These are characterized by a lower socioeconomic level than the surrounding deprived areas, and a significant increased risk level regarding the access rates to the emergency room and hospitalization. All this in the context of an evident centre-periphery gradient of these indicators, which can be correlated not only with socio-economic indicators, but with the development of these portions of the city itself. The complexity of the historical and urban stratification of Rome makes this methodology capable of reading in depth the socio-economic dynamics with an impact on health, and of effectively planning health, territorial and hospital services.

Abstract Background Studies of the epidemiology of amyotrophic lateral sclerosis (ALS) are numerous, with incidence and prevalence estimates varying widely depending on population characteristics, geographical areas, and available data sources. The aim of this study was to estimate prevalence and incidence of ALS in three Italian regions (Latium, Tuscany, and Umbria) using health administrative databases. Methods ALS patients residing in Latium, Umbria and Tuscany were identified through an algorithm based on data from three different health administrative databases: hospital discharges, exemptions from health care co-payment, and emergency departments (study period 2014-2019). We calculated crude, age- and gender specific prevalence estimates on December 31, 2019 and standardised incidence rates of ALS by region, year, and sex between 2014-2019. Moreover, using a clinical dataset available in the Lazio region, we calculated the proportion of individuals correctly identified as ALS cases by the algorithm in this region. Results A total of 1,031 persons affected by ALS, aged ≥ 18 years at the prevalence day were identified: 408 cases in Tuscany, 546 in Latium, and 77 in Umbria. Diseases specific co-payment exemptions accounted for the biggest contribution for case detection, ranging between 24.7% in Umbria and 30.6% in Latium. The algorithm produced standardised overall ALS prevalence rates similar between the three regions, varying between 12.31/100,000 in Tuscany, 11.52/100,000 in Latium and 9.90/100,000 in Umbria. The 5-year crude rates were higher in men, and in people aged 65-79 years. Among 310 patients included in the clinical dataset, 263 (84.8%) were identified by the algorithm based on health administrative databases. Conclusions ALS prevalence and incidence in three regions of Central Italy are rather similar but slightly higher than those previously reported. This finding is plausible given that previous results relate to at least ten years ago and evidenced of increasing trends. Overall, our results encourage the use of administrative data to produce occurrence estimates, useful to both, epidemiological surveillance and research and healthcare policies.

Background: A crucial step for planning effective public health policies for migrants with dementia is the collection of data on the local dimensions of the phenomenon and patients’ characteristics. Objective: This study aimed to identify and characterize migrants with dementia in the Lazio region using health administrative databases. Methods: Residents with dementia aged 50 years or older, living in the Lazio region as of December 31, 2018, were identified using a validated algorithm based on hospital discharge(s), claims for antidementia drugs, and co-payment exemption for dementia. Migrants were defined as people born abroad and grouped in migrants from High Migratory Pressure Countries (HMPCs) and Highly Developed Countries (HDCs). Overall and age-specific prevalence rates were estimated in native- and foreign-born patients. Results: Dementia was ascertained in 38,460 residents. Among them, 37,280 (96.9%) were born in Italy, 337 (0.9%) were migrants from HDCs, and 843 (2.2%) from HMPCs. Dementia prevalence was higher among natives (1.15%, 95% CI 1.14–1.16) relative to migrants from HDCs (0.60%, 95% CI 0.54–0.67) and HMPCs (0.29%, 95% CI 0.27–0.31). The prevalence of comorbidities did not differ between groups. Migrants with dementia had a lower likelihood of receiving antidementia treatments compared with natives (51.6% in migrants from HDCs, 49.3% in migrants from HMPCs, and 53.5% among Italians). Conclusion: Routinely collected data in healthcare administrative databases can support the identification of migrants with dementia. Migrants exhibited a lower age-standardized prevalence of registered dementia and lower access to dedicated treatments than Italians. These findings are suggestive of underdiagnosis and undertreatment of dementia in migrants.

BACKGROUND:More than 500,000 dementia cases can be estimated among migrants living in Europe. There is the need to collect "real world" data on the preparedness of healthcare services to support the inclusion of migrants in the public health response to dementia. The present study aimed (i) to estimate the number of migrants referred to Italian memory clinics (Centers for Cognitive Disorders and Dementia [CCDDs]) and (ii) to identify possible barriers and resources for the provision of diversity-sensitive care.METHODS:A survey of all Italian CCDDs was conducted between December 2020 and April 2021. An online questionnaire was developed to obtain information on the number of migrants referred to Italian CCDDs in 2019, the challenges encountered in the diagnostic approach, and possible facilitators in the provision of care.RESULTS:Overall, 343 of the 570 contacted CCDDs completed the survey questionnaire (response rate: 60.2%). Nearly 4527 migrants were referred to these services in 2019. Migrants accounted for a median 1.1% (IQR: 0.9%-2.8%) of overall CCDD referrals. More than one-third of respondents reported that the number of migrants referred to their facilities had increased in the last 5 years. The overall quality of the migrants' cognitive assessment was deemed to be very poor or insufficient in most cases. A minority of CCDDs had translated information material on dementia and reported the possibility to contact cultural mediators and interpreters.CONCLUSIONS:A relevant number of migrants are being referred to Italian CCDDs that are still not adequately prepared to deliver diversity-sensitive care and support.