Salute della popolazione immigrata -Principali evidenze dalla letteratura italiana recente

Ugo Fedeli

Servizio Epidemiologico Regionale e Registri,

Azienda Zero, Regione del Veneto

XLIII Convegno AIECatania, 23-25 ottobre 2019

Tabella 2. Numero di lavori clinici ed epidemiologici sugli immigrati in Italia disponibili su PubMed

e pubblicati nel decennio 2000-2009: classificazione per tipologia ed argomento.

Sono state utilizzate le chiavi di ricerca ("2000"[Publication Date] : "2009"[Publication Date]) AND ((immigrants OR migrants OR foreigners OR refugees OR asylum seekers) AND Italy). Sono stati esaminati gli abstract dei 308 lavori così selezionati su PubMed

La Tabella 2 mostra la distribuzione delle 187 pubblicazioni esaminate per tipologia dello studio / argomento trattato (la classificazione è mutualmente esclusiva). Vi è una preponderanza di studi su patologie infettive (più del 60% del totale)

E’ da notare invece la quasi totale assenza di studi di incidenza delle neoplasie ed adesione agli screening

Sono disponibili solo due lavori originali sulla salute occupazionale (l’argomento immigrazione si ritrova in quattro lavori di “stato dell’arte”).

Nel biennio 2008/2009, compaiono anche quattro lavori sulla prevalenza di fattori di rischio (in particolare cardiovascolari).

gen-giu 2019 92

2018 161

2017 172

2016 124

2015 99

2014 104

2013 78

2012 79

2011 93

2010 46

1048

(migrants OR immigrants OR asylum seekers OR refugees OR foreigners) AND Italy

From 2010/01/01 to 2019/06/30

Abstract

Case series Clinical,

multicentrico

Survey/

prevalenza

Archivi elettronici/

registri

Altro

TBC 15 4 12 (4) 5 1

Epatiti virali 3 3 15 (2) 1

HIV 5 3 3

MST 3 2

Malaria 3 1

Parassitosi 7 4 11 (2) 1

Varie infettive 3 15 (13) 2

Vaccinaz/ stato imm 6 1

Profilo salute / accesso 7 (2) 12 (4) 12

Fattori di rischio CV 11

Diabete, malattie CV 3 3 4 (1) 11

Screening / HPV 1 1 10 4

Tumori 1 3

Materna-perinatale 3 3 13 9

Emoglobinopatie 9

Bambini-adolescenti 16 3 1

Salute mentale 10 1 10 (3) 6 1

Allergie / pat. Respirat 3 1 4

Medicina del lavoro 1 10 6

Violenza 2 (1) 2 (1) 1

Varie 5 1 5 3

Classificazione studi 2010-2019: risultati preliminari su 341 Abstract selezionati

AmbitoCase

series

Clinical,

multicentrico

Survey/

prevalenza

Archivi/

registriAltro TOT

TBC 15 4 12 (4) 5 1 37

Epatiti virali 3 3 15 (2) 1 22

HIV 5 3 3 11

MST 3 2 5

Malaria 3 1 4

Parassitosi 7 4 11 (2) 1 23

Varie infettive 3 15 (13) 2 20

Vaccinaz/ stato imm 6 1 7

Hum Vaccin Immunother. 2016 Sep;12(9):2383-90

Clinical and economic impact of a specific BCG vaccination program implemented in Prato, central Italy, involving foreign newborns on hospitalizations.

TB

Screening per malattia / infezione tubercolare latente (richiedenti asilo / irregolari)

Contributo crescente della popolazione immigrata alla quota di casi incidenti

Analisi genotipica per descrivere pattern di trasmissione

Drug resistance

Travel Med Infect Dis. 2018 Sep - Oct;25:31-34.Congenital Chagas disease in a non-endemic area: Results from a control programme in Bergamo province, Northern Italy.

PLoS Negl Trop Dis. 2015 Sep 25;9(9):e0004103. Neglect of a Neglected Disease in Italy: The Challenge of Access-to-Care for Chagas Disease in Bergamo Area.

PLoS Negl Trop Dis. 2014 Dec 11;8(12):e3361. Profile of Trypanosoma cruzi infection in a tropical medicine reference center, Northern Italy.

Blood Transfus. 2013 Oct;11(4):558-62.Surveillance of Chagas disease among at-risk blood donors in Italy: preliminary results from Umberto I Polyclinic in Rome.

Clin Microbiol Infect. 2017 May;23(5):335.e1-335.e5. Seroprevalence of five neglected parasitic diseases among immigrants accessing five infectious and tropical diseases units in Italy: a cross-sectional study.

Intern Emerg Med. 2017 Jun;12(4):467-477. Spectrum and burden of neglected tropical diseases observed in an infectious and tropical diseases unit in Florence, Italy (2000-2015).

J Immigr Minor Health. 2016 Jun;18(3):616-23. Chagas Disease in a Non-endemic Country: A Multidisciplinary Research, Bologna, Italy.

BMC Infect Dis. 2018 May 8;18(1):212.Serological evaluation for Chagas disease in migrants from Latin American countries resident in Rome, Italy.

Clin Microbiol Infect. 2018 Dec;24(12):1340.e1-1340.e6Chagas disease knocks on our door: a cross-sectional study among Latin American immigrants in Milan, Italy.

Euro Surveill. 2011 Sep 15;16(37). pii: 19969.Chagas disease in Italy: breaking an epidemiological silence.

Romania 126912

Marocco 45829

Cina Rep. Popolare 35714

Albania 33758

Moldova 33422

Bangladesh 17227

Ucraina 16868

India 15658

Nigeria 15368

Serbia 13556

Sri Lanka 12996

Macedonia 11736

Kosovo 10533

Ghana 8842

Senegal 8542

Filippine 6662

Bosnia-Erzegovina 6631

Brasile 5512

Pakistan 5152

Tunisia 4755

Polonia 4488

Croazia 4448

Burkina Faso 2772

Rep. Dominicana 2610

Costa d'Avorio 2595

Romania 176582

Marocco 93862

Albania 92332

Egitto 85887

Cina Rep. Popolare 69112

Filippine 58408

Ucraina 54295

India 47409

Perù 42882

Pakistan 40280

Ecuador 36694

Senegal 33983

Sri Lanka 33117

Bangladesh 22254

Moldova 21335

Tunisia 17036

Nigeria 16113

Brasile 14310

El Salvador 12870

Ghana 10909

Bolivia 10383

Bulgaria 10046

Costa d'Avorio 9394

Kosovo 8400

Russia Federazione 8339

Lombardia 31/12/2018Veneto 31/12/2018

HCV

AmbitoCase

series

Clinical,

multicentrico

Survey/

prevalenza

Archivi/

registriTOT

Profilo salute / accesso 7 (2) 12 (4) 12 31

Fattori di rischio CV 11 11

Diabete, malattie CV 3 3 4 (1) 11 21

Screening / HPV 1 1 10 4 16

Tumori 1 3 4

J Cardiovasc Med (Hagerstown). 2014 Sep;15(9):683-92.

Cardiovascular health in migrants: current status and issues for prevention. A collaborative multidisciplinary task force report.

Int J Cardiol. 2018 Mar 1;254:353-355.

Foreword by the Guest Editors of the new section of the IJC, "Migration and cardiovascular disease".

The community of clinicians is increasingly interested in the health of immigrants

International Journal of Cardiology Call for Papers

Title: Effects of migration on the epidemiology and prevention of cardiovascular disease Chairs: Gui DeBacker (BE), Aldo Maggioni (IT)1) Impact of migration on cardiovascular disease - McKee M ( UK)2) Are there inequalities in the management of acute coronary syndromes among migrants compared to native patients ? - Maggioni AP (IT)Chapters and topics related to the section on the effects of migration on the prevention, diagnosis and treatment of cardiovascular disease

1. Policiesa. Ethnic inequalities in revascularization proceduresb. Migration related to health inequalities: complex interactions between socio-economic and cultural factors, place of origin, assimilation and health literacy.c. Socio-economic inequalities in diagnosis and treatment of acute coronary events among migrant groups compared to native patients.

2. Methodologya. Definition and categorization of different groups of migrantsb. Distinction between refugee and non-refugee immigrants.c. Methodological issues related to the examination of the effects and interactions of economic, cultural, educational and psychosocial factors on cardiovascular disease risk and incidence.

3. Health promotion/ health educationa. Association between assimilation and health literacy with CVD risk factors among migrantsb. How to prevent an increase in CVD risk among immigrants

4. Epidemiology/Preventiona. Large-scale epidemiological studies that characterize and explain the burden of CVD across countries, regions and neighborhoods.b. Large-scale multi-marker studies using biological, behavioral and environmental factors to better define phenotypes and risk stratification

among patients with CVD across geographical settingsc. Differences in presentation and treatment of migrants versus native patients with cardiac diseasesd. Rates of obesity, metabolic syndrome, pre-diabetes and diabetes among migrantse. Adult cardiometabolic health among migrantsf. Risk of Ischemic Heart Disease and Stroke Among migrant Populationsg. Prognosis after acute coronary events and congestive heart failure by country of birth

5. Gender differencesa. Gender differences in CVD risk and incidence among migrant populations compared to native communities

Epidemiol Prev. 2017 May-Aug;41(3-4 (Suppl 1)):26-32.

[Overweight and obesity among adult immigrant populations resident in Italy].

Int J Hypertens. 2017;2017:6402085.

Prevalence, Awareness, Treatment, and Control of Hypertension among Chinese First-Generation Migrants and Italians in Prato, Italy: The CHIP Study.

Epidemiol Prev. 2019 Mar-Jun;43(2-3):144-151.

[Lifestyles and alterations of finger-stick glucose and cholesterol and blood pressure among fifty-year-old Italian and foreign residents in the Alto Vicentino Health District (Veneto Region, Northern Italy)].

The epidemiology of chronic diseases across immigrants group (partly) mirrors

the epidemic of non-communicable diseases in low-middle income countries

Diverging patterns of cardiovascular diseasesacross immigrant groups in Northern Italy. Int J Cardiol. 2018 Mar 1;254:362-367.

Heart. 2019 Aug;105(15):1168-1174. doi: 10.1136/heartjnl-2018-314436.Cardiovascular risk factors and disease among non-European immigrants living in Catalonia.

J Cardiovasc Med (Hagerstown). 2016 Feb;17(2):105-12.

Heart surgery for immigrants in Italy: burden of cardiovascular disease, adherence to treatment and outcomes.

Major causes of heart disease were rheumatic heart disease (RHD) (n = 64, 41%), nonrheumatic valvulopathies (n = 41, 27%), ischemic heart disease (IHD) (n = 25, 16%), congenital heart disease (n = 13, 9%) and miscellaneous (n = 11, 7%).

Pediatr Rheumatol Online J. 2019 Apr 2;17(1):12.

Screening of asymptomatic rheumatic heart disease among refugee/ migrant children and youths in Italy.

Six hundred fifty-three individuals (13-26 years old) were screened….for a total of 17 'definite RHD', yielding a final prevalence of 26.0‰ (95% CI 16.2-41.5‰) (17/653)

http://rhdaction.org/atlas/People living with RHD (2016)

Screening

Epidemiol Prev. 2019 Jan-Feb;43(1):35-47 [The inappropriateness in the use of female cancer screening tests in Italy: over- and under-utilization determinants]BMJ Open. 2018 Sep 19;8(9):e021653. Geographical and socioeconomic differences in uptake of Pap test and mammography in Italy: results from the National Health Interview Survey.BMJ Open. 2017 Oct 15;7(10):e016306. Cervical and breast cancer screening participation and utilisation of maternal health services: a cross-sectional study among immigrant women in Southern Italy.Health Policy. 2017 Oct;121(10):1072-1078. Inequalities in cervical cancer screening utilisation and results: A comparison between Italian natives and immigrants from disadvantaged countries.Int J Gynaecol Obstet. 2017 Mar;136(3):309-314. Uptake of cervical cancer screening among the migrant population of Prato Province, Italy.Epidemiol Prev. 2015 May-Jun;39(3 Suppl 1):9-18. Cancer screening uptake: association with individual characteristics, geographic distribution, and time trends in Italy.Prev Med. 2015 Dec;81:132-7. Colorectal cancer screening of immigrants to Italy. Figures from the 2013 National Survey.Eur J Cancer Prev. 2016 Jul;25(4):321-8. Cervical cancer screening in immigrant women in Italy: a survey on participation, cytology and histology results.Infect Agent Cancer. 2015 May 7;10:14. HPV prevalence and risk of pre-cancer and cancer in regular immigrants in Italy: results from HPV DNA test-based screening pilot programs.J Immigr Minor Health. 2015 Jun;17(3):670-8. Participation and risk of high grade cytological lesions among immigrants and Italian-born women in an organized cervical cancer screening program in Central Italy.Epidemiol Prev. 2012 Mar-Apr;36(2):95-9. [Immigration from countries with a strong migratory pressure and participation in cervical cancer screening program in the Local Health Unit 2, Umbria Region. Impact on the probability of high-grade lesions and cervical cancer].

APPARTENENTI A: AZIENDA

ZERO REGIONEAZIENDE ULSSUNIVERSITA’

ESPERTI

Causes of mortality across different immigrant groups in Northeastern ItalyPeerJ. 2015 May 21;3:e975

AmbitoCase

series

Clinical,

multicentrico

Survey/

prevalenza

Archivi/

registriAltro TOT

Materna-perinatale 3 3 13 9 28

Emoglobinopatie 9 9

Bambini-adolescenti 16 3 1 20

Salute mentale 10 1 10 (3) 6 1 28

Allergie / pat. Respirat 3 1 4 8

Medicina del lavoro 1 10 6 17

Violenza 2 (1) 2 (1) 1 5

Varie 5 1 5 3 14

J Immigr Minor Health. 2018 Apr;20(2):263-270. Prevalence and Correlates of Psychological Distress and Psychiatric Disorders in Asylum Seekers and Refugees Resettled in an Italian Catchment Area.

Confl Health. 2017 Jan 13;11:1. Mental health and trauma in asylum seekers landing in Sicily in 2015: a descriptive study of neglected invisible wounds.

Materno-infantile

Gynecol Endocrinol. 2011 Jun;27(6):379-83.Pregnancy outcome in immigrant women with gestational diabetes mellitus.

Minerva Ginecol. 2010 Aug;62(4):277-85.[Outcome of pregnancy for immigrant women: a retrospective study].

Int J Endocrinol. 2012;2012:784726. Quality of Life, Wishes, and Needs in Women with Gestational Diabetes: Italian DAWN Pregnancy Study.

Patologie sempre sotto i riflettori: TB

Vecchi ambiti, nuovi interessi: parassitosi

«Storie di successo» della ricerca epidemiologica: screening, medicina del lavoro

Capitoli emergenti: fattori di rischio e malattie CV

Patologie «dimenticate»: cardiopatie reumatiche…..

Partire dalla struttura della popolazione immigrata (paese di provenienza, età, sesso) e dalla sua storia migratoria (percorso, tempo di permanenza)

Investire in global health: raccogliere informazioni (GBD ed atlanti possono non bastare). Identificare priorità per la ricerca. Formazione del personale sanitario

Rete con chi vede i pazienti e può riconoscere patologie emergenti

Imparare dagli altri Paesi, quelli con una lunga tradizione di ricerca (Nord Europa) ma anche quelli con storia simile di movimenti migratori (es. Spagna)