Disparities in access to breast, colorectal, and cervical cancer screening programmes have intensified during the pandemic period. Findings of a health equity audit conducted by the Pavia Healthcare Protection Agency (Lombardy Region, Northern Italy)

OBJECTIVES: to evaluate the disparities in access to cancer screening programmes in the Province of Pavia (Lombardy Region, Northern Italy), along with identifying the factors influencing these disparities; to assess the impact of the pandemic emergency on invitation and screening coverage in the three organized screening programmes, which are provided free of charge to the target population. DESIGN: observational retrospective study covering both the pre-pandemic and the pandemic periods. SETTING AND PARTICIPANTS: for breast cancer screening, the eligible population comprises women aged 45 to 74; colorectal cancer screening is offered to men and women aged 50 to 74; cervical cancer screening is tailored based on women age. The management of all three screening programmes is overseen by the Health Protection Agency of Pavia, which proactively invites the eligible population through invitation letters. MAIN OUTCOMES MEASURES: for each screening programme, the examination coverage (the number of screened individuals out of the total eligible population) was analysed considering its influencing factors, with a specific emphasis on equity-related factors such as demographics (sex, age), geographic factors (country and continent of birth, residential district), comorbidities. RESULTS: the SARS-CoV-2 pandemic has led to a reorganization of healthcare services and to a reduction of the offer, resulting in an overall reduction in test coverage for all three programmes (-16.3% for breast and colorectal cancer screening, -8.5% for cervical cancer screening). The disparities in coverage among various population groups, reflecting inequalities in access, further escalated from the pre-pandemic to the pandemic period. Noteworthy, equity-related predictors of reduced screening access were non-Italian nationality and residency in rural or mountainous districts. CONCLUSIONS: during periods of healthcare system strain, such as the pandemic, disparities in access can become more pronounced. It is crucial to implement measures for enhancing access to screening in a more equitable manner.

Population-based breast cancer screening in Pavia (northern Italy) in 2016-2018: Key performance indicators and sensitivity estimate.

BACKGROUND AND AIM: This study aims to assess the quality of the population-based breast cancer screening programme in Pavia, northern Italy computing its key performance indicators and estimating its sensitivity for the years 2016-2018. METHODS: Invitation and examination coverage, participation rate, recall rate, detection rate and positive predictive values were computed on the basis of data provided yearly to the Italian Ministry of Health. Sensitivity was estimated identifying interval cancers in the local Cancer Registry and computed with the proportional incidence method. RESULTS: In 2016-2018 the adjusted invitation coverage was 90%, and the adjusted participation rate was 62%. Recall rate was 8.4% for first screenings and 3.9% for subsequent ones. The number of screen-detected cases was 268, corresponding to a detection rate of 6.6‰ for first screenings and 4.6‰ for subsequent screenings. The number of interval cancers observed was 110 over the study period; the proportional incidence was 22% for the first interval year and 50% for the second interval. The overall sensitivity of the screening program was 64%. CONCLUSIONS: The analysis of performance indicators and sensitivity estimates for the Pavia programme indicates that the programme performance is in line with the quality standards set by the European Union and the Italian reference scientific society (GISMa).

The Effect of COVID-19 Pandemic on Overall and Cause-Specific Mortality in Pavia, Northern Italy: Updated Estimates for the Year 2021.

Excess mortality estimates are considered relevant indicators of direct and indirect pandemic effects on the population. Scant data have been published on cause-specific excess mortality. Using individual-level administrative data covering the Pavia province of Italian northern Lombardy region, we provided all-cause and cause-specific raw (RMR) and age-standardized (ASMR) mortality rates in 2021 and 2015-2019, the rate ratio, and 95% confidence intervals, overall and by sex. We obtained the excess deaths in 2021 as the difference between the number of observed and expected deaths from all causes and the two leading causes of death (all neoplasms and circulatory system diseases) by fitting over-dispersed quasi-Poisson regression models, accounting for temporal, seasonal and demographic changes. The total ASMR in 2021 was 972.4/100,000 (6836 certified deaths), with the highest ASMRs for circulatory system diseases (272.6/100,000) and all neoplasms (270.3/100,000), followed by COVID-19 (94.8/100,000 and 662 deaths). Compared to the expected, we estimated a total of 6.2% excess deaths in 2021 (7.2% in males and 5.4% in females), with no excess deaths from all neoplasms and a 6.2% reduction from circulatory system diseases. COVID-19 continued to affect total mortality in 2021, albeit to a lesser extent than in 2020, consistently with national patterns.

Asthma, COPD, Respiratory, and Allergic Health Effects in an Adult Population Living near an Italian Refinery: A Cross-Sectional Study.

BACKGROUND AND AIM: Asthma and chronic obstructive pulmonary disease (COPD) are leading causes of morbidity and mortality worldwide. Globally, 545 million people suffer from chronic respiratory diseases with a wide geographical variability. Risk factors for asthma are both genetic and related to several environmental factors (internal and external pollutants); these also have an important role in the occurrence of COPD. The aim of this study was to describe the prevalence of asthma, COPD, and asthma/COPD overlap (ACO) in an adult population living in two municipalities located in the Po Valley. METHODS: A standardized questionnaire on respiratory symptoms and sociodemographic characteristics was self-administered to a random sample of the adult population aged 20-64 years, living near a refinery in Northern Italy during the period between 2016 and 2019. Logistic and multinomial regression were implemented to explore factors associated with asthma, COPD, and ACO. RESULTS: In total, 1108 subjects filled out the questionnaire, the mean age was 48.02 ± 12.34 years (range 21-68), and 53% of the respondents/participants were female. Half of the responders were non-smokers, but the frequency of current and former smokers was significantly greater in men than in women (p < 0.001). The likelihood of being a probable case of asthma decreased with increasing age and increased for smokers. Tobacco smoke was associated with the presence of COPD and ACO. CONCLUSION: Respiratory diseases such as asthma and COPD are common in the general population, with differences among countries worldwide. Our findings show, on the basis of the main confirmed risk factor, namely smoking, that it is useful to plan target programs and actions in order to reduce smoking, thus improving the quality of life in public health.

Impact of the COVID-19 Pandemic on Total and Cause-Specific Mortality in Pavia, Northern Italy.

The COVID-19 pandemic had an unfavorable impact on overall mortality in Italy, with the strongest consequences in northern Italy. Scant data are available on cause-specific mortality. This study aims at investigating the impact of the pandemic on the overall and cause-specific mortality in one province in northern Italy, Pavia. We linked individual-level administrative data (i.e., death certification and population data) from the Health Protection Agency (HPA) in Pavia province between 2015 and 2020. We computed age-standardized mortality rates (Italian population 2011) by cause, sex, and calendar year, and computed the rate ratio and the corresponding 95% confidence intervals to compare rates in 2020 versus 2015-2019. The 2020 excess total mortality in Pavia was 24% in men and 25% in women, reaching rates of 1272.6/100,000 and 1304.4/100,000, respectively. Significant excesses were found for infectious and parasitic diseases, excluding COVID-19 (about +30% in both sexes); respiratory system diseases (44% in men; 30% in women); and dementia and Alzheimer's disease among men (24%). Reductions were reported for neoplasms (-14% in men); cerebrovascular diseases (-25% in men); and ischemic diseases (-13% in women), but also for transport accidents in men. COVID-19 was the third cause of death in both sexes with rates of 274.9/100,000 men (859 total deaths) and 213.9/100,000 women (758 total deaths). Excess mortality in Pavia was higher than Italy but lower than Lombardy. Increases in mortality from causes related to infectious and respiratory diseases can likely be explained by underdiagnosed deaths from COVID-19.

A methodology for the extraction of quantitative risk indexes from medical injuries compensation claims.

The prevention of adverse events and medical injuries due to malpractice or suboptimal delivery of health care services is one of the major concerns of citizens and Health Care Organizations. One way to understand adverse events is to analyze the compensation requests for medical injuries that are claimed to hospital or health care services. In this paper we describe the results obtained by applying a probabilistic model, called the actuarial model, to analyze 317 cases of injuries with compensation requests collected from 1999 to the first semester of 2007 by the Azienda Ospedaliera (A.O.) of Lodi, in the Northern part of Italy. The approach, adapted from operational and financial risk management, proved to be useful to understand the risk structure in terms of frequency, severity, expected and unexpected loss related to adverse events.