Maternal childbirth-related mortality in the last 40 years in Turin, Italy: the impact of universal health coverage on inequalities in a developed country.

The aim of this study was to investigate social disparities in childbirth-related mortality in women (CRM) in Italy during 1972-2013, a period characterised by important changes in the organisation of healthcare services. The relationship between education and CRM was assessed using a Poisson regression model adjusted for age, area of birth and year of delivery.The risk of dying from childbirth related causes was more than double for less educated women when compared to women with better education (RR 2.3; 95% CI 1.1-3.9). CMR was almost 2.5 times higher in 1971-1979 than in the universalistic coverage period (1980-2013): RR 2.6, 95% CI 1.4-4.6. CMR in Turin has decreased in the last 40 years and this success is probably the result of the development of our public health system and of specific health facilities for pregnant women but free access to maternal care alone is not sufficient to erase inequalities.IMPACT STATEMENTWhat do we already know? Mother mortality due to childbirth-related causes has significantly decreased in the last 40 years and the development of the public health system is likely to have contributed to this success.What do the results of this study add? This study shows that, although there has been good progress in pregnancy and partum assistance, inequalities in the incidence of mortality from childbirth-related causes still exists even in a high-income country such as Italy.What are the implications of these findings for clinical practice and/or further research? The results are useful both for clinicians and for policy-makers as it suggests that the assessment of socioeconomic factors should be taken into account by clinicians along with other risk factors. Furthermore, community interventions targeted at more vulnerable women should be implemented to improve the use of healthcare and pre-partum facilities.

[Evaluating health care of the immigrant population in Italy through indicators of a national monitoring system]. / Valutazione dell'assistenza sanitaria della popolazione immigrata in Italia attraverso alcuni indicatori di un sistema nazionale di monitoraggio.

OBJECTIVES: to evaluate maternal and child healthcare, avoidable hospitalisation, access to emergency services among immigrants in Italy. DESIGN: cross sectional study of some health and health care indicators among Italian and foreign population residing in Italy in 2016-2017. SETTING AND PARTICIPANTS: indicators based on the national monitoring system coordinated by the Italian National Institute for Health, Migration and Poverty (INMP) of Rome, calculated on perinatal care (CedAP), hospital discharge (SDO), emergency services (EMUR) archives for the years 2016-2017, by of the following regions: Piedmont, Trento, Bolzano, Emilia-Romagna, Tuscany, Umbria, Lazio, Basilicata, Sicily. MAIN OUTCOME MEASURES: number and timeliness of pregnancy visits, number of ultrasounds, invasive prenatal investigations; perinatal mortality rates, birth weight, Apgar score at 5 minutes, need for neonatal resuscitation; standardized rates of avoidable hospitalisation and access to emergency services by triage code. RESULTS: more often than Italians, immigrant women have during pregnancy: less than 5 gynaecological examination (16.3% vs 8.5%), first examination after the 12th week of gestational age (12.5% vs 3.8%), less than 2 ultrasounds (3.8% vs 1.0%). Higher perinatal mortality rates among immigrants compared to Italians (3.6 vs 2.3 x1,000). Higher standardized rates (x1,000) among immigrants compared to Italians of avoidable hospitalisation (men: 2.1 vs 1.4; women: 0.9 vs 0.7) and of white triage codes in emergency (men: 62.0 vs 32.7; women: 52.9 vs 31.4). CONCLUSIONS: study findings show differences in access and outcomes of healthcare between Italians and immigrants. National monitoring system of indicators, coordinated by INMP, represents a useful tool for healthcare intervention policies aimed to health equity.

[Inequalities in prenatal care and pregnancy outcomes in Piedmont Region (Northern Italy)]. / Le disuguaglianze sociali nel percorso nascita in Piemonte.

OBJECTIVES: to evaluate the impact on prenatal/perinatal care and pregnancy outcomes of the main social determinants (education, professional status and citizenship), with the aim of identifying the areas of care and the subgroups of women who are most at risk as priority targets of interventions for the reduction of inequalities; to evaluate the impact of the pregnancy Agenda on the appropriateness of care. DESIGN: cross-sectional observational study. SETTINGS AND PARTICIPANTS: the childbirth assistance certificates (CedAP) related to childbirths occurred in the Piedmont region in the years 2010-2018 were analysed. MAIN OUTCOMES MEASURES: for each indicator of prenatal and perinatal care, multiple Poisson regression models were performed to estimate the prevalence ratios for the social determinants, adjusted for maternal age, parity, year of birth, and area of residence/maternity ward. RESULTS: the observed deliveries were 274,086 and the newborns were 278,473, with a 25% reduction over time. Among pregnant women, there has been an increase in schooling, a reduction in employed women, and a stabilization of the percentage of immigrant women from countries with strong migratory pressure. Foreigners and inactive women show greater risks of poor prenatal care and less adherence to screening; education has greater impact on pregnancy outcomes. The trend towards greater adherence to the guidelines appears to be related to the introduction of the pregnancy Agenda, in turn associated with a greater use of public health services. CONCLUSIONS: social inequalities persist in prenatal/perinatal care and pregnancy outcomes. The results of this study support the hypothesis that offering quality and low-threshold services, such as family health centres, could be a first effective measure to tackle inequalities.

[Prevalence of acid burns among asylum seekers hosted in an initial reception centre as an example of health assessment in a fragile population]. / La prevalenza di causticazioni in un centro di prima accoglienza per richiedenti asilo come esempio di valutazione sanitaria in una popolazione fragile.

OBJECTIVES: to evaluate the prevalence of acid burns among asylum seekers hosted in an initial reception centre and to evaluate if the prevalence is reduced after the introduction of the European Union (EU) regulation No. 29 (14th September 2016) that indirectly reduced the permanence time of the subjects on board of boats. DESIGN: cross-sectional study. SETTING AND PARTICIPANTS: 10,627 asylum seekers hosted in the centre for initial reception of Piedmont and Valle d'Aosta Regions (Northern Italy) between June 2016 and May 2017. MAIN OUTCOME MEASURES: frequencies of health problems and prevalence of second and third grade acid burns identified on arrival. RESULTS: among the asylum seekers coming to the centre, about 25% suffered at least from a mild disease, mainly cutaneous, respiratory, or digestive; 69 acid burns were identified (prevalence: 6.7‰, 95%CI 5.2-8.3), mainly located in the lower limbs and in the glutes. Median time between disembarkation and treatment is 2 days. Prevalence is significantly higher in women compared to men and a not-significant 20% reduction was observed comparing the situation before and after the introduction of the EU regulation No. 29. CONCLUSION: an assessment of the health status of asylum seekers that takes into account more than the identification of the rare life-threatening or infective diseases allows to take prompt action and to invest economical resources in the fields where they are more useful. This would facilitate a good health care for asylum seekers, that is the basis of an efficient functioning of services for integration.