Forecasting access to health services of immigrant and Italian population: an analysis of proxy indicators in the 2001-2008 time period. [Comunicazione breve]

Background Immigrant population has different access to health services in comparison to natives. This study is a time series analysis of hospitalization rates of immigrant and Italian populations and is aimed to support health planning and interventions. Methods An ecological study was performed from 2001 to 2008. Hospitalization rates for myocardial infarction, stroke, chronic hepatitis/cirrhosis, cervical cancer and mastectomy were chosen as a proxy of lifestyles and access to primary health care. Hospitalizations were requested to the Italian Ministry of Health according to ICD 9 codes. Population at risk was drawn from the National Institute for Statistics and crude hospitalization rates per 100,000 were calculated. Citizenship was used to distinguish immigrants from Italians. Time series analysis was performed with joinpoint regression and ARIMA models. By the first approach an estimate of the Average Annual Percent Change (AAPC) was obtained and significant changes in trend were identified. By the second approach a projection to 2020 was acquired.Results The projection showed a decline in hospitalization rates for myocardial infarction, stroke and chronic hepatitis/cirrhosis in the Italian population being these rates stationary in immigrants. On the contrary, hospitalization rates for cervical cancer were foreseen to remain stable in both groups. With respect to hospitalization for mastectomy, an increase was forecasted for the Italian population. The joinpoint analysis supported ARIMA results and allowed identifying significant changes in time trend for myocardial infarction, chronic hepatitis/cirrhosis and cervical cancer in both groups as well as differences in AAPCs. With this regard, a significant reduction in hospitalization rates for stroke (AAPC -1.4%, 95%CI -1.8; - 1.1) and a significant increase in mastectomy (AAPC 1.2%, 95%CI 0.8; 1.5) were observed in the Italian population only. Conclusions The two methods are complementary for time series analysis and showed a general reduction of hospitalization rates of Italians in comparison to a steady state in immigrants. This may suggest that Italian population has better access to primary care as well as healthier lifestyles and that tailored interventions are needed to control inequalities. Key messages Immigrant population show differences in the admission to hospital which may be considered an effect of inequalities in lifestyles and primary care access and which are estimated to last in time. Time series analysis may allow identifying significant trends in the access to health services and forecasting health demand.