The role of citizenship in the acceptance and completion of COVID-19 vaccine cycle in the resident population with foreign citizenship registered with the Umbrian Health Care System - An analysis of regional data.

Introduction: Non-italian citizens experienced less access to anti-COVID-19 vaccination, compared to the native population. Literature has found differences in adherence to anti-COVID-19 vaccination among these groups; however, there are apparently no studies that investigated the role of citizenship. Our objective was to investigate the role of citizenship in vaccine hesitancy toward anti-COVID-19 vaccination and the completion of vaccine cycle, in the non-Italian citizens resident in the Umbria Region. Study design: This is a population study, performed on resident population in Umbria. Methods: Population data were obtained thanks to a record linkage between the Regional Health Information System and the regional DBCOVID Umbria database. On this dataset, a descriptive and logistic regression analyses were performed. Results: The 19.2% of non-Italian citizens did not take even one dose, 2.1% did not complete it and 40.6% did not take the additional dose. The range of values of which these results are an average, however, is very wide, suggesting important differences in COVID-19 vaccine up taking, among different citizenships. The logistic regression shows that citizenships with the highest probability of non-adherence to vaccination, compared to Philippine, was Romanian (OR=7.8), followed by Macedonian (OR=7.3) and Polish (OR=5.9). Conclusions: The study provides evidence of differences among citizenships that pinpoint the importance of understanding the reasons behind these behaviours, to support decisions around health policies tailored to each citizenship.

[Can citizenship help analyze the risk of underimmunization in the foreign population?] / La cittadinanza può aiutare ad analizzare il rischio di sottoimmunizzazione nella popolazione straniera?

There is emerging evidence of distrustful attitudes towards vaccination of some sub-populations of migrants in Europe, that are at higher risk for under-immunisation. The Covid-19 pandemic has highlighted health disparities also at a national level: lower levels of Covid-19 vaccine uptake in immigrants' population compared with Italian citizens and a substantial heterogeneity in the first-dose vaccine coverage within immigrants' population have been documented. According to immigrants' citizenship, high coverages were observed in subjects from Southeast Asia and from South-Central America while Eastern Europeans showed the lowest coverages. These data suggest that taking into account immigrants' citizenship can help define appropriate strategies in order to promote a personalized approach to health problems and to strengthen vaccination uptake.

COVID-19 Vaccination Actual Uptake and Potential Inequalities Due to Socio-Demographic Characteristics: A Population-Based Study in the Umbria Region, Italy.

Socio-demographic factors are responsible for health inequalities also in vaccination. The aim of this study was to evaluate their role at the population level through a population-based study performed on the whole population entitled to receive COVID-19 vaccines in the Umbria Region, Italy, and registered to the Regional Healthcare Service as of 28 February 2021. Socio-demographic characteristics and vaccination status in terms of uptake of at least one dose of any available vaccine, completion of the primary vaccination cycle and uptake of the booster doses as of 28 February 2022 were collected from the Umbria regional database. The percentage of eligible population who did not initiate the COVID-19 vaccination, complete the full vaccination cycle and get the booster dose was 11.8%, 1.2% and 21.5%, respectively. A younger age, being a non-Italian citizen, and not holding an exemption for chronic disease/disability and a GP/FP were associated with all the endpoints. Females, as compared to males, were more likely to not initiate the vaccination but less likely to not receive the booster dose. On the contrary, the findings did not show a significant association between the deprivation index and the vaccine uptake. The findings, beyond confirming current knowledge at the population level, provide new inputs for better tailoring vaccination campaigns.

Socio-Economic Factors Associated with Ethnic Disparities in SARS-CoV-2 Infection and Hospitalization.

BACKGROUND: There is evidence that non-Italians presented higher incidence of infection and worse health outcomes if compared to native populations in the COVID-19 pandemic. The aim of the study was to compare Italian- and non-Italian-born health outcomes, accounting for socio-economic levels. METHODS: We analyzed data relative to 906,463 people in Umbria (Italy) from 21 February 2020 to 31 May 2021. We considered the National Deprivation Index, the Urban-Rural Municipalities Index and the Human Development Index (HDI) of the country of birth. We used a multilevel logistic regression model to explore the influence of these factors on SARS-CoV-2 infection and hospitalization rates. Diagnosis in the 48 h preceding admission was an indicator of late diagnosis among hospitalized cases. RESULTS: Overall, 54,448 persons tested positive (6%), and 9.7% of them were hospitalized. The risk of hospital admission was higher among non-Italians and was inversely related to the HDI of the country of birth. A diagnosis within 48 h before hospitalization was more frequent among non-Italians and correlated to the HDI level. CONCLUSIONS: COVID-19 had unequal health outcomes among the population in Umbria. Reduced access to primary care services in the non-Italian group could explain our findings. Policies on immigrants' access to primary healthcare need to be improved.

Determinants of COVID-19 vaccination acceptance or hesitancy in Italy: an overview of the current evidence.

INTRODUCTION: Vaccine hesitancy is a major public health issue and a challenge for the implementation of COVID-19 immunization campaigns. The objective of this study was to address the determinants of COVID-19 vaccination acceptance or hesitancy in the Italian population. MATERIALS AND METHODS: We conducted a rapid systematic review by searching PubMed until May 3rd, 2022, according to Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. Articles assessing determinants of Italians' attitudes towards COVID-19 vaccination in terms of hesitancy and/or acceptance were considered eligible. Quality and risk of bias assessment was performed through the Newcastle Ottawa Scale appraisal tool. Determinants were grouped in three categories: contextual, individual and group, and vaccine/vaccination specific influences. RESULTS: Out of 606 articles, 59 studies were included in the analysis. Included studies demonstrated that, in Italy, COVID-19 vaccination acceptance or hesitancy is mostly influenced by perceived safety, efficacy and usefulness of the vaccine. CONCLUSION: These findings should be considered to plan tailored interventions for counteracting COVID-19 vaccination hesitancy in Italy.

Immediate reinfection with Omicron variant after clearance of a previous SARS-CoV-2 infection.

SARS-CoV-2 Omicron variant is spreading worldwide, causing unprecedented epidemic peaks due to its transmissibility and immune evasion. We searched in the archive of the Regional Microbiology Laboratory (Umbria, Italy) for immediate reinfection (i.e. infection occurring 25-60 days from primary infection) among 454,764 RT-PCR tests from 261,217 individuals. Lineage heterogeneity was assessed by S gene target failure phenomenon or whole genome sequencing. We found that BA.1 Omicron variant may cause immediate reinfection of patients just recovered from Delta infection. Immediate reinfection was not observed for any other combination of variants, including Delta over Alpha variant and BA.2 over BA.1 Omicron lineage.

[Nutrition in Umbria: adherence to five-a-day.] / Nutrizione in Umbria: l'adesione al five-a-day.

INTRODUCTION: Our study aim has been to investigate if the Umbrian population follows the healthy diet recommendations; mainly we focused on the daily intake of almost 5 portions of fruit and vegetables (five-a-day). Furthermore, we analyzed the relationship between fruits and vegetables consumption and other lifestyles in order to construct the relative health profile. MATERIALS AND METHODS: Data were extracted from three national population-based surveillance systems, including children (OKkio alla SALUTE), adults aged 18-69 years (PASSI) and elderly people (PASSI d'Argento). Among the 18-69 year-old people, multivariable analyses were used to compare the fruits/vegetables daily consumption with socio-demographic variables and healthy lifestyles patterns. RESULTS: Fruits/vegetables average intake was less than 5 portions/day in all age groups, and it was significantly lower when compared to the national average. The 5 fruits/vegetables daily portions consumption is more frequent with increasing age, higher education and among women. Moreover among the 18-69 year-old people, five-a-day was significantly associated with no economic difficulties, normal weight, not being sedentary, not being smoker, not alcohol drinking. CONCLUSIONS: In Umbria region the 5 portions/day consumption was largely below the guidelines. Moreover, due to the associations, it could be used as a good trace of healthy lifestyles.

Roll-your-own cigarette use in Italy: sales and consumer profile-data from PASSI surveillance, 2015-2016.

OBJECTIVES: The use of roll-your-own (RYO) cigarette has substantially increased in most high-income countries recently. This work aims to update Italian trends on loose tobacco sales and to describe the consumer profile of predominant RYO users. METHODS: Data from the Italian Agency of Customs and State Monopolies and from PASSI (Italian behavioral risk factor surveillance system) were used. Information on 16,858 interviews to current smokers aged 18-69 was analyzed. RESULTS: Sales of loose tobacco increased more than sevenfold between 2004 and 2017. In 2015-2016, 11.6% of smokers reported smoking predominantly RYO cigarettes, with higher percentages among the youngest where a significant association between use of RYO and education was observed, unlike what happened in older adults. The association between economic difficulties and use of RYO was observed only in older adults. CONCLUSIONS: A growing trend in RYO cigarette sales was registered between 2004 and 2017. In young smokers, the greater use of RYO was observed among the most educated regardless of financial strain, while in older ones among those with economic difficulties.

Cervical cancer screening in immigrant women in Italy: a survey on participation, cytology and histology results.

Cervical cancer screening programmes in Italy actively invite all 25-64-year-old resident women for the Pap test every 3 years irrespective of their citizenship. Immigrant women come from countries where screening is absent or poorly implemented and the prevalence of human papillomavirus is often high. These women therefore have significant risk factors for cervical cancer. The Italian Group for Cervical Cancer Screening promoted a survey of all the screening programmes on the participation and the positivity and detection rates in Italian and foreign women in 2009-2011. Aggregated data for participation, cytology results, compliance with colposcopy and histology results were collected, distinguishing between women born in Italy and abroad. All comparisons were age adjusted. Forty-eight programmes out of 120 participated in the immigrant survey, with 3 147 428 invited and 1 427 412 screened Italian women and 516 291 invited and 205 948 screened foreign women. Foreign women had a slightly lower participation rate compared with Italians (39.9 vs. 45.4%), whereas compliance with colposcopy was similar (90%). Foreigners showed a higher risk of pathological findings than Italians: cytology positivity [relative risk (RR)=1.25, 95% confidence interval (CI) 1.24-1.27] and detection rate for cervical intraepithelial neoplasia grade 2 (CIN2) (RR=1.39, 95% CI 1.31-1.47), CIN3 (RR=2.07, 95% CI 1.96-2.18) and cancer (RR=2.68, 95% CI 2.24-3.22). The ratio between cancer and CIN was higher in immigrants (0.06 vs. 0.04, P<0.01). Foreign women had a higher risk of cervical precancer and cancer. Because of their high risk and because opportunistic screening does not cover this often disadvantaged group, achieving high participation in screening programmes for foreigners is critical to further reducing the cervical cancer burden in Italy.

[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]. / Provenienza da Paesi a forte pressione migratoria e partecipazione allo screening citologico nell'AUSL2 dell'Umbria. Impatto sulla probabilità di presentare lesioni di alto grado e tumori del collo dell'utero.

OBJECTIVE: to measure the risk of having serious lesions and cervical cancer for immigrant women, by evaluating the impact of their lack of participation in the previous rounds. DESIGN: retrospective study. SOURCE OF DATA: archive of the screening programme of Local Health Unit 2, Umbria. People subjected to the study: those adhering to the last round (2008- 2010) and belonging to an age group potentially capable of participating in all the previous rounds (1999-2007). MAIN OUTCOME MEASURES: positivity to Pap test; lesions that require colposcopy (AGCH,AGCUS,ASCH, HSIL); tumours (squamous cell carcinomas and adenocarcinomas). RESULTS: 1.7% of the women were positive to the Pap test, 0.7% presented lesions with the immediate need for colposcopy, and 0.039% were diagnosed with cancer. The percentage of women who resulted either positive to the Pap test, or presenting lesions requiring colposcopy or with cancer, is significantly higher among those who come from poor countries. Furthermore, participation in previous rounds has proven to be protective with reference to the above-mentioned markers. CONCLUSION: the independent weight of several risk factors has emerged and consequently the need to promote with particular commitment the participation in screening of women coming from poor countries.

[Hospital admission in terminally ill cancer patients: a survey in the Umbrian Local Health Unit 2]. / Il ricovero ospedaliero nei pazienti oncologici in fase terminale: un'analisi nell'AUSL 2 dell'Umbria.

OBJECTIVE: describing, using administrative data, the extent and modalities of hospitalization in terminally ill cancer patients, residing in Local Health Unit (LHU) 2 of Umbria Region, Italy. DESIGN: retrospective cohort study based on current administrative data: Nominative Registry of Causes of Death (ReNCaM) and Hospital Discharge Records (HDR). SETTING AND PARTICIPANTS: residents in LHU 2 dead of cancer (ICD9-CM categories: 140-239) in 2004-2006 (N=3,122). MAIN OUTCOME MEASURES: percentage of patients hospitalized within thirty days before death, percentage of those admitted to hospital within 2 days before death, percentage of patients discharged once dead, percentage of those discharged alive on the day of death. We used a multivariate logistic analysis model to assess the role played by the variables on the available indicators. RESULTS: percentage of patients hospitalized within thirty days before death was 56.5% (N=1,764) percentage of those admitted to hospital within 2 days before death was 9.0% (N=281) percentage of those discharged alive on the day of death was 24.4% (N=763); percentage of discharged alive on the day of death was 6,1% (N=190). The age group 40-59 years and any residence other than the District of Assisi (the first with a palliative care network), are factors associated with increased hospitalization in the terminally ill.

[Prevalence of arterial hypertension treatment LHU 2 population in Umbria: a comparison between two data sources]. / La prevalenza degli ipertesi in trattamento nella AUSL 2 dell'Umbria: confronto tra due fonti di dati.

OBJECTIVE: verify the consistency of two independent sources of data concerning the prevalence of arterial hypertension under pharmacological treatment. DESIGN: the pharmacological prescriptions database (A) and the Studio PASSI (Italian behavioural risk factor survey) (B) were assessed. Data selection was carried out according with the presence of at least one prescription of antihypertensive drug during the year 2004 (A), the statement of being under treatment with antihypertensive drugs (B). Prevalence rates were calculated. SETTING: resident population registered in the list of Umbrian Local Health Unit 2 (LHU 2); age range: 18-69 years. PARTICIPANTS: A) the pharmacological prescriptions database: 43,146 subjects selected from the 2004 archive, B) Studio PASSI: representative random sample of 200 persons drawn out from the resident population registered in the 2005 record of the LHU2 list. MAIN OUTCOME MEASURES: prevalence rate for arterial hypertension with pharmacological treatment. RESULTS: both studies showed similar prevalence rates: A) pharmacological prescriptions database = 17.2% (95% CI 17.1-17.4) and B) PASSI = 15.0% (95% CI10.4-20.7). Age and gender distribution were also comparable. Moreover, the PASSI survey produced additional socio-economical information. CONCLUSION: the hypothesis that the pharmacological prescription database can be used to monitor in a simple, timely and reproducible way major health-related events was validated. Small size surveys - such as the PASSI study - may add further information to the analysis of large administrative databases and they may serve to periodically verify the consistency of these databases when assessed for epidemiological purposes.