Il Libro Bianco del Diabete in Basilicata. 1° Report 2013

The Basilicata Region was analyzed and compared to the Italian context and to the national benchmarks in terms of demographic situation, epidemiology and burden of diabetes mellitus, exposure to major risk factors and volume and cost of inpatient and outpatient services provided to citizens of the region for the same pathology. The demographic situation has been described as the analysis of the population structure and its evolution over time is of vital importance for the design and programming of health and social services. For the same purpose, a definition of the burden of diabetes mellitus in the Basilicata Region has been conducted. Exposure to almost all major risk factors can be modified by health policies and the “empowerment” of the population (a process of social action through which communities develop competence over their lives, in order to improve equity and quality of life). Knowing the distribution of exposure to these risk factors in the population is therefore essential to the planning of such policies and the identification of the primary objectives. In order to identify those objectives, body weight distribution, physical activity habits, dietary patterns, and high blood pressure incidence in the Basilicata region resident population were analyzed. The number of hospitalizations for diabetes and the use of outpatient and day hospital services were analyzed as they may be indicative of the appropriateness of care provided, which is inevitably reflected on the public spending. Only the most recent data available were used. All data come from institutional sources (Italian National Institute of Statistics - ISTAT; Health for All Database; Basilicata region databases). The Basilicata Region has a population of 577,562 inhabitants (0.97% of the entire Italian population). The population is declining (-3.3 percentage points from 2002). The male/female ratio is 0.96; women predominate especially among the older age groups. The population is aging significantly. Aging is mainly due to the very low birth rate: in Basilicata, a birth rate of 1.70 (Italy: 2.14) and a mortality rate of 2.24 (Italy: 2.34) were observed in 2011. The aging index (the number of persons 65 years old or over per hundred persons under the age of 15) in Basilicata is 154.2 (Italy: 148.6). The two provinces are quite different from the point of view of the distribution of residents in urban centers. Sixty-five percent of the population lives in the province of Potenza, where only 39.4% of the population lives in the 7 municipalities with more than 10,000 inhabitants. The rest of the population of the Potenza province lives in 93 towns, mostly very small (less than 2,000 inhabitants). Instead, in the province of Matera 57.8% of the population lives in the 5 municipalities with more than 10,000 inhabitants and the rest of the population is divided among 26 other municipalities. The prevalence of diabetes mellitus in the Basilicata Region has been increasing in the recent years and was estimated at 6.9% in 2012 (Italy: 5.5%). In Italy, the region with the lowest prevalence of diabetes is the autonomous province of Bolzano (3.2%), while the region with the highest prevalence is the Abruzzo region (7.4%). The standardized mortality rate for diabetes in the Basilicata Region in 2009 (most recent data) amounted to 35.6 per 100,000 for males (Italy: 33.5) and 38.3 per 100,000 for females (Italy: 39.2). The standardized mortality rate increases with age: in patients over 65 is equal to 163.7 per 100,000 for males (Italy: 155.6) and 252.3 per 100,000 for females (Italy: 256.5). There were no deaths due to diabetes in the age group 0-34 in 2009. With regard to risk factors, 49.2% of the Basilicata population is in excess of bodyweight (Italy: 45.8%; benchmark - autonomous province of Bolzano: 39.8%) and 13.1% of the population is obese (Italy: 10.0%; benchmark - autonomous province of Bolzano: 6.4%).