Heart Diseases: More Deaths, Hospitalizations and Voyages of Hope in the South and Lifestyles at a Stalemate
Cardiovascular diseases, the leading cause of death in Italy too, are not yet under control due to the extreme differences in results between one area of the country and another. While overall mortality has dropped significantly by 70% over the last twenty years, the gap between the South and the North has instead increased, with the southern regions being at a disadvantage in terms of higher hospitalizations (except for strokes in 2020), deaths, health migration and lifestyles. The toll in terms of years of life lost, despite the overall improvement in outcomes over the last two decades, is heavy: diseases of the circulatory system - ischemic and cerebrovascular - still contribute to 20% in men and 16% in women of the total years lost by the population. Here too, the values remain higher in the South and the Islands.
The second report of the Working Group on equity and health in the Regions of the Istituto Superiore di Sanità paints the picture. "Regional variations - explains the president of the ISS Rocco Bellantone - depend on the prevalence of risk conditions, the heterogeneity of care models and the organizational resources present in the territory. I wanted this working group with the hope that the data can be very useful for developing strategies that can mitigate regional disparities in access to health care, by far the main problem of health care in our country".
A picture that shows at least two macro-geographic trends, starting with the prevention factor which is also the first determinant of heart health. The differences between the areas of the country become dramatic when looking at lifestyles, with data that "do not show any real improvement from 2008 to today" and a clear disadvantage of the South: except for the share of smokers decreased from 30% to 24%, all other indicators are increasing. In detail: sedentary lifestyle has increased from 23% to 28%, excess weight affects 43% of the population with 33% overweight and 10% obesity while the consumption of fruit and vegetables is worsening. Factors that - the ISS underlines - are directly proportional to social inequalities and therefore to the detriment of people with greater economic difficulties or low education.
Over the last twenty years, the standardized rate has gone from 903.70 per 100,000 inhabitants in 1980 to 266.28 in 2021, a reduction of 70%. The rate for men has dropped from 1,099.90 to 316.59 and for women from 783.82 to 228.65. In the North, the rate for men in 1980 was higher than the average, while for women it has always been lower than the national average. In men in the South, the values in 1980 were slightly lower than the average, while in 2021 they are higher (362.17), while women in the South have always had a mortality rate for diseases of the circulatory system higher than the average.
In men, the Italian rate of hospitalization for acute myocardial infarction decreased from 270.3 in 2010 to 208.3 in 2023, decreasing by approximately 20%, in women it went from a rate of 109.2 in 2010 to 71.5 in 2023 (-34%). In both sexes, the Southern Regions have the highest rates, especially in the last period. In 2023, the populations of Central Italy have the lowest rates (TSI 200.20 and TSI 66.40 for men and women), followed by the Northern Regions (TSI 206.88 and TSI 68.29), while in the South and Islands the standardized rate is 223.46 for men and 78.29 for women. In 2023, Valle d'Aosta has the highest standardized rate for both men and women; followed by Calabria and Liguria for men, Calabria, Friuli Venezia Giulia and Sicily for women.
The trend for stroke is "less clear and shows higher rates in the northern regions in the last period", however, the ISS underlines. Analyzing the standardized rates of the last year, the highest values are found in Liguria, in the Province of Bolzano and in Umbria.
The ISS is examining regional mobility for two cardiovascular interventions: coronary artery bypass grafting and heart valves. For the bypass, the analysis of mobility by territorial macro-areas "shows low levels in the North of the country with a substantially stable trend at values around 6%". For the Central Regions, "trips" increase starting from 2012 up to a peak in 2016 and then decrease. In the South, including the Islands, mobility levels are always higher than in the North.
Molise, Calabria and Basilicata for the South and Liguria and Trentino Alto Adige for the North show particularly high mobility. But Calabria has recorded rates much higher than the national average: over the twenty years considered by the survey - which takes into account the Passi and Passi d'Argento surveillance systems, the Italian Health Examination Survey of the ISS's Cuore Project, the hospital discharge forms (Sdo) of the Ministry of Health and Istat mortality data - the trend of this region is decreasing until 2019 (from 31.9% in 2010 to 14.6% in 2019) and then rises again with the pandemic and reaches 29.5% in 2023.
As for interventions on heart valves, the ISS reports, the Northern Regions show much lower levels than the national average in all years, with values between 9 and 10%. On the contrary, those in the South always show levels of the escape index much higher than the national average with a peak that reached 27% in 2014 and a reduction in the following years to reach the levels of previous years in the post-pandemic years.
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