Open Access Open Badges Research article

Prevalence of chronic diseases by immigrant status and disparities in chronic disease management in immigrants: a population-based cohort study, Valore Project

Alessandra Buja1*, Rosa Gini2, Modesta Visca3, Gianfranco Damiani4, Bruno Federico5, Paolo Francesconi2, Daniele Donato6, Alessandro Marini7, Andrea Donatini8, Salvatore Brugaletta9, Vincenzo Baldo1, Mariadonata Bellentani3 and Valore Project

Author Affiliations

1 Department of Molecular Medicine, Laboratory for Public Health and Population Studies, University of Padova, Via Loredan 18, Padova 35128, Italy

2 Agenzia regionale di sanità della Toscana, Florence, Italy

3 Agenas, Agenzia Nazionale per i Servizi Sanitari, Rome, Italy

4 Facoltà di Medicina, Università Cattolica Sacro Cuore di Roma, Rome, Italy

5 Facoltà di Scienze Motorie, Università degli studi di Cassino, Cassino, Italy

6 ULSS 16 Padova, Regione Veneto, Padova, Italy

7 Zona Territoriale Senigallia, Regione Marche, Ancona, Italy

8 Regione Emilia Romagna, Bologna, Italy

9 ASP 7 Ragusa, Regione Sicilia, Ragusa, Italy

For all author emails, please log on.

BMC Public Health 2013, 13:504  doi:10.1186/1471-2458-13-504

Published: 24 May 2013



For chronic conditions, disparities can take effect cumulatively at various times as the disease progresses, even when care is provided. The aim of this study was to quantify the prevalence of diabetes, congestive heart failure (CHF) and coronary heart disease (CHD) in adults by citizenship, and to compare the performance of primary care services in managing these chronic conditions, again by citizenship.


This is a population-based retrospective cohort study on 1,948,622 people aged 16 years or more residing in Italy. A multilevel regression model was applied to analyze adherence to care processes using explanatory variables at both patient and district level.


The age-adjusted prevalence of diabetes was found higher among immigrants from high migratory pressure countries (HMPC) than among Italians, while the age-adjusted prevalence of CHD and CHF was higher for Italians than for HMPC immigrants or those from highly-developed countries (HDC). Our results indicate lower levels in all quality management indicators for citizens from HMPC than for Italians, for all the chronic conditions considered. Patients from HDC did not differ from Italian in their adherence to disease management schemes.


This study revealed a different prevalence of chronic diseases by citizenship, implying a different burden of primary care by citizenship. Our findings show that more effort is needed to guarantee migrant-sensitive primary health care.