The Italian experience of - The voice of world ?· The Italian experience of monitoring the impact of…

  • View
    212

  • Download
    0

Embed Size (px)

Transcript

The Italian experience of monitoring the impact of

socioeconomic inequalities and of barriers related to ethnicity on

access to CRC screening

Carlo SENORE

Possible conflicts of interest

None related to the presentation

Carlo Senore

MINISTRY OF

HEALTH

ANNUAL SURVEY OF SCREENING ACTIVITY

- FIRST PART : INVITATION AND EXAMINATION

COVERAGE

- SECOND PART: SCREENING PERFORMANCE

INDICATORS

- in collaboration with GISCoR

NATIONAL MONITORING PROCESS

Ministero della Salute

Centro Nazionale per la Prevenzione

e il Controllo delle Malattie

Carlo Senore

National survey based on phone interviews Performed every year since 2007 Coverage: all Regions

Standardized questionnaire administered to a random

sample (stratified by age) of subjects aged 18 to 69

Response rate > 85%

PASSI survey

PASSI 2010-13

Proportion of 50-69 year-old people who had a

faecal occult blood test in the two years before

the interview or colonoscopy/ sigmoidoscopy in

the five years before the interview, within

screening programmes or spontaneously, by

region.

PASSI 2010-13

2010

PASSI 2010-13

Screening coverage by educational level subjects aged 50 to 69

2010

High education

Low education

PASSI 2010-13

2010

Screening coverage by self-reported economic difficulties Subjects aged 50 to 69

None

Major

Minor

PASSI 2010-13

Education and individuals preferences

Better educated subjects were more likely to accept sigmoidoscopy instead of TC colonography screening

Senore et al. submitted

People who accepted the invitation to choose between FS and FIT in the SCORE2 trial were better educated

(high school / university degree versus primary/intermediate degree OR: 3.86; 95% CI: 1.28 11.65)

Senore et al. AJG 2009 Screening uptake by education and test

0,0%2,5%

5,0%7,5%

10,0%12,5%

15,0%17,5%

20,0%22,5%

25,0%27,5%

30,0%32,5%

35,0%

Low Intermediate High

FS FIT

3,292,451 subjects 50 to 69 invited

192,629 (5.9%) immigrants

85 programmes

Adesione corretta per Regione

96

11

2629 29

3639

30

34

42

51

35

10

2022

38

4347

4952

54 54

58

67

52

0

10

20

30

40

50

60

70

Sicilia

Abru

zzo

Laz

io

Sar

deg

na

Liguria

Umbria

Piemonte

Tosc

ana

Lombar

dia

Emilia Romag

na

Friuli V.G

iulia

Ven

eto

2013

x 1

00 invitati

Migranti

Italiani

PARTICIPATION RATE By region IMMIGRANTS

ITALIANS

Positivit ai primi esami

per sesso e cittadinanza

6,0

4,9

6,2

4,2

0

1

2

3

4

5

6

7

Maschi Femmine

sesso

x 1

00

es

am

ina

ti

migranti

italiani

POSITIVITY RATE

INITIAL SCREENING

MEN

WOMEN

ITALIANS

IMMIGRANTS

Positivit agli esami successivi per sesso e

cittadinanza

5,3

4,3

5,1

3,8

0

1

2

3

4

5

6

Maschi Femmine

sesso

x 1

00

es

am

ina

ti

migranti

italiani

POSITIVITY RATE

SUBSEQUENT SCREENING

IMMIGRANTS

ITALIANS

MEN

WOMEN

MEN

WOMEN

IMMIGRANTS

ITALIANS

IMMIGRANTS

Tasso di adesione corretta alla

colonscopia

81,880,5

0

10

20

30

40

50

60

70

80

90

stranieri italiani

x 1

00 p

osit

ivi

COMPLIANCE WITH COLONOSCOPY REFERRAL

ITALIANS IMMIGRANTS

Tassi di identificazione KA: primi esami

vs esami successivi

1,34

1,06

1,62

0,98

0,0

0,5

1,0

1,5

2,0

primi esami esami successivi

x 1

000 e

sam

inati

migranti

italiani

DETECTION RATE CRC

BY SCREENING HISTORY

SUBSEQUENT SCREENING

INITIAL SCREENING

IMMIGRANTS

ITALIANS

IMMIGRANTS

ITALIANS

IMMIGRANTS

ITALIANS

Tassi di identificazione Ad.Av: primi

esami vs esami successivi

8,41

6,90

9,25

6,79

0

2

4

6

8

10

12

primi esami esami successivi

x 1

000 e

sam

inati

migranti

italiani

DETECTION RATE ADVANCED ADENOMAS

BY SCREENING HISTORY IMMIGRANTS

ITALIANS

SUBSEQUENT SCREENING

INITIAL SCREENING

SUBSEQUENT SCREENING

INITIAL SCREENING

IMMIGRANTS

ITALIANS

Exposure to interventions promoting screening participation by duration of stay in Italy

40

28

4126

17 18

35

1923

42

20

32

0

20

40

60

80

100

Lettera

dell'Asl

Consiglio

medico

Campagna

informativa

%

0-4 anni 5-9 anni 10+ anni Italiane

People aged 50-69

Invitation

letter

GPs

counselling

Invitation

letter

Media

campaign

years Italians years years

PASSI 2010-13

Acknowledgements

Manuel Zorzi Marco Zappa Chiara Fedato

Nicoletta Bertozzi

Thank you for your attention

Monitoring impact of inequalities on screening effectiveness

Metrics:

Individual level

Aggregated level

Education

Advantages:

stable over time;

often associated with income/ SES / social resources

Limitations: country specific;

association with income/status should be verified/validated,

Income

Limitations:

Rarely available; often inaccurate

Ethnicity

A combination of culture, education, income and accessibility to services (i.e. citizenship rules).

In the US, after adjusting for SES, ethnicity is no longer associated with screening coverage

Barriers limiting screening uptake

Aggregated level

Census area

Post-code

Limitations:

ecological association

Advantages:

feasibility; standardization;

updated based on census and population surveys results

Outcomes

Usually: participation (i.e. access to screening)

But

Screening effectiveness depends also on access to high quality assessment and treatment

Compliance with referral for assessment

Quality of treatment received

Survival

Thank you for your attention