Italian healthcare, “avoidable deaths” increase. The Istat report

The “avoidable deaths” of patients treated in Italian hospitals are increasingthis is confirmed by the analysis of the data provided by the National Institute of Statistics (ISTAT) which offers us a clear picture of the healthcare situation in our country.

The report, published in May 2024, highlights the correlation between healthcare provision and avoidable mortality. And by focusing on the period between 2007-2009 and 2017-2019, as well as the years 2020 and 2021, it seeks to understand the effects of the Covid-19 pandemic on health and the healthcare context in general.

“Avoidable deaths” are increasing in Italy

From what emerged from the Istat Report, in Italian metropolitan cities, during 2021, approximately 20 avoidable deaths per 10 thousand inhabitants, with a national rate of 19.2. These deaths are considered avoidable as they could be prevented or reduced. Compared to the average recorded in the period 2017-2019, it was found a significant increase of 16.6%.

However, what is worrying is not only the increasing trend in avoidable mortality in metropolitan cities, but the causes that have led to this increase being recorded, mostly attributable to the so-called “preventable component”. In other words, as the word itself suggests, the preventable component of avoidable mortality represents i deaths that could be prevented with appropriate health interventions as well as healthier lifestyles.

And this component has seen a significant increase, although largely attributable to the effects of the pandemic. In fact, Istat reports an average of approximately 13 deaths per 10 thousand inhabitants in 2021 and 2020slightly higher than the national average of 12.8 and largely influenced by the deaths caused by the Covid-19 pandemic, with an average of 3.5 deaths per 10 thousand inhabitants in 2021 and 3.3 in 2020.

Critical situation in the South

The metropolitan cities in the South have highlighted the most critical values ​​of avoidable mortalitywith the exception of Cagliari which is positioned below the national average.

Naples recorded the highest rate, with 27.1 avoidable deaths per 10,000 inhabitants in 2021, followed by Messina and Palermo with approximately 23 deaths per 10 thousand. In detail, the metropolitan city of Campania also holds the highest values ​​in the capital municipality (29.3 deaths per 10 thousand inhabitants) and in its urban belts, with a difference from the relative averages that varies from a maximum of nine deaths in the capital to five deaths for 10 thousand of the first belt.

On the contrary, the metropolitan city of Florencewith 16 avoidable deaths per 10 thousand inhabitants, has the lowest mortality, together with Bologna and Milan (approximately 17 avoidable deaths).

The rate of deaths after the pandemic is decreasing, but the South is still struggling

It must be said, in this regard, that during the years 2020 and 2021, in Italy, the level and dynamics of mortality have been strongly influenced by the spread of the Covid-19 pandemic. In fact, in 2021, the total number of deaths reached 704 thousand, 66 thousand more than the average for the three-year period 2017-2019. In the same year the standardized mortality rate was close to 90 deaths per 10 thousand inhabitants.

The indicator grows by 6.3% compared to the three-year period 2017-2019 and decreases by 5.7% compared to the first year of the pandemic. Analyzing mortality under the age of 74, the threshold used as a reference for measuring avoidable mortality, in 2021 deaths in Italy are around 173 thousand (2 thousand less than 2020), corresponding to approximately a quarter of total deaths.

The standardized Italian mortality rate for this subpopulation, in 2021, is 28.9 deaths per 10 thousand inhabitants and the temporal comparison reveals a decreasing trend of the phenomenon. In fact, mortality reduced by 15.6% between the period 2017-2019 and 2007-2009, a trend interrupted in 2020 and 2021 by a significant recovery in mortality (+9.1% in 2021 and +10.9% in 2020 compared to the three-year period 2017-2019), probably caused by the Covid-19 pandemic.

In 2021 in the metropolitan areas the mortality within 74 years exceeds the national one of 1.3 deaths per 10 thousand inhabitants and presents a growth of 11% compared to the three-year period 2017-2019. In the metropolitan cities of A disadvantaged situation is observed in the South characterized by mortality levels above average (30.2 per 10 thousand), apart from Cagliari and Bari.

From a temporal perspective, the growth of the phenomenon in 2021 compared to the three-year period 2017-2019 can be observed from North to South, with the exception of the metropolitan city of Genoa (-2.5%). The intensity of the increase, however, is not uniformly distributed, being more contained in the metropolitan cities of the North, which remain below the average value, and higher in those of the South, excluding Cagliari (+6.8%).

Hospital mobility is also increasing, with more and more people moving to be treated elsewhere

There hospital mobility, that is, the choice to benefit from health care in a region other than that of residence represents a increasingly widespread phenomenon in Italy.

According to Istat data, in recent years, interregional hospital mobility has become a structural phenomenon in the Italian healthcare landscape. In the three-year period 2007-2009, it concerned 7.4% of hospital discharges, while after 10 years, in the three-year period 2017-2019, a significant increase was recorded, with almost one discharge per 1,000. In 2020, only due to the restrictive measures adopted to contain the Covid-19 pandemic was there a reduction in the phenomenon. In fact, in 2021, with the progressive easing of restrictions, a recovery in travel was observed, with a percentage that post-pandemic almost 8% of hospital discharges.

Even if hospital mobility between regions represents a key element in the Italian healthcare panorama, allowing citizens to access medical care outside their territory of residence, it must be said that this complex phenomenon is influenced by a series of social factors that deserve in-depth analysis.

For example, ISTAT data show that hospital mobility of residents in metropolitan cities it is consistently lower to the national average, with notable territorial variations. That is, there are areas where fewer people feel the need to move elsewhere for treatment, and other places where it is almost systematic to do so, because few people rely on the care of local facilities.

However, in this case a disparity emerges between North and South. Suffice it to say that in the metropolitan city of Reggio Calabria, in 2021, almost one in four patients received medical treatment outside the region, recording an increase compared to previous years. Other metropolitan cities, such as Genoa, also have a significant flow of patients moving to other regions to receive medical care.

Choosing to receive medical care outside your region may result in considerable risks and challenges. First, patients could be exposed to different standards of care and procedures, with additional costs both for them and for the healthcare system. Furthermore, access may be limited by economic and logistical barriers (not everyone has the ability to travel elsewhere for treatment). Finally, another critical aspect is the effect of separation from one's family and usual support network. This detachment can have a negative impact on the patient's physical and mental well-being, affecting the healing and recovery process.