The impact of COVID-19 pandemic on temporal trends of key behavioral risk factors in Italy

Abstract Background Non Communicable Diseases (NCDs) account for approximately 91% of deaths and more than 87% of DALYs in the EU, with a considerable health and economic impact. In Italy the three NCDs that contribute the most DALYs are cardiovascular diseases, chronic respiratory diseases, and cancer. The risk of developing NCDs is influenced by behavioral factors such as smoking, overweight and obesity, alcohol consumption and poor diet. The COVID-19 pandemic has affected individual behaviors, potentially increasing the burden of NCDs. This study aims to assess trends in key behavioral risk factors in Italy and explore whether the pandemic altered their trajectories. Methods Prevalence of smoking, overweight, and obesity (2001-2024), wine and beer consumption, and alcohol use outside meals (2006-2023) were obtained from the Italian National Institute of Statistics. Joinpoint Regression was used to analyze the trends, identifying an Annual Percent Change (APC) and an Average Annual Percent Change (AAPC) over time. Results All factors showed increasing AAPCs over the study period, except smoking (significant AAPC = -0.24). Smoking declined from 2001 to 2019, then reversed in 2020 (APC 2020-2024 = +0.30). Obesity significantly increased (AAPC = +0.12), peaking in 2021 (prevalence: 12%). After a significant increase until 2009, overweight significantly declined (APC = -0.07), albeit an increase in 2020 (prevalence: 36.1%). Overall, Alcohol-related indicators increased, particularly beer consumption (AAPC = +0.043), with no joinpoints near 2020. Conclusions The COVID-19 pandemic appears to have influenced smoking behaviors in Italy, interrupting a prolonged declining trend. Smoking, obesity and overweight, showed more elevated prevalence during and after the pandemic. Poor healthy lifestyles may lead to increased NCDs burden and public health expenditure. Policy interventions aiming at prevention and education are needed to address these trends and support population well-being. Key messages • The COVID-19 pandemic has accentuated Italian trends of the past 20 years characterized by increases in obesity, overweight and alcohol consumption, and reversed the decline in smoking prevalence. • Behavioral risk factors for NCDs in Italy are worsening; policy interventions focused on prevention and education are needed to improve population health and reduce public health costs.