Territorial inequalities for care renunciation and health services access in Italian elderly

Abstract Background Aging in the Italian population creates new challenges for the healthcare system and living environment is crucial in guaranteeing quality of life and health of the elderly. These concepts are core concepts in the Joint Action PreventNCD where ISS participates as Italian country authority. Methods Data from PASSI d'Argento (PdA) surveillance system were used to highlight regional/local inequalities. In 2020-2024, 64,719 interviewees were asked on forgoing medical visits or diagnostic tests, use of out-of-pocket, difficulties in accessing social/healthcare services. Using QGIS software, prevalence was mapped to display geographical differences; logistic regression models were used to analyse space-time differences, adjusting by socio-demographic and health characteristics. Results The geographical analysis on forgoing care showed regional variability, from 9% in Emilia-Romagna to 39% in Apulia. Overall a significant decrease is observed over time: from 50% in 2020 to 18% in 2024. The regression analysis with year interaction shows how a treatment forgoing significantly worsened, among people with many economic issues (OR 1.23; 95%CI: 1.15-1.31) and living in the Central (OR 1.19; 95%CI: 1.14-1.25) and Southern Italy (OR 1.23; 95%CI: 1.17-1.29). People reporting as reasons to forgo long waiting times (from 10% in 2020 to 68% in 2024) and high costs (from 1% to 17%) increased. In 2023-2024, forgoing due to long waiting times was less frequent in big cities, where use of out-of-pocket is higher. A total of 30% declared difficulties in accessing healthcare services, and the regression model shows an unfavorable regional gradient for central regions (OR 1.21; 95%CI: 1.15-1.28) and southern regions (OR 1.40; 95%CI: 1.34-1.46). Conclusions Results highlight the need to address territorial and socioeconomic inequalities, to ensure equal access to healthcare services. Key messages • Territory is a key health determinant. • Monitoring territorial and socio-economic factors supports fair, data-driven policies to ensure equal access to healthcare services.