Mid- to long-term impact of COVID-19 in Italy from PASSI and PASSI d'Argento surveillance systems

Abstract Background Since its onset, the COVID-19 pandemic has has deeply impacted multiple aspects of life. Between August 2020 and December 2022, the PASSI and PASSI d'Argento ongoing population-based surveillance systems, coordinated by the Italian National Institute of Health (ISS), included a dedicated COVID-19 module to assess the medium-long-term impact of the pandemic on the the adult and elderly populations. Methods The COVID module is a set of 17 questions. The sample includes 53,688 adults (18-64 years) and 29,675 elderly individuals (65+ years). Data on medical care renunciation for the elderly was also collected in 2023 from 16,421 interviews. Data were weighted for regional sample sizes by gender and age. Both systems had a response rate above 80%. Multivariate analyses were conducted on selected outcomes. Results In 2020, 36.3% (95% CI 34.8-37.8) of adults reported that this crisis has worsened their economic availability, 30.3% (95% CI 29.4-31.1) in 2021, 32.2% (95% CI 31.5-32.9) in 2022. This proportion increases significantly among those reporting severe economic difficulties, reaching 72.4% (95% CI 67.6-76.8) in 2020, 67.7% (95% CI 64.3-71.0) in 2021, and 69.7% (95% CI: 66.7-72.5) in 2022. Multivariable analysis confirmed these findings. Among those over 65, while the overall share of individuals skipping necessary medical visits decreased over time, the proportion reporting long waiting lists as the reason increased dramatically from 9.7% (95% CI 7.9-11.7) in 2020 to 62.8% (95% CI 17.4-19.3) in 2023. Conclusions These unique national-level results provide strong evidence of the pandemic's impact on socio-economic conditions, service access, and their burden on population health. They are a valuable resource for policymakers and health administrators to guide advocacy efforts, aimed at mitigating long-term syndemic effects, and identifying priority intervention areas, as well as strategic insights for strengthening the National Health Service. Key messages • The pandemic has had a medium-long term impact, especially on those disadvantaged by age or socioeconomic conditions, which should be taken into account to limit the rise in inequalities. • Health systems need to focus on the pandemic's impact on health determinants to prevent increased inequalities and design a need-based, outcome-focused approach. Surveillance systems play a key role.