Chronic diseases, ISS data: more than one in two over 65s suffers from it

In Italy, 18% of people between 18 and 69 have a chronic disease, a figure that rises to 57% if we consider those over 65, an age group in which one in four has at least two. This is what the data from the Passi and Passi d'Argento surveillance published today by the Istituto Superiore di Sanità, relating to the two-year period 2023-24, say.

Flu vaccination data

On this occasion, data on flu vaccination among over 65s are also published: in the latest vaccination campaign investigated by Passi d'Argento (2023-2024), 62% of over 65s were vaccinated against flu and this percentage reached 74% among over 85s and 69% among people with chronic pathologies.

Chronic diseases between 18 and 69 years old

Eighteen percent of people aged 18 to 69 interviewed for the PASSI surveillance between 2023 and 2024 reported that, during their lifetime, a doctor had diagnosed them with one or more of the following diseases: renal failure, chronic bronchitis, emphysema, respiratory failure, bronchial asthma, stroke or cerebral ischemia, diabetes, myocardial infarction, cardiac ischemia or coronary artery disease, other heart diseases, tumors (including leukemia and lymphoma), chronic liver disease or cirrhosis.

Poverty and low levels of education also aggravate the chronicity

Chronicity is more frequent with increasing age (it involves 7% of adults under 34, 12% of those aged 35-49 and 29% of people aged 50-69). Furthermore, chronicity involves more people with a more disadvantaged socioeconomic status, with many economic difficulties (29%) or low education (33% among those with no qualifications or an elementary school diploma). The condition of polychronicity, or the co-presence of two or more chronic pathologies (among those investigated) concerns, on average, 4% of 18-69 year olds: it is more frequent with increasing age (it is reported by 8% of people aged 50-69) and among people with a more disadvantaged socioeconomic status, due to many economic difficulties (11%) or low education (13% among those with no qualifications or an elementary school diploma).

The most widespread and regional differences

The most frequently reported chronic diseases between 18 and 69 years of age are chronic respiratory diseases (6%), cardiovascular diseases, diabetes (5%) and tumors (4%); chronic liver diseases, renal failure and stroke (1%) are the least frequent. The regional variability of chronicity in adults does not describe a clear geographical gradient, because higher prevalences than the national average are recorded in some regions of the South such as Sardinia (26%), but also in the North such as Friuli-Venezia Giulia (22%) or in the Center, such as Marche (23%) and Lazio (20%). The same happens for polychronicity. The prevalence of people diagnosed with a chronic disease (at least one of those investigated) seems unchanged since 2008, but this is the result of a slow but significant increase in the North and a reduction in the South, while it remains stable in the Center, so much so that today the geographic gradient has reversed and is greater among the Northern Regions and less in those of the South. Furthermore, a substantial stability is observed under 34 years of age and a reduction in the more mature classes (50-69 year olds).

Focus on the over 65s

The Passi d'Argento data collected in the two-year period 2023-2024 show that 57% of over-65s report that, during their lifetime, a doctor has diagnosed them with one or more of the following pathologies: kidney failure, chronic bronchitis, emphysema, respiratory failure, bronchial asthma, stroke or cerebral ischemia, diabetes, myocardial infarction, cardiac ischemia or coronary artery disease, other heart diseases, tumors (including leukemia and lymphoma), chronic liver disease or cirrhosis. 27% of those interviewed report heart disease, chronic respiratory diseases affect 16% of over-65s, diabetes 20% and tumors 13%. The condition of polychronicity, that is the co-presence of two or more chronic pathologies (among those investigated), affects 1 in 4 people over 65. Furthermore, it is more frequent with increasing age (it affects 16% of people aged 65-74 and rises to 37% after 85 years of age) and among people with a more disadvantaged socioeconomic status, due to economic difficulties (38% vs 19% among those who declare no difficulties) or low education (30% vs 19%).

In the two-year period 2023-2024, unlike previous years, differences also emerge by gender with a higher estimate among men (24% vs 21% among women). The regional variability of chronicity highlights a significantly different situation among the macro-areas of the country. In Northern Italy, the share of over-65s reporting at least one chronic pathology is equal to 53%, while in the Center and South the estimate is higher, equal to 60% respectively. A similar pattern is also observed for polychronicity: the estimate is equal to 19% in the North, while it reaches 24% in the South and 25% in the Center.

Data during the pandemic showed lower values ​​of polychronicity compared to pre-pandemic years, values ​​that continue to decrease especially in 2024 (22%). The temporal analysis of the prevalence of chronic diseases among the over 65s does not show significant changes between 2016 and 2019, except for an increasing trend attributable, most likely, to the progressive aging of the population which leads ever-increasing numbers of people to reach ever higher ages and which ends up being accompanied by greater chronicity. However, in 2020 there was a reversal of the trend and the share of people among the interviewees reporting diagnoses of chronic diseases decreased, going from 62% in 2019 to less than 56% in 2024.

Data on chronicity and adherence to the vaccination campaign

In the last vaccination campaign investigated by PASSI d'Argento (2023-2024), 62% of people over 65 were vaccinated against influenza, and this percentage reached 74% among people over 85 and 69% among people with chronic diseases. Results that remain at higher values ​​than in the pre-pandemic period, but are no longer significantly different. The COVID-19 pandemic seems to have encouraged participation in influenza vaccination campaigns across the entire population. Before 2020, in fact, vaccination coverage had never reached the minimum recommended levels, not even among the elderly or people with chronic diseases. Always below 60%, vaccination coverage reaches 69% in the midst of the pandemic (almost reaching the minimum target recommended by the Ministry of Health for the categories at greatest risk due to age or chronic conditions), but drops again to 63% in 2023 and 62% in 2024.

Among people with non-communicable diseases, vaccination coverage has always been higher than that observed among people without chronic conditions, but still far from the minimum target, while from 2020 it has increased significantly, by about 10 percentage points, compared to previous campaigns, remaining stable at 73% until 2022, but subsequently falling to 70% in 2023 and 67% in 2024. In particular: 71% among people with chronic respiratory diseases, 70% among people with cerebro and cardiovascular problems, 68% among people with kidney failure, 69% among diabetics and 65% among people with chronic liver diseases.

Even among people without chronic conditions, participation in the vaccination campaign has increased: if before the pandemic less than 50% of people over 65 without chronic conditions were vaccinated against influenza, during the pandemic the use of vaccination against influenza rose to 63% in 2021, and then returned to lower values ​​in 2023, equal to 55% and 54% in 2024. Data by geographical area also seem to suggest an impact of the COVID-19 pandemic: in the pre-pandemic period, the use of influenza vaccination was on average more frequent in the Center and in the South-Islands and less frequent in the North of the country. During the pandemic years, the use of vaccination increased everywhere but the geographical gradient reversed and, in the two-year period 2023-24, coverage changed appearance again with the Centre of the country presenting significantly higher coverage (69%) compared to the South (63%) and the North (57%) where the most accentuated decline was observed compared to the pandemic period.