Variations in diagnostic testing utilization in Italy: Secondary analysis of a national survey

Abstract

BackgroundAccording to the principle of horizontal equity, individuals with similar need may have the same possibility of access to health services. The aim of this study is to identify patterns of diagnostic services utilization, in people with, and without chronic disease in Italy.MethodsSecondary analysis of data from the national survey on Health and use of health care in Italy, carried out in 2013, including 99,497 participants. Multilevel analysis has been used to study the variables associated to diagnostic services utilization.Results13.78% of participants have had one diagnostic testing in the four weeks before the interview. In healthy people, utilization of diagnostic testing is reduced in people with low educational level (OR 0.75; 95%CI 0.67–0.84), in housewives (OR 0.66; 95%CI 0.51–0.87), or in those unable to work (OR 0.48; 95%CI 0.26–0.87), while increased in those perceiving a worse health status (up to OR 4.00, 95%CI 2.00–8.01 in very bad health). In people afflicted with chronic disease, access to diagnostic assessment is impaired by educational level (OR 0.69; 95%CI 0.61–0.78) and low household income (OR 0.75; 95%CI 0.58–0.97), while it is increased in the presence of a ticket exemption (OR 1.55, 95%CI 1.42–1.68), and fixed-term occupation (OR2.28, 95%CI 1.31–3.95). Being former-smokers in associated to an increased utilization of services in both groups.ConclusionsDespite a universal and theoretically egalitarian, public, health care system, variations in diagnostic services utilization are still registered in Italy, both in healthy people and those afflicted by chronic diseases, on socio-economic/occupational basis, and self-perceived health status. Moreover, this significant effect of occupation on healthcare utilization, suggests the need for a comprehensive evaluation of economics in occupational health.

Seroprevalence of SARS-CoV-2 Infection in Portugal in May-July 2020: Results of the First National Serological Survey (ISNCOVID-19)

“…Moreover, selecting participants among users of clinical pathology laboratories may have resulted in bias due to the documented educational gradient in access to diagnostic tests. 18 However, the Portuguese Serological Survey for Vaccine Preventable Disease developed in 2015 -2016, using similar sampling strategy among clinical pathology laboratories and public hospital users, did not demonstrate bias in the educational distribution of participants. 5 Exclusion of institutionalized individuals from the present survey may have contributed to underestimation of SARS-CoV-2 seroprevalence since, according to the national surveillance system, several institutional facilities for the elderly were affected by COVID-19 during the first wave.…”

“…17 In order to reduce this self-selection bias in the ISNCOVID-19 survey participants were recruited among those who already were in a laboratory with the objective to perform routine blood tests prescribed by a physician for reasons unrelated to COVID-19. This methodological option, on the other hand, may have resulted in sampling of individuals with higher proportion of chronic conditions than in general population, 18 particularly among children, and this could have contributed to a lower seroprevalence resulting from a higher awareness and adoption of protection measures by these high-risk groups. Moreover, selecting participants among users of clinical pathology laboratories may have resulted in bias due to the documented educational gradient in access to diagnostic tests.…”