Measuring multimorbidity inequality across Italy through the multisource comorbidity score: a nationwide study
Authors: Corrao Giovanni , Rea Federico , Carle Flavia , Di Martino Mirko , De Palma Rossana , Francesconi Paolo , Lepore Vito , Merlino Luca , Scondotto Salvatore , Garau Donatella , Spazzafumo Liana , Montagano Giuseppe , Clagnan Elena , Martini Nello ,   the working group “Monitoring and assessing care pathways (MAP)” of the Italian Ministry of Health, Bucci Andrea , Carle Flavia , Dajko Marianxhela , Arcà Silvia , Bellentani Donata , Bruno Velia , Carbone Simona , Ceccolini Carla , De Feo Angela , Lispi Lucia , Mariniello Rosanna , Masullo Maurizio , Medici Federica , Pisanti Paola , Visca Modesta , Zanini Rinaldo , Di Fiandra Teresa , Magliocchetti Natalia , Romano Giovanna , Cantarutti Anna , Corrao Giovanni , Pugni Pietro , Rea Federico , Davoli Marina , Fusco Danilo , Di Martino Mirko , Lallo Adele , Marinacci Chiara , Maggioni Aldo , Vittori Patrizia , Belotti Laura , De Palma Rossana , Di Felice Enza , Chiandetti Roberta , Clagnan Elena , Del Zotto Stefania , Di Lenarda Andrea , Mariotto Aldo , Zanier Loris , Agnello Mauro , Lora Antonio , Merlino Luca , Scirè Carlo Alberto , Sechi Giuseppe , Spazzafumo Liana , Massaro Giuseppe , Simiele Maria , Cosentino Mimma , Marvulli Maria Grazia , Attolini Ettore , Bisceglia Lucia , Lepore Vito , Petrarolo Vito , Dondi Letizia , Martini Nello , Pedrini Antonella , Piccinni Carlo , Fantaci Giovanna , Addario Sebastiano Pollina , Scondotto Salvatore , Bellomo Francesco , Braga Mario , Di Fabrizio Valeria , Forni Silvia , Francesconi Paolo , Profili Francesco , Avossa Francesco , Corradin Matteo , Bucci Andrea , Carle Flavia , Dajko Marianxhela , Arcà Silvia , Bellentani Donata , Bruno Velia , Carbone Simona , Ceccolini Carla , De Feo Angela , Lispi Lucia , Mariniello Rosanna , Masullo Maurizio , Medici Federica , Pisanti Paola , Visca Modesta , Zanini Rinaldo , Di Fiandra Teresa , Magliocchetti Natalia , Romano Giovanna , Cantarutti Anna , Corrao Giovanni , Pugni Pietro , Rea Federico , Davoli Marina , Fusco Danilo , Di Martino Mirko , Lallo Adele , Marinacci Chiara , Maggioni Aldo , Vittori Patrizia , Belotti Laura , De Palma Rossana , Di Felice Enza , Chiandetti Roberta , Clagnan Elena , Del Zotto Stefania , Di Lenarda Andrea , Mariotto Aldo , Zanier Loris , Agnello Mauro , Lora Antonio , Merlino Luca , Scirè Carlo Alberto , Sechi Giuseppe , Spazzafumo Liana , Massaro Giuseppe , Simiele Maria , Cosentino Mimma , Marvulli Maria Grazia , Attolini Ettore , Bisceglia Lucia , Lepore Vito , Petrarolo Vito , Dondi Letizia , Martini Nello , Pedrini Antonella , Piccinni Carlo , Fantaci Giovanna , Addario Sebastiano Pollina , Scondotto Salvatore , Bellomo Francesco , Braga Mario , Di Fabrizio Valeria , Forni Silvia , Francesconi Paolo , Profili Francesco , Avossa Francesco , Corradin Matteo 
Published: March 2020

Abstract

Background
Multimorbidity is a growing concern for healthcare systems, with many countries experiencing demographic transition to older population profiles. A simple multisource comorbidity score (MCS) has been recently developed and validated. A very large real-world investigation was conducted with the aim of measuring inequalities in the MCS distribution across Italy.

Methods
Beneficiaries of the Italian National Health Service aged 50–85 years who in 2018 were resident in one of the 10 participant regions formed the study population (15.7 million of the 24.9 million overall resident in Italy). MCS was assigned to each beneficiary by categorizing the individual sum of the comorbid values (i.e. the weights corresponding to the comorbid conditions of which the individual suffered) into one of the six categories denoting a progressive worsening comorbidity status. MCS distributions in women and men across geographic partitions were compared.

Results
Compared with beneficiaries from northern Italy, those from centre and south showed worse comorbidity profile for both women and men. MCS median age (i.e. the age above which half of the beneficiaries suffered at least one comorbidity) ranged from 60 (centre and south) to 68 years (north) in women and from 63 (centre and south) to 68 years (north) in men. The percentage of comorbid population was lower than 50% for northern population, whereas it was around 60% for central and southern ones.

Conclusion
MCS allowed of capturing geographic variability of multimorbidity prevalence, thus showing up its value for addressing health policy in order to guide national health planning.