Italy is not America, in terms of assistance and the availability of care. But even here, the specialist should pay attention to the economic conditions of a person who has had a heart attack, to implement supportive measures that can improve the distant prognosis of the heart attack, especially for the elderly.
The economic difficulties of those returning home from hospital alone could increase the risk of death by 60% in the six months following the acute ischemic attack. To raise the alarm on this aspect, often not too much considered, is a research conducted by experts of theUniversity of Maryland and Yale coordinated by Jason R. Falvey, Alezandra Hajduk, Christopher Keys e Sarwat Chaudhrypublished on JAMA Internal Medicine.
I study
The experts examined the data emerging from the “Silver-Ami” analysis that follows a population of elderly patients with heart attack to evaluate their outcomes in terms of health. In particular, hospitalized in various areas of the US between 2012 and 2016 were considered, considering their economic situation.
Three categories were created: in the first, those who had a good financial availability were included, in the second those who managed to get by without particular worries and in the last one who had serious financial problems. Of those who had more than enough money to pay their bills, 7.2% died within six months of being discharged from the hospital. Among those who had only quiet coverage of expenses, the death rate rose to 9%. Unfortunately, among those who declared themselves in clear economic difficulty, the 16,8% of the people followed.
Obviously these raw data were then “purified” considering health conditions, first of all the presence of other pathologies, and the state of the aging process. And it is at that point, considering only the economic situation, that the increase in the risk of death linked to the financial factor alone was defined.
Result: those who had severe financial difficulties were 61% more likely than patients who had not reported any problems in this sense, within six months following a heart attack. According to experts, the data that emerges has importance on the epidemiological front, since it is only an observation.
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Therapy alone is not enough
However, it can be hypothesized that the lack of availability to perfectly follow a drug treatment is linked to economic difficulties (the payment system in the USA is different from Italy, where medicines are still insured and it is necessary to focus above all on adherence to therapy), together to the action of the emotional stress linked to the lack of economic resources could have played a role in determining the situation.
Final advice: when an elderly person is hospitalized for a heart attack, it is essential to put in place “social protection” systems upon discharge that allow them to cope with any economic problems. We should start from the volume by Michael Marmot, director ofInstitute of Health Equity of University College London, which begins with a question: “Why cure people and send them back to the conditions that made them sick?” In short: people need to be treated, but that’s not enough. Problems that make them sick must also be addressed.
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The differences between the US and the Italian reality
“Clearly in the US, characterized by private healthcare, the economic aspect of the cost of healthcare services and drugs plays a very different role compared to that of a universal and public system like the Italian one – he explains Marcello MontefioriDirector of Aphec Study Center of the Economics Department of the University of Genoa. For example, the problem of access to the drug in the US is mainly attributable to the cost of the drug. The situation in our country is quite different, where “important” drugs are offered free of charge by the national health system. Nonetheless, the data tell us that, even in Italy, conditions of poverty and social disadvantage are associated with a worse state of health. For example, we note the lack of “fairness” of many chronic diseases which proportionally affect the poorest and least educated sections of the population more. In fact, there is a close relationship between the level of education, income, illness and death “.
For example, if we look at the population with a lower middle school education level, we realize that it represents 50% of the Italian population. However, this group represents 73.5% of those who have at least one chronic disease. Symmetrically, the data tell us that, if on the one hand the percentage of Italians with a degree is 14%, only 5% of those who have at least one chronic disease have a degree.
The role of the level of education and lifestyle
“In part this is a consequence of different lifestyles: obesity, sedentary lifestyle and smoking habits are in fact particularly common behaviors among those with a low level of education – continues Montefiori. Life expectancy is also influenced by the so-called” social gradient “: In the BES 2020 report, Istat notes that, although significant inequalities in mortality rates were already detectable to the detriment of the less educated, this gap widened further in correspondence with the first wave of Covid, in particular for the central bands of life and among women. These results are of great importance in a socio-health policy logic because they provide a different interpretation and new indications for resource allocation choices “.
“In other words – he concludes – it could be said that the health of patients is obtained by investing (also) outside health, by acting on the social determinants of health inequalities. Among other things, the reduction of inequalities is one of the challenges of the PNRR ( National Recovery and Resilience Plan) which expressly indicates, among its objectives, that of reducing inequalities and disparities “.
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