Vercelli Marina, Quaglia Alberto, Lillini Roberto
Tumori. 2013 May-Jun;99(3):425-38. doi: 10.1177/030089161309900319.
In the last decades the demographics of most Western countries have undergone a deep transformation, which has caused a steady increase in degenerative chronic diseases and has made maintaining health and social support by the welfare system difficult. This paper aims to present a set of indicators pertaining to the health status of the Italian population and to the national economic and social systems, as an aid to a better interpretation of the cancer burden impact and of its future tendencies.
All indicators were derived from the ISTAT Health for All database. They were presented by region or macro area, globally or by gender, considering the most recent regional distribution and their time trends. The following features of the Italian population were chosen: percent of people aged over 65 years; life expectancy at birth; birth rate; crude and age-standardized overall mortality rates; dependency ratio; percent of single persons; percent of people with no more than a junior high school diploma; percent of people attaining at least the short first university degree; percent of people employed in the service and tertiary sectors; unemployment rate; incidence of poverty; total health expenditure (THE) as an absolute value and as percent of GDP; percent of public THE; percent of out-of-pocket THE of households; percent of smokers; proportion of overweight and obese people aged ≥18 years.
Italy presented an unbalanced demographic situation with an increasingly old population, a decreasing middle-aged age group, a low birth rate, high crude overall mortality rates, and decreasing standardized overall mortality rates. The Italian population is characterized by a constant increase in the dependency ratio and in the percentage of people living alone, together with increasing expenses for health care, both at the public and households levels. Smoking has reduced its impact in men but not yet in women. The increasing proportion of overweight and obese people may explain the convergence in time of the mortality rates of the different Italian macro areas.
The Italian situation seems to be not well fitted to face the expected growing cancer burden. Along with the aging of the population, the corresponding lowering of the national GDP due to the persisting global economic crisis will lead the public sector and families to reduce health expenditure, while the number of people affected by cancer is bound to increase. Moreover, the social support provided by family members and the advantages of the Mediterranean dietary habits are declining. The strategies for facing the challenging evolution of the future should focus on successful primary prevention and a wider application of evidence-based medicine to optimize the choice of diagnostic and therapeutic procedures offered to citizens.
在过去几十年里，大多数西方国家的人口结构经历了深刻变革，导致退行性慢性疾病稳步增加，给福利系统维持健康和社会支持带来困难。本文旨在呈现一组与意大利人口健康状况以及国家经济和社会系统相关的指标，以更好地解读癌症负担影响及其未来趋势。
所有指标均源自意大利国家统计局全民健康数据库。指标按地区或宏观区域、整体或按性别呈现，考虑了最新的区域分布及其时间趋势。选取了意大利人口的以下特征：65岁以上人口百分比；出生时预期寿命；出生率；粗死亡率和年龄标准化总死亡率；抚养比；单身人口百分比；初中及以下学历人口百分比；至少获得短期大学学位的人口百分比；服务业和第三产业就业人口百分比；失业率；贫困发生率；卫生总支出（THE）绝对值及其占国内生产总值的百分比；公共卫生支出百分比；家庭自付卫生支出百分比；吸烟者百分比；18岁及以上超重和肥胖人群比例。
意大利呈现出人口结构失衡的局面，人口老龄化加剧，中年年龄组减少，出生率低，粗总死亡率高，标准化总死亡率下降。意大利人口的特点是抚养比和独居人口百分比不断上升，同时公共和家庭层面的医疗保健费用不断增加。吸烟对男性的影响有所降低，但对女性尚未产生影响。超重和肥胖人群比例的增加可能解释了意大利不同宏观区域死亡率在时间上的趋同。
意大利的情况似乎不太适合应对预期中不断增加的癌症负担。随着人口老龄化，由于全球经济危机持续导致国内生产总值相应下降，公共部门和家庭将减少卫生支出，而癌症患者数量必然会增加。此外，家庭成员提供的社会支持以及地中海饮食习惯的优势正在下降。应对未来具有挑战性的发展趋势的策略应侧重于成功的一级预防以及更广泛地应用循证医学，以优化向公民提供的诊断和治疗程序的选择。
