The two behavioural risk factor surveillances on the adult and elderly populations as information systems for leveraging data on health-related sustainable development goals in Italy

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Highlights

Abstract

Introduction

Current lengthening of average life and constant increase of population ageing associated to forces that include rapid unplanned urbanisation and globalisation of unhealthy behaviours have determined the huge relevance of noncommunicable diseases (NCDs). Monitoring key modifiable behavioural risk factors has resulted to be crucial both in spatial terms and as per temporal trends in order to allow comparisons between different geographic areas or levels and over time.

Materials and Methods

In Italy, PASSI (Progressi delle Aziende Sanitarie per la Salute in Italia) and Passi d’Argento are the ongoing Behavioural Risk Factor Surveillance Systems (BRFSSs), respectively, on adults (people aged 18−69) and elderly (65 and older).

Results

The two Italian surveillances are information systems providing data not only on the third Sustainable Development Goal (SDG) that explicitly addresses ensuring healthy lives and promoting well-being for all, but on a total of nine health-related SDGs (HRSDGs) and 19 HRSDG targets/indicators. We describe these pairs more in detail specifying where in case of BRFSS core indicators (N = 14 HRSDG targets/indicators) concerning six HRSDGs or, on the other hand, as per BRFSS further in-depth analysis (N = five HRSDG targets/indicators) in regard of four different HRSDGs. About the HRSDG 3, HRSDG target 3.4, HRSDG indicator 3.4.1, from the PASSI and Passi d’Argento data it is possible not only to detect the prevalence of NCDs in adults and elderly living in Italy, but also to evaluate the social determinants of health, such as gender, age group, educational level, economic difficulties, as well as the associations with modifiable lifestyle risk factors.

Conclusions

The two Italian BRFSSs generate accurate data, which are highly relevant to design, implement, monitor, and evaluate programs and policies at different levels (local, regional, national) for NCD prevention and health promotion. They provide numbers which can also serve as propaedeutic or, in some cases, complementary ground to address a robust measurement of several HRSDG patterns.

Introduction

Nowadays, lengthening of average life and constant increase of population ageing associated to forces that include rapid unplanned urbanisation and globalisation of unhealthy behaviours have determined the huge relevance of noncommunicable diseases (NCDs) which are by far the leading cause of death in the world [[1], [2], [3]]. In 2016, NCDs were responsible for 71 % of the world’s 57 million deaths, killing more than 41 million people in one year [4]. Beside mortality rates, this group of disease impacts on other relevant public health indicators globally, such as morbidity, disability-adjusted life years (DALYs), years of life lost (YLL), global burden of disease (GBD) [5]. Under such scenario, monitoring key modifiable behavioural risk factors has resulted to be crucial both in spatial terms and as per temporal trends in order to allow comparisons between different geographic areas or levels and over time [[6], [7], [8], [9]]. The targets for the NCD global control were afterwards aligned to those included in the 2030 Agenda for Sustainable Development adopted at the United Nations Summit on Sustainable Development in September 2015, identifying 17 Sustainable Development Goals (SDGs) [10,11]. In more recent years, further studies have been developed to understand achievements attained [12,13], and 12 goals, 33 targets and 57 indicators have been defined as health-related SDGs (HRSDGs) [14].

In Italy, PASSI (Progressi delle Aziende Sanitarie per la Salute in Italia) [15] and Passi d’Argento [16] are the ongoing Behavioural Risk Factor Surveillance Systems (BRFSSs) [17], respectively, on adults (people aged 18−69) and elderly (65 and older). Based on the international model of the US Centers for Disease Prevention and Control (CDC) [18] and committed by the Italian Ministry of Health, they both are officially recognised as per the Decree of the Prime Minister’s Office on Registries and Surveillances, March 2017, 3rd [19]. The National Institute of Health in Italy (namely, Istituto Superiore di Sanità – ISS) is in charge of their coordination at state level, but the operational centres are the Local Health Authorities (LHAs) where, each month, specially trained healthcare workers interview representative samples of resident population [20,21].

As PASSI and Passi d’Argento stand for actual and factual data population-based sources in Italy, they run the main action lines for public health, which are the three “As”: Analysis, Advocacy, Action. It means that the two systems contribute in matter of: delivering scientific analysis, fostering advocacy to policies, supporting action and interventions in public health [22]. A fortiori, in time of Public Health Emergency of International Concern (PHEIC) due to the novel coronavirus disease, coronavirus disease 2019 (COVID-19), it is even more appropriate to highlight the importance of PASSI and Passi d’Argento as surveillances providing prompt information on several HRSDG indicators in population aged 18+ living in Italy [23].

Section snippets

BRFSS sampling procedures and data collection

In the PASSI and Passi d’Argento frameworks, if the base for data collection is the Local Health Unit (LHU), actions as training or data quality monitoring, analysis and dissemination are centrally supervised. In the LHUs participating in the two surveillances, monthly samples are extracted by a random modality from an enrolment list of residents and stratified by gender and age group in the same proportion than the reference target population (adult for PASSI, elderly for Passi d’Argento). The

Description of BRFSS indicators corresponding with HRSDGs

Overall, PASSI and Passi d’Argento are information systems providing data on a total of nine HRSDGs and 19 HRSDG targets/indicators. We describe these pairs more in detail specifying on the one hand where in case of BRFSS core indicators (N = 14 HRSDG targets/indicators) concerning six HRSDGs or, on the other hand, as per BRFSS further in-depth analysis (N = five HRSDG targets/indicators) in regard of four different HRSDGs.

Study results

The two Italian BRFSSs PASSI and Passi d’Argento offer broad information on HRSDGs, by routine and further variables. The larger group of indicators concern either health outcomes, as NCD prevalence including cardiovascular disease, cancer, diabetes or chronic respiratory disease, health professional advice received on correct lifestyles and access to essential services, or social determinants of health as per gender driver, educational level, socioeconomic inequalities, neighbourhood security.

Declaration of Competing Interest

The Authors declare no competing conflicts of interest.

Acknowledgments

Special thanks to the whole PASSI (https://www.epicentro.iss.it/passi/network/coordinatoriLocali) and Passi d’Argento (https://www.epicentro.iss.it/passi-argento/network/rete) networks that, with a great effort, allows the two systems go forward on the national territory. This large surveillance network as a whole is made of the several professionals from the LHUs who conduct the interviews routinely, and regional reference points and the regional/local coordinators who contribute to the data

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