Patients with chronic diseases know they are living with a disease that will follow them for their entire life. There is a wide range of chronic diseases, ranging from diabetes to respiratory diseases, muscular-skeletal disorders to vision impairment, hearing loss and even cancer. Chronic diseases are the leading cause of death in the world today and WHO has defined them as an “invisible epidemic”. In addition to their high mortality rate, chronic diseases can be quite invalidating.
The situation in Italy
The situation in Italy is anything but reassuring. According to the National Observatory on Health in the Italian Regions, 40% of the population is affected by chronic diseases. This is more than 24 million people, half of which suffer from multiple chronic conditions. If this is what the present holds, the future will be even more bleak. It is estimated that in 2028 more than 12 million Italians will have been affected by hypertension, 5.3 million by osteoporosis and 3.6 by diabetes.
Not only are these numbers burdensome for patients, but take a toll on the National healthcare system which will have to spend more than 70 billion euro only in 2028 to treat chronic diseases.
The only real solution is staying one step ahead of the game by identifying the most common risk factors and what can be done to change them.
The majority of chronic diseases are caused by alcohol and tobacco consumption, an unhealthy diet and a lack of physical exercise. Other risk factors include age and genetic predisposition, but these cannot be changed. For this reason, prevention through a healthy lifestyle is essential and the most effective in fighting chronic diseases. Everyone can significantly reduce the risk of developing these diseases simply by adopting healthy habits and, in particular, by not smoking, maintaining a balanced diet, limiting alcohol consumption and engaging in regular physical activity.
The impact of an unhealthy lifestyle
In Europe alone, chronic diseases have become such a widespread problem that WHO has developed a European strategy called “Gaining health” for the prevention, awareness and monitoring of chronic diseases. The strategy has also been adopted by the Ministry of Health in Italy. While Italy is one of the countries with the highest life expectancy, hope for a long life with good health is not as high in other European countries. For example, despite the number of prevention campaigns against smoking, the number of smokers since 2014 has practically remained the same. Data gathered in 19 countries by WHO from 2012-2013 shows that Italy is one of the countries with the highest prevalence of overweight and obesity in children 8-9 years old, alongside Greece and Spain. In general, Italians are overweight. One-third of the population is overweight and one out of ten people is obese. In the future, the national healthcare system must intensify its efforts to promote prevention in the population and change standards with respect to how treatment services are carried out. New healthcare pathways must be defined that are able to take care of the patient in the long term, prevent and contain disabilities and ensure the continuity of care and the integration of social-health activities.
Territory and gender
The National Observatory on Health in the Italian Regions also highlighted that territory, gender and social class impact the spread of chronic diseases. This is yet more proof that change can deter the spread of chronic diseases.
The first fact to emerge is the lower the level of education, the higher the incidence of chronicity and this gap increases the higher the degree obtained. In 2017, in the 45-64 years old age group (the group with the highest level of chronicity), 56% of people with at least one chronic disease had either an elementary education or no formal education at all, a percentage that decreased to 46.1% for people with a diploma and to 41.3% for people that had a degree.
Geography also influences chronicity. Regions with a higher pro capita income have a lower incidence of chronic diseases. For example, the Basilicata has the highest prevalence of chronic bronchitis, Sardinia the highest of osteoporosis and Calabria the highest of diabetes.
Regarding the impact of gender, women are affected by chronic diseases more than men (even though women have a higher life expectancy) and have a higher rate of multiple chronic conditions.
The most wide-spread chronic diseases
Cardiovascular diseases: the number one cause of death in the world and in Italy, responsible for 240,000 deaths per year of which 110,000 are men and 130,000 are women. There are many risk factors for these diseases and some, such as age, cannot be changed while others, such as a balanced diet and a healthy lifestyle can be. According to the Italian National Institute of Health (Iss), people who do not smoke and are not overweight (with a body mass index lower than 25) have a lower risk of being affected.
Tumors: the second cause of death in the world after cardiovascular diseases. According to the “Cancer Figures in Italy” 2016 report by AIOM and AIRTUM (Italian Association of Cancer Registries), almost 1000 new cases of cancer are diagnosed in Italy each day. The most frequent type of cancer is breast cancer, followed by colorectal cancer, prostate and finally lung cancer. According to ISTAT, there were 373,000 cases of malignant tumors in 2018. Fortunately, mortality rates for cancer are decreasing in both men and women and the percentage of recoveries has improved overall as well, especially due to the increased adherence to screening campaigns that allow for early diagnosis and, thus, more effective treatments.
Diabetes: a major global health emergency currently affecting 422 million people and that could arrive at more than 5 million in Italy alone by 2030. Diabetes arises when the body is not able to use insulin (the hormone that regulates the quantity of sugar in the blood) efficiently, or when the pancreas does not produce the amount of insulin the body needs. According to the Non-profit Italian Association of Diabetes, more than 3.5 million Italians have been diagnosed with diabetes and another million people do not know they have the disease, thus putting 3.6 million people at risk. The majority of people with diabetes are affected by type 2 diabetes. Type 1 diabetes, instead, is rarer. It is an autoimmune disease that often affects young people and requires a daily intake of insulin. In Italy, 18,000 children are affected by type 1 diabetes.
Dementia and mental illnesses: these disorders affect more than 450 million people throughout the world and one out of four people are affected in Europe. These illnesses also include serious diseases such as schizophrenia, depression, anxiety, anorexia, bulimia and alcohol abuse disorders. These diseases have a strong impact on the social spheres of the patient, provoking isolation, a low quality of life and a high rate of mortality. The word dementia, instead, comprises a large group of chronic degenerative diseases that progressively lead to a loss of autonomy and different degrees of disability. According to the “World Alzheimer Report 2016” published by Alzheimer’s Disease International, 47 million people suffer throughout the world. There are many forms of dementia. Some forms are reversible (when the deficit is due to disease within another organ or system) and some are irreversible, such as Alzheimer’s or frontotemporal dementia. According to experts, due to the aging population, the number of patients affected by dementia is destined to rise by 2050 to 131 million. Italy, as reported by the Dementia Observatory of the Italian National Institute of Health, has one of Europe’s oldest populations and almost 17% of the population (9.5 million) is over 65. For now, over 1 million patients suffer from dementia, 600,000 from Alzheimer’s and approximately 3 million other people are directly or indirectly involved in taking care of these loved ones.
Respiratory diseases: According to the Ministry of Health, all respiratory diseases combined represent a serious public health problem, bringing about important negative effects on the quality of life as well as disability in patients. Main risk factors include environmental aspects such as smog, occupational exposure, air pollution, unhealthy diets and infections. Nevertheless, individual risk factors such as genetic influences and family history, specific nutritional aspects and lack of physical activity must not be ignored. Chronic respiratory diseases represent a vast range of diseases including bronchial asthma, chronic obstructive pulmonary disease (COPD), occupational respiratory diseases, rhinitis, rhinosinusitis, sleep apnea syndrome and pulmonary hypertension. In Italy, chronic respiratory diseases are the third leading cause of death (more than 16,000 deaths each year) after cardiovascular and neoplastic diseases.
Improving the course of the disease: PSPs
With the hope that prevention is increasingly more effective in dramatically decreasing the percentage of chronic diseases in the future, right now we must deal with the millions of people who are currently affected. Patient Support Programs provide invaluable support in the treatment of chronic diseases and aim at improving a patient’s state of health and adherence to therapy by providing services such as home care, the administration of drugs at home or in hospitals and telematic and online support 24/7 for any type of problem including psychological. Domedica has been designing personalized Patient Support Programs for more than 15 years and offers patient-centered care that guarantees the most effective treatment possible.