This content was translated from Italian with assistance from generative AI technology.
A study on the evolution of the disease burden in Italy from 2000 to 2021, based on estimates from the Global Burden of Disease 2021 study, highlighted steady improvement in the population’s health until 2019. However, the COVID-19 pandemic disrupted this trend, leading to a reduction in life expectancy and an increase in disease burden, both in terms of mortality and morbidity. The analysis reveals marked regional inequalities, with the North showing more favorable health indicators compared to the South and the Islands, highlighting the urgency of targeted health policies to bridge this gap. In the years before the pandemic, life expectancy at birth in Italy had progressively increased, moving from 79.6 to 83.4 years between 2000 and 2019. With the pandemic, there was a drop to 82.2 years in 2020, followed by a partial recovery in 2021 to 82.7 years. A similar trend was observed for healthy life expectancy, which reached 70.9 years in 2021, highlighting the growing challenge of ensuring quality aging.
The study shows that, between 2000 and 2019, years of life lost due to premature death (YLLs) decreased significantly, mainly thanks to progress in treating cardiovascular diseases and cancers. However, in 2020, the COVID-19 pandemic reversed this trend, resulting in a significant increase in years of life lost, followed by a slight reduction in 2021, but without a return to pre-pandemic levels. Another notable finding is the drastic increase in the fatal burden of Alzheimer’s disease, which has risen by over 50% since 2000, a phenomenon mainly linked to the aging population. However, considering a constant demographic structure, YLLs due to Alzheimer’s remained substantially unchanged during the analyzed period.
At the same time, the number of years lived with disability (YLDs) has continued to increase, with a significant impact from chronic diseases like diabetes and mental illnesses. Before the pandemic, there was a slight reduction in disability related to depressive disorders and an increase for anxiety disorders, but between 2019 and 2021, the YLDs due to both anxiety and depression increased by up to 20%, highlighting the strong psychological impact of COVID-19.
The analysis confirms the existence of significant health inequalities between different areas of the country. Despite the northern regions having an older population compared to the South and the Islands, they continue to show a higher life expectancy and better overall health status. This suggests that the quality and accessibility of health care services play a crucial role in determining population health outcomes. In contrast, the South faces a more fragile health care system, characterized by fewer resources and a lower capacity to meet the population’s needs.
Furthermore, in Northern Italy, many families try to compensate for the deficiencies of the National Health Service by resorting to private spending, while in the South and the Islands, this possibility is more limited, increasing the risk of insufficient access to essential care. The lower out-of-pocket health care spending in these regions does not reflect a lesser need for assistance but rather a greater difficulty in bearing the costs of care.
The pandemic amplified pre-existing critical issues in the health care system, making the need for structural reforms to ensure equitable access to care across the national territory even more urgent. It is essential to invest in strengthening health care infrastructure, with particular attention to the most disadvantaged areas, and to reinforce strategies for preventing chronic diseases. However, the challenge is not limited to physical health: the significant increase in mental
disorders requires making mental health a top priority. In this context, it is crucial to enhance dedicated services, reduce social stigma, and integrate psychological care more effectively into primary health care.
“These results demonstrate that Italy boasts a high life expectancy, but living long does not necessarily mean living well. The main challenge for our country is to reduce health inequalities between the North and South and ensure healthy and quality aging for everyone. The pandemic has highlighted the fragilities of our system, underlining the urgency of rethinking health policies and strengthening prevention and care,” said Giulia Zamagni, an author of the study.
“The burden due to the aging of the population certainly weighs more significantly on some northern regions such as Liguria and Friuli Venezia Giulia. However, the analysis of the disease burden shows how the regions of the South and Islands bear a greater burden on the entire population, which, despite being younger, is more exposed to behavioral risk factors and a health care system in difficulty," said Lorenzo Monasta, an author of the study and national coordinator of the Italian GBD Initiative.
Addressing these challenges requires a joint effort among institutions, the scientific community, and health care professionals, with the goal of building a more equitable, accessible, resilient, and sustainable health care system for the future.
The Global Burden of Disease Study (GBD) is an international research project that comprehensively assesses the health status of people worldwide. Started in 1991, it is currently coordinated by IHME at the University of Washington, with a network of over 12,000 experts from more than 160 countries. Using the latest statistical techniques for large-scale data analysis, it continuously estimates the global burden of diseases and the impact of risk factors, providing a scientific basis for global health policy.
