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. 2025 Apr;10(4):e309-e320.
doi: 10.1016/S2468-2667(25)00045-3.

State of health and inequalities among Italian regions from 2000 to 2021: a systematic analysis based on the Global Burden of Disease Study 2021

Mohsen Naghavi; GBD 2021 Italy Subnational Burden of Disease Collaborators
Collaborators

State of health and inequalities among Italian regions from 2000 to 2021: a systematic analysis based on the Global Burden of Disease Study 2021

Mohsen Naghavi et al. Lancet Public Health. 2025 Apr.

Abstract

Background: Over the past two decades, the Italian National Health Service has been gradually decentralised, with Italy's 21 regional governments now responsible for managing their health services. This change, coupled with austerity measures and a steadily ageing population, has adversely affected universal health coverage and equity, exacerbating inequalities and regional disparities. This study aimed to analyse time trends and subnational differences in the burden of disease from 2000 to 2019, and from 2019 to 2021 to capture the effects of the COVID-19 pandemic.

Methods: This study uses estimates for Italy from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021. We analyse trends and geographical differences in disease burden from 2000 to 2021. Metrics include life expectancy, health-adjusted life expectancy (HALE), years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) observed at national, macroregional, and subnational levels. Percent changes in rates, with both all-age and age-standardised rates, and 95% uncertainty intervals (95% UIs) are reported.

Findings: Life expectancy at birth in Italy increased from 79·6 years in 2000 to 83·4 years in 2019, dropped to 82·2 years in 2020 due to COVID-19, and recovered slightly to 82·7 years in 2021. HALE was 70·9 years (95% UI 67·4-73·8) in 2021. Substantial regional disparities were observed: in general, despite higher YLD rates, northern regions had better health outcomes, with higher life expectancy and HALE and lower YLL rates compared with southern regions. Overall, the top causes of YLDs were low back pain (1556·5 [1098·5-2080·2]), falls (926·2 [638·8-1253·8]), and headache disorders (858·0 [173·7-1808·2]). Anxiety and depressive disorders both had substantial increases in the period from 2019 to 2021 (19·8% and 17·3%, respectively). YLDs for Alzheimer's disease and diabetes increased substantially from 2000 to 2019 and 2019 to 2021 (70·6% and 3·0% for Alzheimer's disease and 46·8% and 7·9%, respectively for each timepoint). YLL rates declined for ischaemic heart disease from 2000 (-29·9% in 2019), but increased for Alzheimer's disease and other dementias (54·5%). DALY rates decreased overall from 2000 to 2019, but rose again in 2021 due to the COVID-19 pandemic.

Interpretation: The study highlights considerable regional disparities in Italy's health outcomes, driven by demography, heterogeneous health service quality, and economic inequalities. Addressing the increasing burden of Alzheimer's disease, diabetes, and mental health disorders, as well as regional disparities, requires strengthened preventive measures, equitable health service access, and socioeconomic policies, both at the national and regional levels.

Funding: Bill & Melinda Gates Foundation.

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Conflict of interest statement

Declaration of interests FB declares the position of Secretary of International Commission on Occupational Health Scientific Committee on Cardiology in Occupational Health. MBe declares payment or honoraria from Lundbeck and Angelini. ML declares payment for attending meetings or travel from the European Academy of Neurology Society of Neurology and from the Italian Society of Neurology. GZ, LGM, LMo, and LR declare payments to their institutions from the Italian Ministry of Health in support of this work. RaP declares grants or contracts from the UK Multiple Sclerosis Society and payment or honoraria from Biogen, MSD, Sanofi, and BMS. RoP declares membership of a data safety monitoring board for Fondazione Italiana Linfomi–ETS; an unpaid leadership role at the European Society for Blood and Marrow Transplantation; and past membership of the IRB/IEC Comiato Etico AO SS. SS declares grants or contracts with Novartis and Uriach; consulting fees and payments or honoraria from Novartis, Allergan (AbbVie), Teva, Lilly, Lundbeck, Pfizer, Novo Nordisk, Abbott, and AstraZeneca; support for attending a meeting or travel costs from Lilly, Novartis, Teva, Lundbeck, and Pfizer; receipt of medical equipment, drugs, or materials from Allergan (AbbVie) and Novo Nordisk; and is President of the European Stroke Organisation and Editor-in-Chief of Cephalalgia. DT declares payments or honoraria from AstraZeneca, Eli Lilly, and Novo Nordisk; support for attending meetings or travel from AstraZeneca, participation on data safety monitoring boards at Amarin, Npejringer Ingelheim, and Novo Nordisk; receipt of medical equipment, drugs, or materials from Abbott and PharmaNutra; and leadership roles at the European Association for the Study of Diabetes Early Career Academy and Committee on Clinical Affairs.

Figures

Figure 1
Figure 1
Trends of LE by region and macroregions in Italy for females (A) and males (B) between 2000 and 2021 Estimates are reported with 95% UIs. AP=Autonomous Province. UI=uncertainty interval.
Figure 2
Figure 2
Percentage change in life expectancy at birth by cause of death and region between 2000 and 2021 AP=Autonomous Province. NCDs=non-communicable diseases. CKD=chronic kidney disease. IPV=interpersonal violence. LRIs=lower respiratory infections.
Figure 3
Figure 3
Ten leading causes of all-age YLDs in 2019 in Italy and the five macroregions between 2000 and 2021 Rates are expressed per 100 000 people. Changes indicate the YLD rate change in percent. Alzheimer=Alzheimer's disease and other dementias. CMNNDs=communicable, maternal, neonatal, and nutritional disorders. NCDs=non-communicable diseases. UI=uncertainty interval. YLD=years lived with disability.
Figure 4
Figure 4
Ten leading causes of all-age YLLs in 2019 in Italy and the five macroregions between 2000 and 2021 Rates are expressed per 100 000 people. Changes indicate the YLL rate change in percent. Alzheimer=Alzheimer's disease and other dementias. COPD=chronic obstructive pulmonary disease. CLDs=chronic liver diseases. CMNNDs=communicable, maternal, neonatal, and nutritional disorders. NCDs=non-communicable diseases. UI=uncertainty interval. YLL=years of life lost.
Figure 5
Figure 5
All-age versus age-standardised YLL rates in Italy by region, 2021 Rates are expressed per 100 000 people. Regions and APs are numbered following the classification provided by the National Institute of Statistics. AP=autonomous province. YLL=years of life lost.
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