Setting
cardiovascular and metabolic diseases
DISEASES, CHRONIC DISEASES
The data used for the present study were retrieved from the healthcare utilization databases of Lombardy, a region of Italy that accounts for about 16% (almost 10 million people) of its population. All Italian citizens have equal access to healthcare services (e.g., hospitalizations, outpatient visits, instrumental examinations, laboratory tests, bioimaging, and drugs for chronic diseases) as part of the National Health Service (NHS). In Lombardy, these data are included in an automated system of databases that provides information on individual demographics, drug prescriptions (according to the Anatomical Therapeutic Chemical—ATC—system), medical or surgical interventions, and hospitalizations, according to diagnoses and procedures coded as in the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) system. Because a unique identification code was used for all databases, their linkage provided information on the complete care pathway supplied to NHS beneficiaries for several years. To preserve privacy, in the analyses of the Lombardy databases each individual identification code is automatically deidentified, the inverse process being allowed only to the Regional Health Authority upon request from judicial authorities. A detailed description of the healthcare utilization databases of the Lombardy region in the field of cardiovascular and metabolic diseases is available in previous studies [