The Indian Journal of Pediatrics

, Volume 86, Supplement 1, pp 3–9 | Cite as

The Role of Maternal Citizenship on Pediatric Avoidable Hospitalization: A Birth Cohort Study in North-East Italy

  • Andrea Bardin
  • Teresa Dalla Zuanna
  • Susanna Favarato
  • Lorenzo Simonato
  • Loris Zanier
  • Rosanna Irene Comoretto
  • Cristina CanovaEmail author
Review Article



Avoidable hospitalization (AH) has been widely studied as a possible measure of primary health care performance. Since studies evaluating AH in migrant children, particularly in Europe, are lacking, the aim of this study was to investigate the role of maternal citizenship on the risk of AH in children.


The cohort study included all live newborns recorded in the Medical Birth Register (MBR) of Friuli-Venezia Giulia Region (Italy) in the years 1989–2012, followed from 30 d after their birth up to the 14th year of life. Cox regression models were used to estimate Hazard Ratios (HRs) for any AH and for specific conditions.


Among the 213,635 children included in the cohort, authors identified 23,011 AHs in 16,744 children, most of which occurred between 1 and 4 y of age. Children born to mothers from High Migration Pressure Countries had a higher risk of AH for any condition (HR 1.35; 95% CI = 1.27–1.44) than children born to Italian mothers. The risks were higher concerning gastroenteritis (HR 1.74; 1.57–1.94), upper respiratory tract infections (HR 1.58; 1.35–1.84), asthma (HR 1.53; 1.12–2.06) and bacterial pneumonia (HR 1.18; 1.01–1.37). There were no differences in urinary tract infections, short term complications of diabetes and perforated appendix.


Despite the inclusiveness and universality of the Italian healthcare system, children born to immigrant mothers experienced more need of avoidable hospital care than children born to Italian mothers. Access barriers to primary care are plausible causes for the observed disparities.


Avoidable hospitalization Migration Children Maternal citizenship Socio demographic factors Italy 


Author’s Contributions

AB and CC designed the study and wrote the manuscript; LS and LZ participated in coordination of the study; CC performed the statistical analysis; TDZ, SF, LZ and RIC critically revised the manuscript and contributed to the discussion. All authors contributed to results interpretation, read and approved the final manuscript. Prof. Cristina Canova will act as guarantor for this paper.

Compliance with Ethical Standards

Conflict of Interest


Source of Funding



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Copyright information

© Dr. K C Chaudhuri Foundation 2019

Authors and Affiliations

  • Andrea Bardin
    • 1
  • Teresa Dalla Zuanna
    • 1
  • Susanna Favarato
    • 1
  • Lorenzo Simonato
    • 1
  • Loris Zanier
    • 2
  • Rosanna Irene Comoretto
    • 1
  • Cristina Canova
    • 1
    Email author
  1. 1.Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public HealthUniversity of PaduaPaduaItaly
  2. 2.Epidemiological Service, Health Directorate, Friuli Venezia-Giulia RegionUdineItaly

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