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Background Insufficient physical activity (PA) or physical inactivity (PI) is one of the ten leading risk factors for global mortality. PI leads to 20-30% increased risk of all-cause mortality and monitoring its current levels and trends in general population is essential to track progress towards health targets, identify at-risk groups, assess policies' effectiveness, guide future planning. Methods PASSI (Progressi delle Aziende Sanitarie per la Salute in Italia - Progresses in ASSessing adult population health in Italy) is an ongoing cross-sectional Behavioral Risk Factor Surveillance System (BRFSS) that monitors prevalence and temporal trends for the major modifiable health-related risk factors in the adults (18-69 years) residing in Italy. Data are collected in the Local Health Units (LHU) by trained personnel who administer a standardized questionnaire telephonically to sampled people. In the period 2015-2018, 132,717 people were interviewed in more of 90% LHUs (89 out of 101 in 2018), achieving a response rate above 80%. Concerning PA/PI, respondents are classified as per the WHO indicators in: (i) Active - basing on levels achieved in leisure time and/or heavy work; (ii) Partially active - in leisure time and/or moderate work or in spare time and without regular work; (iii) Inactive - in leisure time with sedentary work or in spare time and without regular work. PASSI calculates prevalence of PA/PI overall and by socio-demographic characteristics, including 95% confidence intervals (CI), and a logistic regression model estimates adjusted prevalence ratios (APR). Results In Italy, 28.8% (CI95%:28.5-29.1%) of adult population is featured by a sedentary lifestyle: PI is greater among women (32.4% vs. 25.1%; APR: 1.26), grows with age (34% in over50 vs. 24.7% among 18-34 year-old; APR: 1.34), is higher among deprived people both per economic difficulties (41.7% if many vs. 22.4% if none; APR: 1.39) and for education level (23.7% university vs. 47.2% primary/any; APR: 1.33). We observed a highly evident geographic gradient: PI amounts to 18.3% in the North, 25.2% in the Centre and 40.6% in the South. A multivariate analysis confirms these values are statistically significant. Conclusions PASSI data provide strong evidence to support community prevention interventions on territorial planning or advice by health professionals.

(1) Age-friendly health systems ensure access to quality healthcare services to all people, especially older adults. (2) We used data on elderly population collected from 2016 to 2019 by the Italian ongoing surveillance system PASSI d’Argento to analyze the prevalence and associations between accessing health services and modifiable risk factors included in the 25 × 25 strategy for the burden of noncommunicable diseases with health outcomes. (3) Chronic diseases and hospitalization as descriptors of health status showed that the elderly perceived as having poor access to care and prevention incurred a higher risk of hospitalization. The association between difficulties in accessing health services and hospitalization was always the highest in terms of the adjusted prevalence ratio (aPR), regardless of the other behavioral risk factors considered, controlling each model with sociodemographic conditions. Elderly hospitalized at least once for two days or more in the last 12 months had greater risk to have problems in accessing health services, whereas the model included health conditions such as obesity (aPR = 1.95 95% CI 1.75–2.17), smoking (aPR = 1.95 95% CI 1.76–2.16), alcohol use (aPR = 1.93 95% CI 1.73–2.14), hypertension (aPR = 1.92 95% CI 1.73–2.13) and diabetes (aPR = 1.91 95% CI 1.73–2.12). (4) Health policies should encompass socio-economic and living environment barriers which prevent access to care among older adults.