Multidimensional Stratification of Severe Disability: Demographic, Clinical, Geographic, Socio-Economic Profiles and Healthcare Pathways in a Cross-Sectional Italian Cohort

Highlights: What are the main findings? This is the first study to systematically describe the stratification and management of individuals with severe disability in Sicily under the D.M. of 26 September 2016, using data from ASP Catania, in Sicily (Italy). The analysis integrates multiple dimensions—age, sex, healthcare district, type of disorders, and income level—revealing significant demographic, clinical, and territorial heterogeneity in the distribution and needs of the population. What are the implications of the main findings? The findings highlight the need for integrated, personalized care models that are sensitive to age, gender, geographic, and socioeconomic differences, particularly in underserved districts. Addressing the complex needs of individuals with severe disability requires coordinated, multisectoral strategies that ensure equitable access to care while safeguarding social rights and economic sustainability. Background: Individuals with severe disability require intensive and long-term healthcare, rehabilitation and social support. Updated population data are essential to inform planning and resource allocation. This study aimed to quantify—with a cross-sectional analysis conducted in 2025—the demographic, clinical, socioeconomic, and geographic characteristics of individuals with severe disability within the Provincial Health Authority (ASP) of Catania (Sicily) in Italy, and to identify statistically significant differences across subgroups. Methods: A cross-sectional analysis was conducted on 3277 individuals officially certified as having severe disability under the Italian Ministerial Decree of 26 September 2016. Data were extracted from administrative records and stratified by age, sex, clinical classification, income level, and healthcare district. Associations were tested using chi-square statistics. Results: Participants had a mean age of 39.14 ± 28.64 years; Minors represented 33% of the disability cohort (vs. 19.4% minors in the general provincial population) with a mean age 10.28 ± 3.55. Adults accounted for 67% of the cohort (vs. 81% adults in the general population), with a mean age of 69.94 ± 24.61 years. Females constituted 43% of the sample (compared with 51% females in the provincial population), whereas males represented 57% (vs. 49% males in the general population). Most individuals (95.9% of the cohort) had an income level below €25,000/year. Conclusions: The study reveals substantial demographic, socioeconomic, and clinical heterogeneity among individuals with severe disability and highlights significant district-level disparities. Notably, minors appear markedly over-represented in the disability cohort compared with the general population, while females are under-represented, indicating potential age- and sex-related differences in disability burden, access to assessment, or underlying diagnostic patterns. These findings indicate the need for stratified, district-sensitive planning approaches, ensuring equitable access to services and optimizing allocation of healthcare and social resources.