Roberto Lillini - Academia.edu (original) (raw)
Papers by Roberto Lillini
Questo studio pilota affronta la correlazione fra deprivazione socioeconomica, disabilita, non au... more Questo studio pilota affronta la correlazione fra deprivazione socioeconomica, disabilita, non autosufficienza e strategie di copertura a livello nazionale e regionale, cercando di individuare punti critici e di forza per i sistemi regionali. L’esistenza di un legame tra queste dimensioni e infatti verificato dai dati: oltre ad essere aumentato il tasso generale di poverta relativa, aumenta il rischio di poverta tra gli anziani e tra le famiglie ad alto carico di cura. La non autosufficienza, intesa come rischio individuale che si corre o come bisogno a cui si deve far fronte, e il punto di incontro. Il lavoro, svolto su dati da fonti ufficiali (Istat, Inps, etc.), ha prodotto una selezione delle variabili correlate significativamente con l’incidenza di poverta, evidenziando come un aumento del tasso di disabilita, dell’indice di dipendenza e di altri fattori di contesto (livello di istruzione bassa, numerosita elevata del nucleo familiare) produca un aumento proporzionale dell’indi...
Journal of Preventive Medicine and Hygiene, 2021
Summary Aims Genoa is a city hit by a strong economic, demographic and social involution. The cha... more Summary Aims Genoa is a city hit by a strong economic, demographic and social involution. The changes in the demographic and socio-economic (SE) situation were analysed and the capacity of two Socio-Economic and Health Deprivation Indices (SEHDI) in describing the evolutions of the recent period were verified. Material and methods The data about the evolution of demographic and SE situation in Genoa came from publications of Statistics Offices of Genoa Municipality and Liguria Region and from published analyses of Bank of Italy. The two SEHDIs, referring to 2001 and 2011 population, were computed at census tract level by linear regression, factor and clusters analyses and had been already validated and published. Results Wide transformations in aging and population composition by age groups and gender occurred in Genoa between 1951 and 2016. Internal (from other Italian regions) and external (from other countries) migrations concurred to change the profile of Genoese population. The...
Neurological Sciences
The risk of malignancy associated with sequential disease-modifying therapies (DMTs) for patients... more The risk of malignancy associated with sequential disease-modifying therapies (DMTs) for patients with multiple sclerosis (MS) is uncertain. The aim of this study was to analyze the risk of cancer in patients with MS treated with azathioprine (AZA) and the influence of sequential DMTs on the risk. We retrospectively enrolled a cohort of AZA-treated MS patients followed in two Italian centers from 1987 to 2019. The ratio between observed and expected cancers in the Italian general population was calculated as standardized incidence ratio (SIR). Associations between AZA and DMTs and cancer were estimated by Cox proportional hazards model. We identified 500 AZA-treated MS patients, followed for a median time of 9.7 (0.1–45.7) years: 61.8% of them were treated with DMTs. We found 22 cases of cancer (4.4%). The SIR was 1.14 (95% CI 0.98–1.29), not significantly increased in comparison with the general population. However, the risk was significantly higher in the quintiles of age 32–45, SIR 1.21 (95% CI 1.21–1.42), and 46–51, SIR 1.11 (95% CI 1.11–1.32) than in older cases. Age at AZA treatment onset was the only covariate significantly related to cancer incidence (HR = 1.049, 95% CI 1.007–1.093). The exposure to other DMTs did not modify the risk. The risk of malignancy in MS patients after AZA was similar to that of the general population and did not change with other DMTs sequential treatments. The increased risk in the younger ages should be considered in treatment assessment.
Summary Objective The aim of this paper is to describe the results obtained from the application ... more Summary Objective The aim of this paper is to describe the results obtained from the application of a specific local deprivation index, to general and cause-specific mortality and influenza vaccination coverage among elderly people in the municipality of Florence. Methods General and cause-specific mortality data (2009-2013) and influenza vaccination coverage data (2015/16 and 2016/17) were collected for subjects aged ≥ 65 years residing in the municipality of Florence (Tuscany), at the 2011 Census section level. A Socio-Economic and Health Deprivation Index (SEHDI) was constructed and validated by means of socio-economic indicators and mortality ratios. Results Half of the population of Florence belonged to the medium deprivation group; about 25% fell into the two most deprived groups, and the remaining 25% were deemed to be wealthy. Elderly people mostly belonged to the high deprivation group. All-cause mortality and cause-specific mortality (cancer and respiratory diseases) reach...
BACKGROUND The objective is to show variations in the number of non-tenured personnel (NTP) in a ... more BACKGROUND The objective is to show variations in the number of non-tenured personnel (NTP) in a public health research centre (IRCCS) between 30th June 2016 and 31st December 2017. In this time interval, the issue of NTP was at the centre of governmental discussions. METHODS Data collection was performed from CVs and scientific publications of NTP working at the Fondazione IRCCS Istituto Nazionale dei Tumori (INT). We compared the characteristics of NTP entering or leaving INT and those of NTP who remained in the considered time interval. RESULTS NTP in INT counted 465 members of staff at 30th June 2016 and 472 at 31st December 2017. 75% of these works in the research. 26% of NTP left INT and their position resulted entirely substituted by other NTP. NTP staff who left are mainly aged under 40 and show fewer publications than those who stayed. Newly acquired NTP are younger and show a fewer number of publications compared to the personnel who left. CONCLUSIONS 1 out of 4 NTP member...
Journal of Preventive Medicine and Hygiene, 2018
Summary Introduction The elderly are among the main targets of influenza vaccination campaigns. P... more Summary Introduction The elderly are among the main targets of influenza vaccination campaigns. Previous studies have shown that socio-economic status influences compliance with influenza vaccination, particularly in the elderly. Deprivation indexes can therefore be useful in identifying population groups with lower vaccination uptake and guide targeted intervention to improve vaccination coverage. We analysed the correlation between influenza vaccination coverage and levels of socio-economic and health deprivation among the population of Cagliari, by means of an Index of Socio-Economic and Health Deprivation (SEHDI) specifically tailored to the city, in order to identify population subgroups needing specific intervention to improve vaccination coverage. Methods A combination of linear regression, factor analysis and cluster analysis was adopted in order to build the SEHDI at the Census Tract (CT) level; data were taken from the 2011 Italian Census. Mortality among subjects aged ≥ 6...
European Journal of Cancer Prevention
BACKGROUND Early diagnosis of breast, colon, rectum and prostate cancers improves health outcomes... more BACKGROUND Early diagnosis of breast, colon, rectum and prostate cancers improves health outcomes. Low socioeconomic status (SES) is related to advanced stages at diagnosis; inequalities could explain differences in outcomes by age. The influence of SES, age and residence area on staging was explored in the Umbrian population. METHODS 2001-2010 cases were geo-coded by census tract of residence. Stage distribution or Gleason score were analyzed by multilevel multinomial logistic regression with age and SES as the fixed effects and census tract as the random-effect. RESULTS For breast and colorectal cancers, the screening age class was advantaged. For breast, age effect was modulated by deprivation and census tract. In the elderly, the richest were advantaged, the poorest disadvantaged; issues emerged for the young. For colon, age effect is modulated by census tract in early stages and deprivation in late stages. The elderly were disadvantaged; the young and the deprived had more stages IV. About rectum, age effect was modulated by deprivation in the late stages. The elderly were disadvantaged; the young and the deprived presented more stages IV. For prostate, age effect was modulated by deprivation and census tract. The intermediate age class was advantaged, the elderly disadvantaged. CONCLUSION Age was not always the determinant of a delayed staging when SES was considered. For breast and colorectal cancers, issues of delayed diagnosis emerged in the young. If the care center was near the residence, the census tract modified the stage at diagnosis. These results are useful to reduce SES barriers by specific programs adapted to the age of the patient and area of residence.
Reviews of Environmental Contamination and Toxicology
Health risks at population level may be investigated with different types of environmental studie... more Health risks at population level may be investigated with different types of environmental studies depending on access to data and funds. Options include ecological studies, case-control studies with individual interviews and human sample analysis, risk assessment or cohort studies. Most public health projects use data and methodologies already available due to the cost of ad-hoc data collection. The aim of the article is to perform a literature review of environmental exposure and health outcomes with main focus on methodologies for assessing an association between water and/or soil pollutants and cancer. A systematic literature search was performed in May 2019 using PubMed. Articles were assessed by four independent reviewers. Forty articles were identified and divided into four groups, according to the data and methods they used, i.e.: (1) regression models with data by geographical area; (2) regression models with data at individual level; (3) exposure intensity threshold values for evaluating health outcome trends; (4) analyses of distance between source of pollutant and health outcome clusters. The issue of exposure assessment has been investigated for over 40 years and the most important innovations regard technologies developed to measure pollutants, statistical methodologies to assess exposure, and software development. Thanks to these changes, it has been possible to develop and apply geo-coding and statistical methods to reduce the ecological bias when considering the relationship between humans, geographic areas, pollutants, and health outcomes. The results of the present review may contribute to optimize the use of public health resources.
PLoS ONE, 2014
We stratified the Italian population according to age and gender in order to evaluate mortality t... more We stratified the Italian population according to age and gender in order to evaluate mortality trends over more than one century. Data covering the 1901-2008 period were used to study the yearly variations in mortality. Fluctuations in age-adjusted mortality curves were analyzed by Join Point Regression Models, identifying Join Points and Annual Percent Changes. A consistent decline in all-cause mortality occurred across the whole period, the most striking variations being observed in the 0-49 years population. In 1901, other and undefined diseases were the main causes of death, followed by infectious, digestive, and respiratory diseases in the 0-49 years population and by respiratory, cardiovascular, and cerebrovascular diseases in the >50 years population groups. In 2008 the main causes of death were accidents (males) and tumors (females) in the 0-49 age class, tumors in the 50-69 age class (both genders), and tumors (males) and cardiovascular diseases (females) in the elderly. The results highlight the interplay between age and gender in affecting mortality trends and reflect the dramatic progress in nutritional, lifestyle, socioeconomic, medical, and hygienic conditions.
International Journal of Hygiene and Environmental Health, 2013
Critical Reviews in Oncology/Hematology, 2013
During the past few decades, many studies on socio-economic factors and health outcomes have been... more During the past few decades, many studies on socio-economic factors and health outcomes have been developed using various methodologies with differing approaches. A bibliographic research in MEDLINE/PubMed and SCOPUS was carried out for the period 2000-2011 to describe the influence of socio-economic status (SES) on cancer survival, in particular with reference to the outcome of European research results and the results of some cases of other Western studies. This review is divided into two sections: the first describing the different approaches of the study on individuals and populations of the concept of "social class" as well as methods used to measure the association between deprivation and health (i.e. ecological level studies, deprivation indexes, etc.); and the second discussing the association between socio-economic factors and cancer survival, describing the roles of various determinants of differences in survival, such as clinical and pathological prognostic factors, together with consideration of diagnosis and treatment and some patients' characteristics.
Sustainability
The sustainability of European Long-Term Care systems faces the demographic and socio-economic ci... more The sustainability of European Long-Term Care systems faces the demographic and socio-economic circumstances, mainly the increasing ageing of the population, with its chronic disease conditions, and the simultaneous economic general crises, exacerbated by the recent COVID-19 pandemic. Beyond the increase in general rate of relative poverty, there is a higher risk of poverty among elderly and families in a high demand of care, especially if situations of Activities Daily Living (ADL) disability are present. Italian welfare, which is based on family care regimes and regional strategies, and is oriented to private or public care, is a relevant case study with which to analyze such a relationship. This paper aims to study the relationship between ADL disability and the socio-economic deprivation of families, that is, household poverty. Variables came from the ISTAT Health for All Italian Database and the INAIL Disability Allowance Database. A pool of statistical methods, based on bivari...
Journal of Preventive Medicine and Hygiene, 2019
Summary Objectives The aim was to provide an affordable method of computing socio-economic (SE) d... more Summary Objectives The aim was to provide an affordable method of computing socio-economic (SE) deprivation indices at the regional level, in order to reveal the specific aspects of the relationship between SE inequalities and health outcomes. The Umbria Region Socio-Health Index (USHI) was computed and compared with the Italian National Deprivation Index at the Umbria regional level (NDI-U). Methods The USHI was computed by applying factor analysis to census tract SE variables correlated with general mortality and validated through comparison with the NDI-U. Results Overall mortality presented linear positive trends in USHI, while trends in NDI-U proved non-linear or non-significant. Similar results were obtained with regard to specific causes of death according to deprivation groups, gender and age. Conclusions The USHI better describes a local population in terms of health-related SE status. Policy-makers could therefore adopt this method in order to obtain a better picture of SE...
Social Indicators Research
"This report analyses the quality assurance policies for long-term care (LTC) in the following co... more "This report analyses the quality assurance policies for long-term care (LTC) in the following countries: Austria, Estonia, Finland, France, Germany, Hungary, Italy, Latvia, Poland, Slovakia, Slovenia, Spain, Sweden, the Netherlands, and the United Kingdom.
The authors first discuss quality assurance in LTC by analysing: the dimensions of quality, the policy frameworks for quality in LTC, the different levels of development of LTC quality policies at the international, national, organisational, and individual levels. Second, they describe the methodology for collecting and analysing data on quality policies in the selected countries, and report and discuss the results. Policy recommendations are proposed at the end."
Epidemiologia E Prevenzione, May 1, 2012
During the last twenty years, in the most of the European nations, studies on how measuring socio... more During the last twenty years, in the most of the European nations, studies on how measuring socioeconomic differences related to inequities in take in charge of patients, health care and outcomes have been developed. The aim of this paper is the computation of a Liguria Region Deprivation Index (IDR), able to describe the peculiar health characteristics of the Liguria population, economically and socially quite homogeneous, on the basis of the socioeconomic (SE) differences related to health outcomes according to the differences in general mortality. All the population and households variables from the 2001 Italian Census have been considered at municipal level and, for Genoa and Savona, at lower administrative area level, selecting only the ones significantly correlated to the general mortality by Pearson correlation. The Standard Mortality Ratios (SMR on 2001 standard Liguria population) for Overall Mortality by gender and age groups (0-64 years and 65+ years) have been used as dependent variables. In order to build the RDI and classify the areas on the basis of increasing socioeconomic deprivation, a multivariate methodology have been used by means of principal component factor analysis of the previous selected variables and k-means clustering of the geographical areas; then these results have been compared with the SMR by analysis of variance. Finally, the RDI has been applied to the SMR of some groups of principal causes of death (all tumours and cardiovascular, respiratory and digestive system diseases), in order to differentiate the population by health outcomes. Two factors have been identified: an economic-educational factor and a socio-familiar one. The first factor describes the educational level and occupation, while the second one the marital status, the family dimension and the house peculiarities. The clustering procedure has allowed to identify five groups of geographical areas, distributed by the increasing of the SE deprivation. The most problematic areas are located in the countryside or in some spot places of the seaside, far from the health care centres and with difficult access by travel connection. The association between RDI and overall mortality SMRs confirms the relationship between deprivation and mortality increases, according to a statistically significant linear trend. Similar relationships have been observed for cardiovascular and digestive system diseases, while no associations have been found for respiratory illness and overall cancers. The RDI is able to give information on the health differences in the population, by differentiating the mortality trend on the basis of specific situations of richness and social hardship. It is useful not only for disentangling by economic condition, but also by the resources of the social and familiar support to cope with the illness situations. So, the relationship between deprivation and mortality, according to a statistically significant linear trend, shows how groups of Liguria people suffer by a lack of familiar resources, which strongly reduces the possibility of a quick take in charge and the adhesion to the more adequate therapeutic procedure, till to fatal results. In this way, areas of aimed actions can be defined by the local decision-makers, in order to optimize the health resources allocation and to reduce inequities.
Questo studio pilota affronta la correlazione fra deprivazione socioeconomica, disabilita, non au... more Questo studio pilota affronta la correlazione fra deprivazione socioeconomica, disabilita, non autosufficienza e strategie di copertura a livello nazionale e regionale, cercando di individuare punti critici e di forza per i sistemi regionali. L’esistenza di un legame tra queste dimensioni e infatti verificato dai dati: oltre ad essere aumentato il tasso generale di poverta relativa, aumenta il rischio di poverta tra gli anziani e tra le famiglie ad alto carico di cura. La non autosufficienza, intesa come rischio individuale che si corre o come bisogno a cui si deve far fronte, e il punto di incontro. Il lavoro, svolto su dati da fonti ufficiali (Istat, Inps, etc.), ha prodotto una selezione delle variabili correlate significativamente con l’incidenza di poverta, evidenziando come un aumento del tasso di disabilita, dell’indice di dipendenza e di altri fattori di contesto (livello di istruzione bassa, numerosita elevata del nucleo familiare) produca un aumento proporzionale dell’indi...
Journal of Preventive Medicine and Hygiene, 2021
Summary Aims Genoa is a city hit by a strong economic, demographic and social involution. The cha... more Summary Aims Genoa is a city hit by a strong economic, demographic and social involution. The changes in the demographic and socio-economic (SE) situation were analysed and the capacity of two Socio-Economic and Health Deprivation Indices (SEHDI) in describing the evolutions of the recent period were verified. Material and methods The data about the evolution of demographic and SE situation in Genoa came from publications of Statistics Offices of Genoa Municipality and Liguria Region and from published analyses of Bank of Italy. The two SEHDIs, referring to 2001 and 2011 population, were computed at census tract level by linear regression, factor and clusters analyses and had been already validated and published. Results Wide transformations in aging and population composition by age groups and gender occurred in Genoa between 1951 and 2016. Internal (from other Italian regions) and external (from other countries) migrations concurred to change the profile of Genoese population. The...
Neurological Sciences
The risk of malignancy associated with sequential disease-modifying therapies (DMTs) for patients... more The risk of malignancy associated with sequential disease-modifying therapies (DMTs) for patients with multiple sclerosis (MS) is uncertain. The aim of this study was to analyze the risk of cancer in patients with MS treated with azathioprine (AZA) and the influence of sequential DMTs on the risk. We retrospectively enrolled a cohort of AZA-treated MS patients followed in two Italian centers from 1987 to 2019. The ratio between observed and expected cancers in the Italian general population was calculated as standardized incidence ratio (SIR). Associations between AZA and DMTs and cancer were estimated by Cox proportional hazards model. We identified 500 AZA-treated MS patients, followed for a median time of 9.7 (0.1–45.7) years: 61.8% of them were treated with DMTs. We found 22 cases of cancer (4.4%). The SIR was 1.14 (95% CI 0.98–1.29), not significantly increased in comparison with the general population. However, the risk was significantly higher in the quintiles of age 32–45, SIR 1.21 (95% CI 1.21–1.42), and 46–51, SIR 1.11 (95% CI 1.11–1.32) than in older cases. Age at AZA treatment onset was the only covariate significantly related to cancer incidence (HR = 1.049, 95% CI 1.007–1.093). The exposure to other DMTs did not modify the risk. The risk of malignancy in MS patients after AZA was similar to that of the general population and did not change with other DMTs sequential treatments. The increased risk in the younger ages should be considered in treatment assessment.
Summary Objective The aim of this paper is to describe the results obtained from the application ... more Summary Objective The aim of this paper is to describe the results obtained from the application of a specific local deprivation index, to general and cause-specific mortality and influenza vaccination coverage among elderly people in the municipality of Florence. Methods General and cause-specific mortality data (2009-2013) and influenza vaccination coverage data (2015/16 and 2016/17) were collected for subjects aged ≥ 65 years residing in the municipality of Florence (Tuscany), at the 2011 Census section level. A Socio-Economic and Health Deprivation Index (SEHDI) was constructed and validated by means of socio-economic indicators and mortality ratios. Results Half of the population of Florence belonged to the medium deprivation group; about 25% fell into the two most deprived groups, and the remaining 25% were deemed to be wealthy. Elderly people mostly belonged to the high deprivation group. All-cause mortality and cause-specific mortality (cancer and respiratory diseases) reach...
BACKGROUND The objective is to show variations in the number of non-tenured personnel (NTP) in a ... more BACKGROUND The objective is to show variations in the number of non-tenured personnel (NTP) in a public health research centre (IRCCS) between 30th June 2016 and 31st December 2017. In this time interval, the issue of NTP was at the centre of governmental discussions. METHODS Data collection was performed from CVs and scientific publications of NTP working at the Fondazione IRCCS Istituto Nazionale dei Tumori (INT). We compared the characteristics of NTP entering or leaving INT and those of NTP who remained in the considered time interval. RESULTS NTP in INT counted 465 members of staff at 30th June 2016 and 472 at 31st December 2017. 75% of these works in the research. 26% of NTP left INT and their position resulted entirely substituted by other NTP. NTP staff who left are mainly aged under 40 and show fewer publications than those who stayed. Newly acquired NTP are younger and show a fewer number of publications compared to the personnel who left. CONCLUSIONS 1 out of 4 NTP member...
Journal of Preventive Medicine and Hygiene, 2018
Summary Introduction The elderly are among the main targets of influenza vaccination campaigns. P... more Summary Introduction The elderly are among the main targets of influenza vaccination campaigns. Previous studies have shown that socio-economic status influences compliance with influenza vaccination, particularly in the elderly. Deprivation indexes can therefore be useful in identifying population groups with lower vaccination uptake and guide targeted intervention to improve vaccination coverage. We analysed the correlation between influenza vaccination coverage and levels of socio-economic and health deprivation among the population of Cagliari, by means of an Index of Socio-Economic and Health Deprivation (SEHDI) specifically tailored to the city, in order to identify population subgroups needing specific intervention to improve vaccination coverage. Methods A combination of linear regression, factor analysis and cluster analysis was adopted in order to build the SEHDI at the Census Tract (CT) level; data were taken from the 2011 Italian Census. Mortality among subjects aged ≥ 6...
European Journal of Cancer Prevention
BACKGROUND Early diagnosis of breast, colon, rectum and prostate cancers improves health outcomes... more BACKGROUND Early diagnosis of breast, colon, rectum and prostate cancers improves health outcomes. Low socioeconomic status (SES) is related to advanced stages at diagnosis; inequalities could explain differences in outcomes by age. The influence of SES, age and residence area on staging was explored in the Umbrian population. METHODS 2001-2010 cases were geo-coded by census tract of residence. Stage distribution or Gleason score were analyzed by multilevel multinomial logistic regression with age and SES as the fixed effects and census tract as the random-effect. RESULTS For breast and colorectal cancers, the screening age class was advantaged. For breast, age effect was modulated by deprivation and census tract. In the elderly, the richest were advantaged, the poorest disadvantaged; issues emerged for the young. For colon, age effect is modulated by census tract in early stages and deprivation in late stages. The elderly were disadvantaged; the young and the deprived had more stages IV. About rectum, age effect was modulated by deprivation in the late stages. The elderly were disadvantaged; the young and the deprived presented more stages IV. For prostate, age effect was modulated by deprivation and census tract. The intermediate age class was advantaged, the elderly disadvantaged. CONCLUSION Age was not always the determinant of a delayed staging when SES was considered. For breast and colorectal cancers, issues of delayed diagnosis emerged in the young. If the care center was near the residence, the census tract modified the stage at diagnosis. These results are useful to reduce SES barriers by specific programs adapted to the age of the patient and area of residence.
Reviews of Environmental Contamination and Toxicology
Health risks at population level may be investigated with different types of environmental studie... more Health risks at population level may be investigated with different types of environmental studies depending on access to data and funds. Options include ecological studies, case-control studies with individual interviews and human sample analysis, risk assessment or cohort studies. Most public health projects use data and methodologies already available due to the cost of ad-hoc data collection. The aim of the article is to perform a literature review of environmental exposure and health outcomes with main focus on methodologies for assessing an association between water and/or soil pollutants and cancer. A systematic literature search was performed in May 2019 using PubMed. Articles were assessed by four independent reviewers. Forty articles were identified and divided into four groups, according to the data and methods they used, i.e.: (1) regression models with data by geographical area; (2) regression models with data at individual level; (3) exposure intensity threshold values for evaluating health outcome trends; (4) analyses of distance between source of pollutant and health outcome clusters. The issue of exposure assessment has been investigated for over 40 years and the most important innovations regard technologies developed to measure pollutants, statistical methodologies to assess exposure, and software development. Thanks to these changes, it has been possible to develop and apply geo-coding and statistical methods to reduce the ecological bias when considering the relationship between humans, geographic areas, pollutants, and health outcomes. The results of the present review may contribute to optimize the use of public health resources.
PLoS ONE, 2014
We stratified the Italian population according to age and gender in order to evaluate mortality t... more We stratified the Italian population according to age and gender in order to evaluate mortality trends over more than one century. Data covering the 1901-2008 period were used to study the yearly variations in mortality. Fluctuations in age-adjusted mortality curves were analyzed by Join Point Regression Models, identifying Join Points and Annual Percent Changes. A consistent decline in all-cause mortality occurred across the whole period, the most striking variations being observed in the 0-49 years population. In 1901, other and undefined diseases were the main causes of death, followed by infectious, digestive, and respiratory diseases in the 0-49 years population and by respiratory, cardiovascular, and cerebrovascular diseases in the >50 years population groups. In 2008 the main causes of death were accidents (males) and tumors (females) in the 0-49 age class, tumors in the 50-69 age class (both genders), and tumors (males) and cardiovascular diseases (females) in the elderly. The results highlight the interplay between age and gender in affecting mortality trends and reflect the dramatic progress in nutritional, lifestyle, socioeconomic, medical, and hygienic conditions.
International Journal of Hygiene and Environmental Health, 2013
Critical Reviews in Oncology/Hematology, 2013
During the past few decades, many studies on socio-economic factors and health outcomes have been... more During the past few decades, many studies on socio-economic factors and health outcomes have been developed using various methodologies with differing approaches. A bibliographic research in MEDLINE/PubMed and SCOPUS was carried out for the period 2000-2011 to describe the influence of socio-economic status (SES) on cancer survival, in particular with reference to the outcome of European research results and the results of some cases of other Western studies. This review is divided into two sections: the first describing the different approaches of the study on individuals and populations of the concept of "social class" as well as methods used to measure the association between deprivation and health (i.e. ecological level studies, deprivation indexes, etc.); and the second discussing the association between socio-economic factors and cancer survival, describing the roles of various determinants of differences in survival, such as clinical and pathological prognostic factors, together with consideration of diagnosis and treatment and some patients' characteristics.
Sustainability
The sustainability of European Long-Term Care systems faces the demographic and socio-economic ci... more The sustainability of European Long-Term Care systems faces the demographic and socio-economic circumstances, mainly the increasing ageing of the population, with its chronic disease conditions, and the simultaneous economic general crises, exacerbated by the recent COVID-19 pandemic. Beyond the increase in general rate of relative poverty, there is a higher risk of poverty among elderly and families in a high demand of care, especially if situations of Activities Daily Living (ADL) disability are present. Italian welfare, which is based on family care regimes and regional strategies, and is oriented to private or public care, is a relevant case study with which to analyze such a relationship. This paper aims to study the relationship between ADL disability and the socio-economic deprivation of families, that is, household poverty. Variables came from the ISTAT Health for All Italian Database and the INAIL Disability Allowance Database. A pool of statistical methods, based on bivari...
Journal of Preventive Medicine and Hygiene, 2019
Summary Objectives The aim was to provide an affordable method of computing socio-economic (SE) d... more Summary Objectives The aim was to provide an affordable method of computing socio-economic (SE) deprivation indices at the regional level, in order to reveal the specific aspects of the relationship between SE inequalities and health outcomes. The Umbria Region Socio-Health Index (USHI) was computed and compared with the Italian National Deprivation Index at the Umbria regional level (NDI-U). Methods The USHI was computed by applying factor analysis to census tract SE variables correlated with general mortality and validated through comparison with the NDI-U. Results Overall mortality presented linear positive trends in USHI, while trends in NDI-U proved non-linear or non-significant. Similar results were obtained with regard to specific causes of death according to deprivation groups, gender and age. Conclusions The USHI better describes a local population in terms of health-related SE status. Policy-makers could therefore adopt this method in order to obtain a better picture of SE...
Social Indicators Research
"This report analyses the quality assurance policies for long-term care (LTC) in the following co... more "This report analyses the quality assurance policies for long-term care (LTC) in the following countries: Austria, Estonia, Finland, France, Germany, Hungary, Italy, Latvia, Poland, Slovakia, Slovenia, Spain, Sweden, the Netherlands, and the United Kingdom.
The authors first discuss quality assurance in LTC by analysing: the dimensions of quality, the policy frameworks for quality in LTC, the different levels of development of LTC quality policies at the international, national, organisational, and individual levels. Second, they describe the methodology for collecting and analysing data on quality policies in the selected countries, and report and discuss the results. Policy recommendations are proposed at the end."
Epidemiologia E Prevenzione, May 1, 2012
During the last twenty years, in the most of the European nations, studies on how measuring socio... more During the last twenty years, in the most of the European nations, studies on how measuring socioeconomic differences related to inequities in take in charge of patients, health care and outcomes have been developed. The aim of this paper is the computation of a Liguria Region Deprivation Index (IDR), able to describe the peculiar health characteristics of the Liguria population, economically and socially quite homogeneous, on the basis of the socioeconomic (SE) differences related to health outcomes according to the differences in general mortality. All the population and households variables from the 2001 Italian Census have been considered at municipal level and, for Genoa and Savona, at lower administrative area level, selecting only the ones significantly correlated to the general mortality by Pearson correlation. The Standard Mortality Ratios (SMR on 2001 standard Liguria population) for Overall Mortality by gender and age groups (0-64 years and 65+ years) have been used as dependent variables. In order to build the RDI and classify the areas on the basis of increasing socioeconomic deprivation, a multivariate methodology have been used by means of principal component factor analysis of the previous selected variables and k-means clustering of the geographical areas; then these results have been compared with the SMR by analysis of variance. Finally, the RDI has been applied to the SMR of some groups of principal causes of death (all tumours and cardiovascular, respiratory and digestive system diseases), in order to differentiate the population by health outcomes. Two factors have been identified: an economic-educational factor and a socio-familiar one. The first factor describes the educational level and occupation, while the second one the marital status, the family dimension and the house peculiarities. The clustering procedure has allowed to identify five groups of geographical areas, distributed by the increasing of the SE deprivation. The most problematic areas are located in the countryside or in some spot places of the seaside, far from the health care centres and with difficult access by travel connection. The association between RDI and overall mortality SMRs confirms the relationship between deprivation and mortality increases, according to a statistically significant linear trend. Similar relationships have been observed for cardiovascular and digestive system diseases, while no associations have been found for respiratory illness and overall cancers. The RDI is able to give information on the health differences in the population, by differentiating the mortality trend on the basis of specific situations of richness and social hardship. It is useful not only for disentangling by economic condition, but also by the resources of the social and familiar support to cope with the illness situations. So, the relationship between deprivation and mortality, according to a statistically significant linear trend, shows how groups of Liguria people suffer by a lack of familiar resources, which strongly reduces the possibility of a quick take in charge and the adhesion to the more adequate therapeutic procedure, till to fatal results. In this way, areas of aimed actions can be defined by the local decision-makers, in order to optimize the health resources allocation and to reduce inequities.