Socio-economic Inequality in Mortality in Italy (original) (raw)
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The main causes of death contributing to absolute and relative socio-economic inequality in Italy
Public Health, 2018
Objectives: Monitoring socioeconomic inequality has become a priority for many governments, especially after the socioeconomic changes that followed the 2008 financial crisis. This study aimed at detecting the causes of death with the largest socioeconomic inequality in relative and absolute terms in Italy. Study design: This is a historical cohort study. Methods: We used two regression-based measures of socioeconomic inequality, the relative index of inequality (RII) and the slope index of inequality (SII), to rank the causes of death with the highest relative and absolute socioeconomic inequality. We obtained these measures on a large census-based cohort study with more than 35 million individuals and 452,273 deaths registered in the period 2012e2014. Results: The causes with the highest relative socioeconomic inequality were the following:
The European Journal of Public Health, 2013
Background: There is extensive documentation on social inequalities in mortality across Europe, showing heterogeneity among countries. Italy contributed to this comparative research, through longitudinal systems from northern or central cities of the country. This study aims to analyse educational inequalities in general and cause-specific mortality in a sample of the Italian population. Methods: Study population was selected within a cohort of 123 056 individuals, followed up for mortality through record linkage with national archive of death certificates for the period 1999-2007. People aged between 25 and 74 years were selected (n = 81 763); relative risks of death by education were estimated through Poisson models, stratified according to sex and adjusted for age and geographic area of residence. Heterogeneity of risks by area of residence was evaluated. Results: Men and women with primary education or less show 79% and 63% higher mortality risks, respectively, compared with graduates. Mortality risks seem to frequently increase with decreasing education, with a significant linear trend among men. For men, social inequalities appear related to mortality due to diseases of the circulatory system and to all neoplasms, whereas for women, they are related to inequalities in cancer mortality. Conclusions: Results from the first follow-up of a national sample highlight that Italy presents significant differences in mortality according to the socioeconomic conditions of both men and women. These results not only challenge policies aimed at redistributing resources to individuals and groups, but also those policies that direct programmes and resources for treatment and prevention according to the different health needs.
Mortality amenable to health care services and health inequalities across the regions of Italy
European Journal of Public Health, 2020
Background Amenable mortality is an indicator that measures the extent to which health services contribute to the improvement of the health of a population. It can also highlight geographical and socioeconomic inequalities. Therefore, it is used to assess quality and performance of health care systems, both at national and subnational level. The Italian National Health Service sets the essential levels of care (Livelli Essenziali di Assistenza, LEA), a health-benefit package for all citizens. Because every region is responsible for providing the LEA and can offer additional health care, monitoring the performance of the Regional Health Services (RHSs) is of increasing interest. Methods We used Nolte and McKee's list of amenable conditions to analyze the temporal trend of the standardized mortality rate (per 100.000) in Italy from 2006 to 2015, overall and by gender. We also examined the standardized rate at regional level by comparing the two-year periods 2006/7 and 2014/5, over...
Inequality in health: socioeconomic differentials in mortality in Rome, 1990-95
Journal of Epidemiology & Community Health, 1999
Population groups with a lower socioeconomic status (SES) have a greater risk of disease and mortality. The aim of this study was to investigate the relation between SES and mortality in the metropolitan area of Rome during the six year period 1990-1995, and to examine variations in mortality differentials between 1990-92 and 1993-95. Rome has a population of approximately 2,800,000, with 6100 census tracts (CTs). During the study period, 149,002 deaths occurred among residents. The cause-specific mortality rates were compared among four socioeconomic categories defined by a socioeconomic index, derived from characteristics of the CT of residence. Among men, total mortality and mortality for the major causes of death showed an inverse association with SES. Among 15-44 year old men, the strong positive association between total mortality and low SES was attributable to AIDS and overdose mortality. Among women, a positive association with lower SES was observed for stomach cancer, uterus cancer and cardiovascular disease, whereas mortality for lung and breast cancers was higher in the groups with higher SES. Comparing the periods 1990-92 and 1993-95, differences in total mortality between socioeconomic groups widened in both sexes. Increasing differences were observed for tuberculosis and lung cancer among men, and for uterus cancer, traffic accidents, and overdose mortality among women. The use of an area-based indicator of SES limits the interpretations of the findings. However, despite the possible limitations, these results suggest that social class differences in mortality in Rome are increasing. Time changes in lifestyle and in the prevalence of risk behaviours may produce differences in disease incidence. Moreover, inequalities in the access to medical care and in the quality of care may contribute to an increasing differentials in mortality.
Socioeconomic differentials in premature mortality in Rome: changes from 1990 to 2001
BMC public health, 2006
While socioeconomic inequalities in mortality have widened in many countries, evidence of social differentials is scarce in Southern Europe. We studied temporal changes in premature mortality across socioeconomic groups in Rome between 1990 and 2001. We analysed all 126,511 death certificates of residents of Rome aged 0-74 years registered between 1990-2001. A 4-level census block index based on the 1991 census was used as an indicator of socioeconomic position (SEP). Using routine mortality data, standardised mortality rates (per 100,000 inhabitants) were calculated by SEP and gender for four time periods. Rate ratios were used to compare mortality by gender and age. Overall premature mortality decreased in both genders and in all socioeconomic groups; the change was greater in the highest socio-economic group. In both men and women, inequalities in mortality strengthened during the 1990s and appeared to stabilise at the end of the 20th century. However, for 60-74 year old women th...
Cause-specific mortality as a sentinel indicator of current socioeconomic conditions in Italy
Demographic Research, 2018
BACKGROUND In the last few years the need for disaggregated statistics at small territorial levels to monitor the social and economic conditions of the various areas of a country has increased considerably. The question of how to define these indicators has been the topic of a recent international debate. OBJECTIVE This study aims to assess whether simple, widely available demographic indexes, like mortality measures, may serve as sentinel indicators of economic development and social wellbeing in Italy. METHODS We analyse and compare the geographical patterns of the infant mortality rate and of the mortality rates for leading causes of death with the spatial pattern found for a more complex index, the vulnerability index, recently introduced by the Italian National Institute for Statistics at the provincial level in contemporary Italy. RESULTS Mortality from leading causes of death such as diseases of the circulatory system, and mortality from increasingly emergent causes of death such as diabetes, may offer a valid statistic to grasp economic development and social wellbeing in Italy today. CONCLUSIONS Our findings are important because policymakers need to rely on indicators with the following fundamental properties: easy availability, clear definition, temporal continuity, and spatial comparability. Barbi, Casacchia & Racioppi: Cause-specific mortality as sentinel indicator of socioeconomic conditions http://www.demographic-research.org CONTRIBUTION This study contributes to the literature by showing that mortality data is a straightforward and powerful tool to help policymakers plan appropriate interventions.
When does morbidity start? An analysis of changes in morbidity between 2013 and 2019 in Italy
Statistical Methods & Applications
Morbidity is one of the key aspects for assessing populations’ well-being. In particular, chronic diseases negatively affect the quality of life in the old age and the risk that more years added to lives are years of disability and illness. Novel analysis, interventions and policies are required to understand and potentially mitigate this issue. In this article, we focus on investigating whether in Italy the compression of morbidity is in act in the recent years, parallely to an increase of life expectancy. Our analysis rely on large repeated cross-sectional data from the national surveillance system passi, providing deep insights on the evolution of morbidity together with other socio-demographical variables. In addition, we investigate differences in morbidity across subgroups, focusing on disparities by gender, level of education and economic difficulties, and assessing the evolution of these differences across the period 2013–2019.
… of epidemiology and …, 2004
To evaluate the independent and mutual effects of neighbourhood deprivation and of individual socioeconomic conditions on mortality and to assess the trends over the past 30 years and the residual neighbourhood heterogeneity. Design: General and cause specific mortality was analysed as a function of time period, highest educational level achieved, housing conditions, and neighbourhood deprivation, using multilevel Poisson models stratified by gender and age class. Setting: The study was conducted in Turin, a city in north west Italy with nearly one million inhabitants and consisting of 23 neighbourhoods. Participants: The study population included three cohorts of persons aged 15 years or older, recorded in the censuses of 1971, 1981, and 1991 and followed up for 10 years after each census. Main results: Individual and contextual socioeconomic conditions showed an independent and significant impact on mortality, both among men and women, with significantly higher risks for coronary heart and respiratory diseases among people, aged less than 65 years, residing in deprived neighbourhoods (9% and 15% excess for coronary heart diseases, 20% and 24% for respiratory diseases, respectively for men and women living in deprived neighbourhoods compared with rich). The decreasing time trend in general mortality was less pronounced among men with lower education and poorer housing conditions, compared with their more advantaged counterparts; the same was found in less educated women aged less than 65 years. Conclusions: These results and further developments in the evaluation of impact and mechanisms of other contextual effects can provide information for both health and non-health oriented urban policies.
Individual and Contextual Determinants of Inequalities in Health: The Italian Case
International Journal of Health Services, 2003
The geographic distribution of health status across Italian regions shows a North-South gradient, with better conditions in the North for both males and females. Using data from the 2000 National Health Interview Survey, the authors first analyze the geographic variation in subjective health and presence of chronic conditions, with specific attention to the effects of individual and area-based socioeconomic conditions and their heterogeneity across regions. The results suggest the North-South gradient in health is mainly affected, at least for subjective health, by the different composition of macro-areas with respect to individual education, and is slightly influenced by contextual circumstances. Moreover, being less educated results in poorer health in some regions (mainly South and Isles) than in others (mainly Northeast). The authors next analyze the circumstances affecting the presence of more disadvantaged people in the South, to highlight features of the Southern context that...
Socioeconomic inequalities in health status and survival: a cohort study in Rome
BMJ Open, 2022
Objectives To analyse the association between individual and contextual socioeconomic position (SEP) with health status and to investigate the role of SEP and baseline health status on survival. Design Cross-sectional and cohort study. Setting Rome, Italy. Participants, primary and secondary outcomes We selected the 25-99 year-olds included in the Rome 2011 census cohort. As a measure of health status on the census reference date (09 October 2011), we used the presence of chronic or rare conditions from the Disease-Related Co-payment Exemption Registry, a database implemented to provide free care to people with chronic or rare diseases. We used logistic regression to analyse the association between both individual (educational attainment) and contextual SEP (neighbourhood real estate price quintiles) with baseline health status. We analysed the role of SEP and the presence of chronic or rare conditions on 5-year survival (until 31 December 2016) using accelerated failure time models with Weibull distribution, reporting time ratios (TRs; 95% CI). Results In middle-aged, subjects with low SEP (either individual or contextual) had a prevalence of chronic conditions comparable with the prevalence in high SEP individuals 10 years older. Adjusted logistic models confirmed the direct association between SEP and baseline health status in both women and men. The lowest educated were up to 67% more likely to have a chronic condition than the highest educated, while the difference was up to 86% for lowest versus highest contextual SEP. Low SEP and the presence of chronic conditions were associated with shorter survival times in both sexes, lowest versus highest educated TR was TR=0.79 for women (95% CI: 0.77 to 0.81) and TR=0.71 for men (95% CI: 0.70 to 0.73). The contextual SEP shrunk survival times by about 10%. Conclusion Inequalities were present in both baseline health and survival. The association between SEP and survival was independent of baseline health status.