Place of living and health inequality: a study for elderly Italians (original) (raw)
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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...
Journal of Public Health, 2018
Backgrounds The empirical evidence shows discordant results regarding the role of local contexts on individual health. This article considers the role of the municipal socioeconomic contexts on self-rated health in Italy, taking into account some individual variables. Methods Multilevel model software (MlwiN) is used to fit multilevel linear regression models of perceived health. Individual data are from the Italian surveys on BAspects of Daily Life^2010, 2011 and 2012, collected by the Italian National Institute of Statistics (Istat). In addition, municipality-level social, demographic and economic characteristics are from the 2011 Census and the database BAtlas of Italian Municipalities^(Istat). Results The main findings of this study confirm that, controlling for age and gender at the individual level, poor health is influenced by socioeconomic positions: lower education, not working or looking for employment and disadvantaged family social class predict higher perceived health. The individual level explains the 70.1% heterogeneity in self-assessed health, the family level 25.6% and the municipality level only 4.3%. The additional influence of the socioeconomic context is, conversely, of little substantive importance. Conclusions Finally, by showing that variability in health relates mainly to individual characteristics, this study suggests that intervention to mitigate social inequalities in health should focus on structural factors, such as education and the labour market.
SPATIAL AND REGIONAL HEALTH INEQUALITIES IN EUROPE
Purpose – We have studied the spatial interrelations of the regional health inequalities in Europe in view of the social selection hypothesis. The primary objective of our paper is to demonstrate the effect of health status on various socioeconomic development indicators. Design/methodology/approach – According to the social selection hypothesis, an individual's health status influences both his own socioeconomic status and the economy as a whole. Accordingly, we have operationalised the regional health status and socioeconomic development and analysed their correlations. For such purpose we have used correlation analysis and explanatory spatial data analysis (ESDA): spatial autocorrelation and regional regression models. Findings – According to our results, there are synergistic effects between the two phenomena, both in view of global and local statistics. Regions with better health status are characterised with better socioeconomic conditions. The spatial regression models have also justified and confirmed the use of the social selection hypothesis for the explanation of regional differences in economic development. Research limitations/implications – It is advisable to use panel databases for the future analysis of this topic. To give correct answer on social selection hypothesis on regional level, other examinations (Markov chain model) must be done. Practical implications – Furthermore, it is advisable to extend the range of health status indicators with variables such as noncommunicable chronic diseases or other causes of death associated with socioeconomic phenomena (e.g. TBC incidence indicates poverty). Originality/Value – As far as the social selection hypothesis is concerned, our paper presents new and innovative results whose approach (method for the exploration of regional data) has not been discussed so far in the international literature.
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...
Regional indices of socio-economic and health inequalities: a tool for public health programming
Journal of Preventive Medicine and Hygiene, 2019
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...
BMC Medical Research Methodology, 2010
Background: Geographical health inequalities are naturally described by the variation in health outcomes between areas (e.g. mortality rates). However, comparisons made between countries are hampered by our lack of understanding of the effect of the size of administrative units, and in particular the modifiable areal unit problem. Our objective was to assess how differences in geographic and administrative units used for disseminating data affect the description of health inequalities. Methods: Retrospective study of standard populations and deaths aggregated by administrative regions within 20 European countries, 1990-1991. Estimated populations and deaths in males aged 0-64 were in 5 year age bands. Poisson multilevel modelling was conducted of deaths as standardised mortality ratios. The variation between regions within countries was tested for relationships with the mean region population size and the unequal distribution of populations within each country measured using Gini coefficients. Results: There is evidence that countries whose regions vary more in population size show greater variation and hence greater apparent inequalities in mortality counts. The Gini coefficient, measuring inequalities in population size, ranged from 0.1 to 0.5 between countries; an increase of 0.1 was accompanied by a 12-14% increase in the standard deviation of the mortality rates between regions within a country. Conclusions: Apparently differing health inequalities between two countries may be due to differences in geographical structure per se, rather than having any underlying epidemiological cause. Inequalities may be inherently greater in countries whose regions are more unequally populated.
What impact do contextual variables have on the changing geography of mortality in Italy?
Using data for 94 provinces, three periods (1971-1973, 1981-1983 and 1991-1993), and for men and women, we present an interesting picture of the geography of adult and elderly mortality by cause of death in Italy. This picture brings into focus the North/South gap that has yet again emerged, this time in gender differences in mortality. Particular attention is given to mortality from those causes that would appear to depend on the geographical context and that have a greater role to play in overall mortality differences. We then define which causes of death have changed the geographic pattern in the period considered. Lastly we study the relationship between mortality by cause and socio-economic, health care, environmental, cultural, and nutritional variables.
Regional Differences in Socio-Economic Health Inequalities in Spain
SSRN Electronic Journal, 2000
This paper derives from the project "La dinámica del estado de salud y los factores socieconómicos a lo largo del ciclo vital. Implicaciones para las políticas públicas", which is supported by the Fundación BBVA. We are grateful to Guillem López and two anonymous referees for useful comments and suggestions. The views expressed in this paper are those of the authors and not necessarily those of the funders or the authors' em ployers.
Research in Social Stratification and Mobility, 2018
In the literature there is a lack of investigation on health inequalities in South America and their differences with respect to those in the developed countries. Since Italy has recorded similar economic trends in recent years and has some similarities with Argentina, we decided to use the Mediterranean country for comparative purposes. Our hypothesis was that, beyond structural differences, health inequalities present similar patterns in these two countries characterized by a capitalist economy. Social groups in advantaged educational and occupational positions exhibit better health than disadvantaged groups. We present some descriptive statistics on the overall situation in the two countries, and we then analyse data stemming from two surveys that collected individual information on social conditions and health statuses (OASD from 2010 to 2015, and "Multiscopo-Health condition and use of health services", ISTAT 2013). The findings show that Argentina and Italy have different levels of wellbeing, mortality rates, and health services. But relative disparities in health seem very similar, confirming the hypothesis of Marmot (2017) about the general form of health inequalities. Manual and precarious workers (in particular unemployed persons) present systematically worse perceived health with respect to higher social classes.