rubrica

Diseguaglianze

  • Chiara Marinacci1

  1. S.C. a D.U. Scuola di Sanità Pubblica, ASL TO3

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Ricerca bibliografica periodo 16 gennaio 2011 – 1 aprile 2011

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Database: Pubmed/MEDline
Stringa: ("socioeconomic factors"[MeSH Terms] OR "social class"[MeSH Terms] or "educational status"[MESH terms] OR inequalities[Title/Abstract] OR inequities[Title/Abstract] OR socioeconomic[Title/Abstract]) AND ("italy"[MeSH Terms] OR "italy"[All Fields]) AND ("2011/01/16"[PDAT]: "2011/04/01"[PDAT])

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1. Marengoni A, Angleman S, Melis R, Mangialasche F, Karp A, Garmen A, Meinow B, Fratiglioni L. Aging with multimorbidity: A systematic review of the literature. Ageing Res Rev. 2011 Mar 23. [Epub ahead of print]
Aging Research Center, NVS Department, Karolinska Institutet and Stockholm University, Sweden; Geriatric Unit, Department of Medical and Surgery Sciences, University of Brescia, Italy.
Abstract
A literature search was carried out to summarize the existing scientific evidence concerning occurrence, causes, and consequences of multimorbidity (the coexistence of multiple chronic diseases) in the elderly as well as models and quality of care of persons with multimorbidity. According to pre-established inclusion criteria, and using different search strategies, 41 articles were included (four of these were methodological papers only). Prevalence of multimorbidity in older persons ranges from 55 to 98%. In cross-sectional studies, older age, female gender, and low socioeconomic status are factors associated with multimorbidity, confirmed by longitudinal studies as well. Major consequences of multimorbidity are disability and functional decline, poor quality of life, and high health care costs. Controversial results were found on multimorbidity and mortality risk. Methodological issues in evaluating multimorbidity are discussed as well as future research needs, especially concerning etiological factors, combinations and clustering of chronic diseases, and care models for persons affected by multiple disorders. New insights in this field can lead to the identification of preventive strategies and better treatment of multimorbid patients.
2. Minardi V, Campostrini S, Carrozzi G, Minelli G, Salmaso S. Social determinants effects from the Italian risk factor surveillance system PASSI. Int J Public Health. 2011 Feb 22. [Epub ahead of print]
National Centre for Epidemiology, Surveillance and Health Promotion, Italian National Institute of Health, Rome, Italy, valentina.minardi@iss.it.
Abstract
OBJECTIVES: To offer examples on how risk factor surveillance systems can help in providing useful information on social determinants effects and health inequalities.
METHODS: The Italian risk factor surveillance system (PASSI) collects monthly information from most of the Italian Local Health Units (over 85% of the Italian population is covered) on major health-related behaviours together with information on health practices, attitudes and opinions. Multivariate analysis of associations with possible indicators of social determinants collected by the system, offers important indications on the value that the system has in providing useful information on the effects of social determinants.
RESULTS: Social determinants, although measured through very simple indicators, have major influence on health outcomes (in the example here, depression), geographical disparities in health (efficacy of smoking ban), and access to preventive services (pap test in our analysis).
CONCLUSIONS: Risk factor surveillance can offer valuable information for monitoring social determinants effects and inequalities, and, when considering data over time, for evaluating the gross impact of future interventions and policies aimed at reducing them.

Breve commento a cura di Chiara Marinacci
Di interesse le differenze di ricorso al PAP test negli ultimi 3 anni, valutate nel periodo 2007-2008 in un campione della popolazione femminile assistita dalle ASL partecipanti del nord. A parità di informazioni ricevute sullo screening, le donne con cittadinanza non italiana, oppure con bassa istruzione o coloro che dichiarano difficoltà economiche sembrano aver ricorso a PAP test meno frequentemente dei corrispondenti gruppi più avvantaggiati. Il sistema di sorveglianza fornisce utili indicazioni verso l’orientamento all’equità degli interventi dei Piani di Prevenzione, sia a livello nazionale che locale, ed informazioni per valutarne l’impatto nel tempo anche sulle diseguaglianze.

3. Marengoni A, Fratiglioni L, Bandinelli S, Ferrucci L. Socioeconomic Status During Lifetime and Cognitive Impairment No-Dementia in Late Life: The Population-Based Aging in the Chianti Area (InCHIANTI) Study. J Alzheimers Dis. 2011 Feb 1. [Epub ahead of print]
Department of Medical and Surgery Sciences, University of Brescia, Brescia, Italy Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm University, Stockholm, Sweden.
Abstract
Thousand and twelve dementia-free elderly (60-98 years old) enrolled in the InChianti Study (Italy) were evaluated at baseline (1998-2000) and at 3-year follow-up (2001-2003) with the aim of analyzing the association of lifetime socioeconomic status (SES) with prevalent and incident cognitive impairment no-dementia (CIND). SES was defined from information on formal education, longest held occupation, and financial conditions through life. CIND was defined as age-adjusted Mini-Mental State Examination score one standard deviation below the baseline mean score of participants without dementia. Logistic regression and Cox proportional-hazards models were used to estimate the association of SES with CIND. Demographics, occupation characteristics (i.e., job stress and physical demand), cardiovascular diseases, diabetes, apolipoprotein E (APOE) genotype, smoking, alcohol consumption, depressive symptoms, and C-reactive protein were considered potential confounders. Prevalence of CIND was 17.7%. In the fully adjusted model, low education (OR = 2.1; 95% confidence intervals, CI = 1.4 to 3.2) was associated with prevalent CIND. Incidence rate of CIND was 66.0 per 1000 person-years. Low education (HR = 1.7; 95% CI = 1.04 to 2.6) and manual occupation (HR = 1.9; 95% CI = 1.0 to 3.6) were associated with incident CIND. Among covariates, high job-related physical demand was associated with both prevalent and incident CIND (OR = 1.6; 95% CI = 1.1 to 2.4 and HR = 1.5; 95% CI = 1.0 to 2.3). After stratification for education, manual occupation was still associated with CIND among participants with high education (HR = 2.2; 95% CI = 1.2 to 4.3 versus HR = 1.4; 95% CI = 0.2 to 10.4 among those with low education). Proxy markers of lifetime SES (low education, manual occupation and high physical demand) are cross-sectional correlates of CIND and predict incident CIND over a three-year follow-up.
4. Kirchmayer U, Agabiti N, Belleudi V, Davoli M, Fusco D, Stafoggia M, Arcà M, Barone AP, Perucci CA. Socio-demographic differences in adherence to evidence-based drug therapy after hospital discharge from acute myocardial infarction: a population-based cohort study in Rome, Italy. J Clin Pharm Ther. 2011 Feb 6. doi: 10.1111/j.1365-2710.2010.01242.x. [Epub ahead of print]
Department of Epidemiology, Lazio Region, Rome, Italy.
Abstract
What is known and Objective:  Adherence to evidence-based drug therapy after acute myocardial infarction has increased over the last decades, but is still unsatisfactory. Our objectives are to set out to analyse patterns of evidence-based drug therapy after acute myocardial infarction (AMI), and evaluating socio-demographic differences. Methods:  A cohort of 3920 AMI patients discharged from hospital in Rome (2006-2007) was selected. Drugs claimed during the 12 months after discharge were retrieved. Drug utilization was defined as density of use (boxes claimed/individual follow-up; chronic use = 6+ boxes/365 days) and therapeutic coverage, calculated through Defined Daily Doses (chronic use: ≥80% of individual follow-up). Patterns of use of single drugs and their combination were described. The association between poly-therapy and gender, age and socio-economic position (small-area composite index based on census data) was analysed through logistic regression, accounting for potential confounders. Results and Discussion: Most patients used single drugs: 90•5% platelet aggregation inhibitors (antiplatelets), 60•0%β-blockers, 78•1% agents acting on the renin-angiotensin system (ACEIs/ARBs), 77•8% HMG CoA reductase inhibitors (statins). Percentages of patients with ≥80% of therapeutic coverage were 81•9% for antiplatelets, 17•8% for β-blockers, 64•4% for ACEIs/ARBs and 76•1% for statins. The multivariate analysis showed gender and age differences in adherence to poly-therapy (females: OR = 0•84; 95% CI 0•72-0•99; 71-80 years age-group: OR = 0•82; 95% CI 0•68-0•99). No differences were observed with respect to socio-economic position. What is new and Conclusion: The availability of information systems offers the opportunity to monitor the quality of care and identify weaknesses in public health-care systems. Our results identify specific factors contributing to non-adherence and hence define areas for more targeted health-care interventions. Our results suggest that efforts to improve adherence should focus on women and older patients.

Commento a cura di Chiara Marinacci
Lo studio evidenzia, nel contesto romano, un’aderenza subottimale alle indicazioni di provata efficacia per la prevenzione secondaria dell’infarto; a parità di condizioni cliniche misurate, l’aderenza sembra presentare diseguaglianze di genere e di età (a svantaggio delle donne e dei pazienti più anziani).

5. Mandalà M, Imberti GL, Piazzalunga D, Belfiglio M, Lucisano G, Labianca R, Marchesi L, Merelli B, Robone S, Poletti P, Milesi L, Tondini C. Association of socioeconomic status with Breslow thickness and disease-free and overall survival in stage I-II primary cutaneous melanoma. Mayo Clin Proc. 2011 Feb;86(2):113-9.
Unit of Medical Oncology, Ospedali Riuniti Bergamo, Largo Barozzi 1, Bergamo, Italy. mariomandala@tin.it
Abstract
OBJECTIVE: To investigate the influence of socioeconomic status (SES) on Breslow thickness, disease-free survival, and overall survival in patients with stage I-II primary cutaneous melanoma (PCM).
PATIENTS AND METHODS: The study consists of all consecutive patients who were diagnosed as having PCM and were treated and followed up at our hospital between November 1, 1998, and July 31, 2009. Pathologic and sociodemographic characteristics of the patients were obtained. We categorized SES into 3 levels: low (manual employees and skilled/unskilled workers, including farmers, with primary education level), middle (nonmanual employees and clerks with middle education level), and high (professionals, executives, administrators, and entrepreneurs with tertiary education).
RESULTS: A total of 1443 consecutive patients were evaluated. In a multivariate logistic regression analysis, sex (female vs male: odds ratio [OR], 1.37; 95% confidence interval [CI], 1.08-1.75), SES (high vs middle: OR, 1.27; 95% CI, 0.96-1.69; high vs low: OR, 1.73; 95% CI, 1.26-2.38), age (<60 vs ≥60 years: OR, 1.35; 95% CI, 1.03-1.78), and family context (single vs living with relatives: OR, 1.37; 95% CI, 0.97-1.94) were the strongest correlates of Breslow thickness. Compared with high SES, the risk of melanoma-related death, adjusted for age and sex, was 7 times higher (hazard ratio, 7.44; 95% CI, 3.27-16.93) and almost 2 times higher (hazard ratio, 1.88; 95% CI, 1.04-3.39) in patients with low SES living alone or living with relatives, respectively.
CONCLUSION: In patients with PCM, low SES is associated with thicker melanoma and a poorer clinical outcome. PMCID: PMC3031435 [Available on 2011/8/1] PMID: 21282485 [PubMed - indexed for MEDLINE]
6. Caprara GV, Vecchione M, Alessandri G, Gerbino M, Barbaranelli C. The contribution of personality traits and self-efficacy beliefs to academic achievement: A longitudinal study. Br J Educ Psychol. 2011 Mar;81(1):78-96. doi: 10.1348/2044-8279.002004. Epub 2010 Nov 18.
Sapienza University of Rome, Italy.
Abstract
Background. The personal determinants of academic achievement and success have captured the attention of many scholars for the last decades. Among other factors, personality traits and self-efficacy beliefs have proved to be important predictors of academic achievement.
Aims. The present study examines the unique contribution and the pathways through which traits (i.e., openness and conscientiousness) and academic self-efficacy beliefs are conducive to academic achievement at the end of junior and senior high school. Sample. Participants were 412 Italian students, 196 boys and 216 girls, ranging in age from 13 to 19 years.
Methods. The hypothesized relations among the variables were tested within the framework of structural equation model.
Results and conclusions. Openness and academic self-efficacy at the age of 13 contributed to junior high-school grades, after controlling for socio-economic status (SES). Junior high-school grades contribute to academic self-efficacy beliefs at the age of 16, which in turn contributed to high-school grades, over and above the effects of SES and prior academic achievement. In accordance with the posited hypothesis, academic self-efficacy beliefs partially mediated the contribution of traits to later academic achievement. In particular, conscientiousness at the age of 13 affected high-school grades indirectly, through its effect on academic self-efficacy beliefs at the age of 16. These findings have broad implications for interventions aimed to enhance children's academic pursuits. Whereas personality traits represent stable individual characteristics that mostly derive from individual genetic endowment, social cognitive theory provides guidelines for enhancing students' efficacy to regulate their learning activities.
7. Quaglia A, Lillini R, Casella C, Giachero G, Izzotti A, Vercelli M; Liguria Region Tumour Registry. The combined effect of age and socio-economic status on breast cancer survival. Crit Rev Oncol Hematol. 2011 Mar;77(3):210-20. Epub 2010 Mar 15.
Liguria Region Tumour Registry, S.S. Descriptive Epidemiology, IST - National Institute of Cancer Research, Genoa, Italy.
Abstract
The study aims to investigate the effect of age and socio-economic status (SES) on breast cancer relative survival at 5 years from diagnosis (RS-5%). The Liguria Region Cancer Registry collected clinico-pathological information for 1081 patients resident in Genoa city diagnosed in 1996 and 2000. Patients were divided into three age groups (0-49, 50-69 and ≥70 years) and into quintiles of SES, measured according to a synthetic regional deprivation index built by Census tract variables and validated by comparison with the national deprivation index. The association of prognostic factors and RS-5% was evaluated by bivariate and multivariate analyses. RS-5% was very high for the first two age groups (91%) and decreased in patients aged 70 or older (82%) (unadjusted HR=2.7, P=0.001). The first four SES quintiles had homogeneous RS-5% (89-92%) and only the last very deprived group had lower rates (77%) (unadjusted HR=2.3, P=0.011). Very deprived elderly patients showed a much lower RS-5% (58%). Elderly and very deprived women were more likely to have large tumours, positive lymph nodes and less likely to receive conserving surgery, axillary dissection and adjuvant therapies. After adjusting for tumour characteristics and treatment modalities the increased risk of dying in the elderly disappeared completely, while the higher risk of very deprived women was eliminated only after correction for all the covariates simultaneously. The survival observed for breast cancer patients resident in Genoa was very high, however elderly and very low SES women have to be monitored. These variations are probably due to inequity in healthcare access and to a difficult taken in charge.

Commento a cura di Nicolàs Zengarini
Interessante studio sull’effetto di età e deprivazione socioeconomica (a livello micro-ecologico) nei confronti della sopravvivenza a 5 anni per tumore della mammella nelle donne genovesi, controllando accuratamente per fattori prognostici legati alle caratteristiche anatomopatologiche del tumore cosi come al tipo di trattamento eseguito. I risultati di questo studio sono in linea con la letteratura internazionale. Le pazienti in avanzata età e socio economicamente più deprivate hanno maggior probabilità di carcinomi in stadio più avanzato e di essere sottoposte a terapie più invasive. Le differenze demografiche e socioeconomiche nella sopravvivenza sembrano spiegate dalle covariate considerate, sebbene i dati confermino comunque un incremento marginalmente significativo del rischio di mortalità tra le donne più deprivate.

8. Akre O, Barone-Adesi F, Pettersson A, Pearce N, Merletti F, Richiardi L. Differences in citation rates by country of origin for papers published in top-ranked medical journals: do they reflect inequalities in access to publication? J Epidemiol Community Health. 2011 Feb;65(2):119-23. Epub 2009 Nov 24.
Cancer Epidemiology Unit, CeRMS and CPO-Piemonte, University of Turin, Turin, Italy.
Abstract
BACKGROUND: The acceptance of a paper in a top-ranked journal depends on the importance of the study, and should not depend on its country of origin. If the papers' citation rate is a proxy for their importance, and the threshold for acceptance is unrelated to the country of origin, papers from different countries published in the same journal should have a similar number of citations. Conversely, if the threshold is lowered for some countries, their papers will have a lower mean citation rate.
METHODS: The number of citations and the corresponding author's country were obtained for 4724 papers published between 1998 and 2002 in the British Medical Journal, the Lancet, Journal of the American Medical Association and New England Journal of Medicine. Countries were grouped according to the World Bank classification and geographical location: low-middle income countries; high-income European countries; high-income non-European countries; UK and USA. The probability of papers being poorly cited by country of origin was estimated, using domestic papers (British papers published in British journals and US papers published in US journals) as the reference.
RESULTS: Compared with domestic papers, the OR of being poorly cited was 0.67 (95% CI 0.55 to 0.81) for papers from high-income European countries, 0.97 (0.76 to 1.24) for papers from high-income non-European countries and 1.93 (1.28 to 2.89) for papers from low-middle income countries.
CONCLUSIONS: Papers from different countries published in the same journal have different citation rates. This may reflect difficulties for researchers from some countries to publish their research in leading medical journals.