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Disuguaglianze

  • Chiara Marinacci1

  1. Ministero della Salute, Dipartimento della programmazione e dell'ordinamento del Servizio sanitario nazionale, Direzione Generale della Programmazione Sanitaria.
Chiara Marinacci -

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Ricerca bibliografica periodo dal 1 novembre – 15 gennaio 2013

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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]) OR socio-economic[Title/Abstract]) OR disparities[Title/Abstract]) AND ("italy"[MeSH Terms] OR "italy"[All Fields]) AND ("2012/11/01"[PDAT] : "2013/01/15"[PDAT])
1. Marinacci C, Grippo F, Pappagallo M, Sebastiani G, Demaria M, Vittori P, Caranci N, Costa G. Social inequalities in total and cause-specific mortality of a sample of the Italian population, from 1999 to 2007. Eur J Public Health. 2013 Jan 8. [Epub ahead of print]
Epidemiology Unit, Local Health Unit TO3, Turin, Italy.

Abstract 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 socio-economic 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.

2. Costa G, Marra M, Salmaso S; Gruppo AIE su crisi e salute. Collaborators: Bena A, Dalmasso M, d'Errico A, Gnavi R, Landriscina T, Marino M, Motta M, Migliardi A, Mondo L, Spadea T, Demaria M, Diecidue R, Ranzi A, Caranci N, Bisceglia L, Marinacci C, Petrelli A, Maria M, Gianluigi F, Valentina M, Gargiulo L, Murianni L, Sebastiani G, Solipaca A, de Belvis AG, Ricciardi W, Di Monaco R, Pilutti S, Leombruni R, Pacelli L. [Health indicators in the time of crisis in Italy]. [Article in Italian] Epidemiol Prev. 2012 Nov;36(6):337-66.
Servizio di epidemiologia ASL TO3, Piemonte. michele.marra@epi.piemonte.it.

Abstract SCOPE: to estimate for the first time in Italy the consequences of the national current economic crisis on health and on social determinants of health, assessing its impact on a set of distal determinants (development and economic wellbeing, labour and environment) and of prossimal ones (material, psychosocial, professional, environmental and behavioural risk factors) on health care performance and on health outcomes normally related to economic trends, as self-perceived health, depression, number of suicides attempts, road traffic incidents and work injuries. The analysis is therefore aimed at identifying the most promising entry points in order to plan and implement either health care and other policies to tackle the negative effects of crisis on health. DESIGN: using the main international and national references on the measure of wellbeing and on the role of social determinants, this paper draws a conceptual framework of all the connections between recession and health. For each mechanism identified, it examines the value of the main available indicators before and during the crisis in order to measure its impact, adjusting if possible for the trend observed in the previous years. Indicators have been selected according to their availability in the main Italian national informative sources and, when not possible, circumscribing the analysis to the regional or local level. RESULTS: regarding the short term impact, results have shown an association between the recession and the raise of mental health related problems (measured in terms of number of suicides, depression and substance misuse), especially on the most disadvantaged groups because of their higher job and financial insecurity. A first ex-ante impact assessment on long term effects allows to attribute almost two hundred deaths a year due to the increase of unemployment rate. Regarding the budget cuts on public expenditure of the health care sector, significant reductions have been shown in specialist care and in drug prescriptions, associated with the increase of co-payment and with a stronger effect on the most vulnerable socioeconomic groups. Nevertheless the crisis does not seem to be associated with a reduction of indicators of quality, continuity and outcomes of the health care, at least in the considered clinical pathways (diabetes and maternal and child health). At the same time the crisis seems to be associated with the reduction in the rate of injuries in the workplace (although it has been observed an increase of the serious ones) and car crashes, probably explained by the reduction of industrial production and of household consumptions. CONCLUSIONS: the conceptual framework seems to be the appropriate tool to set an Italian surveillance system for assessing the short and medium term impact of crisis on health, in particular the health of the most disadvantaged groups, mainly focusing on unemployed which are the most vulnerable target.

3. Innamorati M, Serafini G, Lester D, Amore M, Girardi P, Pompili M. Violent deaths among Russian and EU male older adults. Int J Soc Psychiatry. 2013 Jan 1. [Epub ahead of print]
Sapienza University of Rome, Italy; University of Parma, Italy.

Abstract AIMS: This ecological comparison study explored temporal trends since 1985 in age-adjusted suicide and homicide rates for older male adults (over the age of 65) resident in the EU and the Russian Federation. METHODS: The data were extracted from the World Health Organization's (WHO) European mortality database. RESULTS: Older men resident in the Russian Federation had a higher risk of dying a violent death (by homicide and by suicide) than their younger compatriots (relative risks (RR) ranging from 1.13 to 1.31). Conversely, in the EU, older men had a higher risk of dying from suicide (RRs of 1.52 for men over the age of 65 and 3.27 for men over the age of 75) and a lower risk of being victims of homicide (RRs ranging between 0.84 and 0.89) than their younger compatriots. CONCLUSIONS: The European region is characterized by great inequalities in rates of violent deaths among the elderly.

4. Rapicetta M, Monarca R, Kondili LA, Chionne P, Madonna E, Madeddu G, Soddu A, Candido A, Carbonara S, Mura MS, Starnini G, Babudieri S. Hepatitis E virus and hepatitis A virus exposures in an apparently healthy high-risk population in Italy. Infection. 2012 Dec 22. [Epub ahead of print]
Viral Hepatitis Unit, Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanità, Viale Regina Elena, 299-00161, Rome, Italy, maria.rapicetta@iss.it.

Abstract PURPOSE: The prevalence of anti-hepatitis E virus (HEV) and anti-hepatitis A virus (HAV), as well as the possible links with socio-demographic and other viral risks factors, were evaluated in an inmates population. METHODS: The study population consisted of 973 consecutively recruited inmates of eight Italian prisons. RESULTS: The anti-HEV prevalence was 11.6 % (113/973). It increased significantly by age (χ(2) for linear trend: p = 0.001) and was significantly higher among non-Italian compared to Italian inmates (15.3 vs. 10.7 %, respectively). Age >40 years [odds ratio (OR) 2.1; 95 % confidence interval (CI) 1.4-3.1], non-Italian citizenship (OR 1.8; 95 % CI 1.1-2.9) and anti-HIV seropositivity (OR 2.2; 95 % CI 1.2-4.2) were the only factors independently associated to anti-HEV positivity by logistic regression analysis. The overall anti-HAV prevalence was 86.4 %, and was significantly higher in non-Italian compared to Italian prisoners (92.6 vs. 84.9 %, respectively; p = 0.02). Age older than 40 years (OR 3.6; 95 % CI 2.2-5.9), <5 years formal education (OR 2.1; 95 % CI 1.3-3.2) and non-Italian nationality (OR 2.7; 95 % CI 1.5-4.8) were factors independently associated to anti-HAV positivity by the logistic regression analysis. CONCLUSIONS: Compared to the general population, significantly higher anti-HEV and anti-HAV prevalences were observed in an inmates population in Italy. Old age and non-Italian nationality were factors independently related to both HEV and HAV exposures. This data suggest the important role of low socio-economic factors in the transmission of both infections in high-risk populations. The possible epidemiological and/or pathogenetic links between HEV and HIV exposures need to be studied further.

5. Lenzi M, Vieno A, Santinello M, Perkins DD. How Neighborhood Structural and Institutional Features Can Shape Neighborhood Social Connectedness: A Multilevel Study of Adolescent Perceptions. Am J Community Psychol. 2012 Dec 20. [Epub ahead of print]
Department of Developmental and Social Psychology, University of Padova, via Belzoni, 80, 35131, Padua, Italy, michela.lenzi@unipd.it.

Abstract According to the norms and collective efficacy model, the levels of social connectedness within a local community are a function of neighborhood structural characteristics, such as socioeconomic status and ethnic composition. The current work aims to determine whether neighborhood structural and institutional features (neighborhood wealth, percentage of immigrants, population density, opportunities for activities and meeting places) have an impact on different components of neighborhood social connectedness (intergenerational closure, trust and reciprocity, neighborhood-based friendship and personal relationships with neighbors). The study involved a representative sample of 389 early and middle adolescents aged 11-15 years old, coming from 31 Italian neighborhoods. Using hierarchical linear modeling, our findings showed that high population density, ethnic diversity, and physical and social disorder might represent obstacles for the creation of social ties within the neighborhood. On the contrary, the presence of opportunities for activities and meeting places in the neighborhood was associated with higher levels of social connectedness among residents.

6. Fano V, Pezzotti P, Gnavi R, Bontempi K, Miceli M, Pagnozzi E, Giarrizzo ML, Fortino A. The role of socio-economic factors on prevalence and health outcomes of persons with diabetes in Rome, Italy. Eur J Public Health. 2013 Jan 9. [Epub ahead of print]
Health Systems and Epidemiology Unit, Local Health Authority RMD, Rome, Italy.

Abstract BACKGROUND: We investigated the role of socio-economic status on diabetes prevalence, on mortality and hospitalization in a large population-based cohort enrolled in Rome, Italy. METHODS: Diabetic residents aged ≥35 years in 2007 were identified using multiple data sources. The effect of the deprivation of the area of residence on diabetes prevalence and on mortality and hospitalization (years 2008-10) was investigated by multilevel regression models, both among diabetic and non-diabetic populations. RESULTS: Prevalence of diabetes (8.3%) was directly related to the deprivation of the area of residence, especially for women. Diabetes increased the risk of mortality and hospitalization, mainly for cardiovascular complications, compared with non-diabetic subjects, with increasing relative risks in more deprived areas. The social gradients observed among diabetic patients are modest compared with non-diabetic subjects, both for some acute complications (myocardial infarction, stroke) and chronic complications (ischaemic heart disease, nephropathy, retinopathy and amputation). CONCLUSIONS: Prevalence of diabetes is directly related to deprivation, especially for women. Diabetes increases the risk of mortality and hospitalization for cardiovascular complications. However, similar to another study conducted in Northern Italy, we found that social differences in health outcomes do not differ between people with and without diabetes, suggesting that the care for diabetic patients living in Rome is provided without social disparities, and in some cases, it protects against the adverse effects of social inequalities. The Italian care system for diabetes deserves to be further investigated, as it could represent a model for the care of other chronic conditions and for contrasting social inequities in health.

7. De Luca G, Ponzo M, Andrés AR. Health care utilization by immigrants in Italy. Int J Health Care Finance Econ. 2012 Dec 13. [Epub ahead of print]
Department of Economics and Statistics, University of Calabria, via Ponte Bucci, 87036, Arcavacata di Rende, CS, Italy, gideluca@unical.it.

Abstract Healthcare utilization studies show how well documented disparities between migrants and non-migrants. Reducing such disparities is a major goal in European countries. However, healthcare utilization among Italian immigrants is under-studied. The objective of this study is to explore differences in healthcare use between immigrant and native Italians. Cross-sectional study using the latest available (2004/2005) Italian Health Conditions Survey. We estimated separate hurdle binomial negative regression models for GP, specialist, and telephone consultations and a logit model for emergency room (ER) use. We used logistic regression and zero-truncated negative binomial regression to model the zero (contact decision) and count processes (frequency decisions) respectively. Adjusting for risk factors, immigrants are significantly less likely to use healthcare services with 2.4 and 2.7 % lower utilization probability for specialist and telephone consultations, respectively. First- and second-generation immigrants' probability for specialist and telephone contact is significantly lower than natives'. Immigrants, ceteris paribus, have a much higher probability of using ERs than natives (0.7 %). First-generation immigrants show a higher probability of visiting ERs (1 %). GP visits show no significant difference. In conclusion Italian immigrants are much less likely to use specialist healthcare and medical telephone consultations than natives but more likely to use ERs. Hence, we report an over-use of ERs and under-utilization of preventive care among immigrants. We recommend improved health policies for immigrants: promotion of better information dissemination among them, simplification of organizational procedures, better communications between providers and immigrants, and an increased supply of health services for the most disadvantaged populations.

8. Bonaccio M, Bonanni AE, Di Castelnuovo A, De Lucia F, Donati MB, de Gaetano G, Iacoviello L; Moli-sani Project Investigators. Low income is associated with poor adherence to a Mediterranean diet and a higher prevalence of obesity: cross-sectional results from the Moli-sani study. BMJ Open. 2012 Nov 19;2(6). pii: e001685. doi: 10.1136/bmjopen-2012-001685. Print 2012.
Science Communication Unit, Laboratory of Genetic and Environmental Epidemiology, Research Laboratories, Fondazione di Ricerca e Cura "Giovanni Paolo II", Campobasso, Italy.

Abstract OBJECTIVES: To examine cross-sectional associations of socioeconomic status (ie, income and education) with an adherence to a Mediterranean dietary pattern and obesity prevalence. DESIGN: Cross-sectional study on a sample of Italian subjects enrolled in the Moli-sani Project, a population-based cohort study. The Italian EPIC food frequency questionnaire was used to determine food intake. Adherence to a Mediterranean diet (MD) was appraised according to both the Mediterranean score elaborated by Trichopoulou (MDS) and the novel Italian Mediterranean Index (IMI) and to the a posteriori scores derived from principal component analysis. Four income categories were identified. SETTING: Molise region, Italy. PARTICIPANTS: 13 262 subjects (mean age 53±11, 50% men) out of 24 318 citizens (age ≥35) randomly enrolled in the Moli-sani Project. MAIN OUTCOMES: Dietary patterns and risk factors for cardiovascular disease. RESULTS: Household higher income were significantly associated with greater adherence to an MD (p<0.0001) and to Olive oil and Vegetables dietary pattern in a multivariable model including age, sex, daily energy intake, body mass index, physical activity, smoking, alcohol consumption, education and marital status. The odds of having the highest adherence to an MD clearly increased according to income levels. People having the highest income had 54% (95% CI 21% to 97%, MDS) or 72% (95% CI 34% to 121%, IMI) higher probability to stick to an MD-like eating pattern than those in the lowest-income group. Obesity prevalence was higher in the lowest-income group (36%) in comparison with the highest-income category (20%, p<0.0001). Income was associated with dietary patterns in all categories of education. CONCLUSIONS: A higher income and education are independently associated with a greater adherence to MD-like eating patterns and a lower prevalence of obesity.

9. Melotti R, Lewis G, Hickman M, Heron J, Araya R, Macleod J. Early life socio-economic position and later alcohol use: birth cohort study. Addiction. 2012 Nov 16. doi: 10.1111/add.12018. [Epub ahead of print]
School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom; Center for Biomedicine, EURAC, Bolzano, Italy.

Abstract AIMS: To investigate associations between socio-economic position in early life and later alcohol use and problem use among male and female adolescents. DESIGN: Birth cohort study. SETTING: South West England. PARTICIPANTS: A total of 2711 girls and 2379 boys with one or more measures of alcohol use or problem use at age 15 years. MEASUREMENTS: Exposure measures were highest parental social class, maternal education and household disposable income (all maternal self-report before school-age); outcome measures were heavy typical drinking, frequent drinking, regular binge drinking, alcohol-related psychosocial problems and alcohol-related behavioural problems. FINDINGS: Alcohol use and related problems were relatively common amongst adolescent girls and boys. Boys were slightly more likely to report frequent drinking and girls were slightly more likely to drink heavily and to experience alcohol-related psychosocial problems. Higher maternal education appeared protective in relation to alcohol-related problems, particularly among boys. Higher household income was associated with greater risk of alcohol use and problem use, most apparently among girls. CONCLUSIONS: Children from higher-income households in England appear to be at greater risk of some types of adolescent alcohol problems, and these risks appear different in girls compared to boys. Childhood social advantage may not generally be associated with healthier behaviour in adolescence.

Breve commento a cura di C. Marinacci
Lo studio si basa su un ricco set di informazioni sociali familiari raccolte su una nota coorte di nati (Avon Longitudinal Study of Parents and Children, ALSPAC), nei primi anni novanta, in un’area sud-occidentale inglese, con follow up del consumo di alcool in adolescenza per un sottoinsieme della coorte stessa. La relazione tra condizioni sociali familiari e consumo di alcool in adolescenza risulta variabile con il genere e la dimensione della posizione sociale: l’istruzione materna presenta una correlazione significativa e negativa con la probabilità di esordio precoce del consumo e con il rischio di problemi comportamentali legati all’abuso, soprattutto tra i maschi; tra le femmine, invece, si evidenzia una maggiore frequenza di problemi psicosociali da abuso, al crescere delle risorse economiche familiari.

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