Skip to main content
NCBI home page
Journal of Epidemiology and Community Health logoLink to Journal of Epidemiology and Community Health
. 1999 Nov;53(11):687–693. doi: 10.1136/jech.53.11.687

Inequality in health: socioeconomic differentials in mortality in Rome, 1990-95

P Michelozzi, C A Perucci, F Forastiere, D Fusco, C Ancona, V Dell'Orco
PMCID: PMC1756797  PMID: 10656097

Abstract

STUDY OBJECTIVE: 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. DESIGN: 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. MAIN RESULTS: 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. CONCLUSIONS: 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.

 

Full Text

The Full Text of this article is available as a PDF (93.8 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anderson R. T., Sorlie P., Backlund E., Johnson N., Kaplan G. A. Mortality effects of community socioeconomic status. Epidemiology. 1997 Jan;8(1):42–47. doi: 10.1097/00001648-199701000-00007. [DOI] [PubMed] [Google Scholar]
  2. Bentham G., Eimermann J., Haynes R., Lovett A., Brainard J. Limiting long-term illness and its associations with mortality and indicators of social deprivation. J Epidemiol Community Health. 1995 Dec;49 (Suppl 2):S57–S64. doi: 10.1136/jech.49.suppl_2.s57. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Borrell C., Plasència A., Pasarin I., Ortún V. Widening social inequalities in mortality: the case of Barcelona, a southern European city. J Epidemiol Community Health. 1997 Dec;51(6):659–667. doi: 10.1136/jech.51.6.659. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Carstairs V., Morris R. Deprivation: explaining differences in mortality between Scotland and England and Wales. BMJ. 1989 Oct 7;299(6704):886–889. doi: 10.1136/bmj.299.6704.886. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Curtis S. E. Use of survey data and small area statistics to assess the link between individual morbidity and neighbourhood deprivation. J Epidemiol Community Health. 1990 Mar;44(1):62–68. doi: 10.1136/jech.44.1.62. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Faggiano F., Zanetti R., Costa G. Cancer risk and social inequalities in Italy. J Epidemiol Community Health. 1994 Oct;48(5):447–452. doi: 10.1136/jech.48.5.447. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Ferraroni M., La Vecchia C., Pagano R., Negri E., Decarli A. Smoking in Italy, 1986-1987. Tumori. 1989 Dec 31;75(6):521–526. doi: 10.1177/030089168907500601. [DOI] [PubMed] [Google Scholar]
  8. Ferraroni M., La Vecchia C., Pagano R., Negri E., Parazzini F., Decarli A. Pattern of cervical screening utilization in Italy. Tumori. 1989 Oct 31;75(5):420–422. doi: 10.1177/030089168907500504. [DOI] [PubMed] [Google Scholar]
  9. Hyndman J. C., Holman C. D., Hockey R. L., Donovan R. J., Corti B., Rivera J. Misclassification of social disadvantage based on geographical areas: comparison of postcode and collector's district analyses. Int J Epidemiol. 1995 Feb;24(1):165–176. doi: 10.1093/ije/24.1.165. [DOI] [PubMed] [Google Scholar]
  10. Kennedy B. P., Kawachi I., Prothrow-Stith D. Income distribution and mortality: cross sectional ecological study of the Robin Hood index in the United States. BMJ. 1996 Apr 20;312(7037):1004–1007. doi: 10.1136/bmj.312.7037.1004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Krieger N., Fee E. Social class: the missing link in U.S. health data. Int J Health Serv. 1994;24(1):25–44. doi: 10.2190/2JG7-YMD5-WCP2-XXNT. [DOI] [PubMed] [Google Scholar]
  12. Krieger N. Overcoming the absence of socioeconomic data in medical records: validation and application of a census-based methodology. Am J Public Health. 1992 May;82(5):703–710. doi: 10.2105/ajph.82.5.703. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Krieger N., Williams D. R., Moss N. E. Measuring social class in US public health research: concepts, methodologies, and guidelines. Annu Rev Public Health. 1997;18:341–378. doi: 10.1146/annurev.publhealth.18.1.341. [DOI] [PubMed] [Google Scholar]
  14. Krieger N. Women and social class: a methodological study comparing individual, household, and census measures as predictors of black/white differences in reproductive history. J Epidemiol Community Health. 1991 Mar;45(1):35–42. doi: 10.1136/jech.45.1.35. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Kunst A. E., Groenhof F., Mackenbach J. P., Health E. W. Occupational class and cause specific mortality in middle aged men in 11 European countries: comparison of population based studies. EU Working Group on Socioeconomic Inequalities in Health. BMJ. 1998 May 30;316(7145):1636–1642. doi: 10.1136/bmj.316.7145.1636. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Mackenbach J. P. Socioeconomic inequalities in health in The Netherlands: impact of a five year research programme. BMJ. 1994 Dec 3;309(6967):1487–1491. doi: 10.1136/bmj.309.6967.1487. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Marang-van de Mheen P. J., Davey Smith G., Hart C. L., Gunning-Schepers L. J. Socioeconomic differentials in mortality among men within Great Britain: time trends and contributory causes. J Epidemiol Community Health. 1998 Apr;52(4):214–218. doi: 10.1136/jech.52.4.214. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Marshall S. W., Kawachi I., Pearce N., Borman B. Social class differences in mortality from diseases amenable to medical intervention in New Zealand. Int J Epidemiol. 1993 Apr;22(2):255–261. doi: 10.1093/ije/22.2.255. [DOI] [PubMed] [Google Scholar]
  19. Mays N., Chinn S. Relation between all cause standardised mortality ratios and two indices of deprivation at regional and district level in England. J Epidemiol Community Health. 1989 Jun;43(2):191–199. doi: 10.1136/jech.43.2.191. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. McLoone P., Boddy F. A. Deprivation and mortality in Scotland, 1981 and 1991. BMJ. 1994 Dec 3;309(6967):1465–1470. doi: 10.1136/bmj.309.6967.1465. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Pappas G., Queen S., Hadden W., Fisher G. The increasing disparity in mortality between socioeconomic groups in the United States, 1960 and 1986. N Engl J Med. 1993 Jul 8;329(2):103–109. doi: 10.1056/NEJM199307083290207. [DOI] [PubMed] [Google Scholar]
  22. Perucci C. A., Davoli M., Rapiti E., Abeni D. D., Forastiere F. Mortality of intravenous drug users in Rome: a cohort study. Am J Public Health. 1991 Oct;81(10):1307–1310. doi: 10.2105/ajph.81.10.1307. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Phillimore P., Beattie A., Townsend P. Widening inequality of health in northern England, 1981-91. BMJ. 1994 Apr 30;308(6937):1125–1128. doi: 10.1136/bmj.308.6937.1125. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Poikolainen K., Eskola J. Regional and social class variation in the relative risk of death from amenable causes in the city of Helsinki, 1980-1986. Int J Epidemiol. 1995 Feb;24(1):114–118. doi: 10.1093/ije/24.1.114. [DOI] [PubMed] [Google Scholar]
  25. Ronco G., Segnan N., Ponti A. Who has Pap tests? Variables associated with the use of Pap tests in absence of screening programmes. Int J Epidemiol. 1991 Jun;20(2):349–353. doi: 10.1093/ije/20.2.349. [DOI] [PubMed] [Google Scholar]
  26. Rosso S., Faggiano F., Zanetti R., Costa G. Social class and cancer survival in Turin, Italy. J Epidemiol Community Health. 1997 Feb;51(1):30–34. doi: 10.1136/jech.51.1.30. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Smith G. D., Egger M. Socioeconomic differences in mortality in Britain and the United States. Am J Public Health. 1992 Aug;82(8):1079–1081. doi: 10.2105/ajph.82.8.1079. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Smith G. D., Hart C., Watt G., Hole D., Hawthorne V. Individual social class, area-based deprivation, cardiovascular disease risk factors, and mortality: the Renfrew and Paisley Study. J Epidemiol Community Health. 1998 Jun;52(6):399–405. doi: 10.1136/jech.52.6.399. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Smith G. D., Morris J. Increasing inequalities in the health of the nation. BMJ. 1994 Dec 3;309(6967):1453–1454. doi: 10.1136/bmj.309.6967.1453. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Vineis P., Fornero G., Magnino A., Giacometti R., Ciccone G. Diagnostic delay, clinical stage, and social class: a hospital based study. J Epidemiol Community Health. 1993 Jun;47(3):229–231. doi: 10.1136/jech.47.3.229. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Vineis P., Paci E. Epidemiology and the Italian national health service. J Epidemiol Community Health. 1995 Dec;49(6):559–562. doi: 10.1136/jech.49.6.559. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Westerling R., Gullberg A., Rosén M. Socioeconomic differences in 'avoidable' mortality in Sweden 1986-1990. Int J Epidemiol. 1996 Jun;25(3):560–567. doi: 10.1093/ije/25.3.560. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Epidemiology and Community Health are provided here courtesy of BMJ Publishing Group

RESOURCES