Socioeconomic inequalities in avoidable mortality in Italy: results from a nationwide longitudinal cohort

Alessio Petrelli; Martina Ventura; Anteo Di Napoli; Marilena Pappagallo; Silvia Simeoni; Luisa Frova

doi:10.1186/s12889-024-18205-6

Socioeconomic inequalities in avoidable mortality in Italy: results from a nationwide longitudinal cohort

BMC Public Health. 2024 Mar 11;24(1):757. doi: 10.1186/s12889-024-18205-6.

Authors

Alessio Petrelli¹, Martina Ventura², Anteo Di Napoli², Marilena Pappagallo³, Silvia Simeoni³, Luisa Frova³

Affiliations

¹ National Institute for Health, Migration and Poverty (INMP), Via di San Gallicano, 25/a, 00153, Rome, Italy. alessio.petrelli@inmp.it.
² National Institute for Health, Migration and Poverty (INMP), Via di San Gallicano, 25/a, 00153, Rome, Italy.
³ National Institute of Statistics (Istat), Viale Liegi 13, 00198, Rome, Italy.

Abstract

Background: Disparities in avoidable mortality have never been evaluated in Italy at the national level. The present study aimed to assess the association between socioeconomic status and avoidable mortality.

Methods: The nationwide closed cohort of the 2011 Census of Population and Housing was followed up for 2012-2019 mortality. Outcomes of preventable and of treatable mortality were separately evaluated among people aged 30-74. Education level (elementary school or less, middle school, high school diploma, university degree or more) and residence macro area (North-West, North-East, Center, South-Islands) were the exposures, for which adjusted mortality rate ratios (MRRs) were calculated through multivariate quasi-Poisson regression models, adjusted for age at death. Relative index of inequalities was estimated for preventable, treatable, and non-avoidable mortality and for some specific causes.

Results: The cohort consisted of 35,708,459 residents (48.8% men, 17.5% aged 65-74), 34% with a high school diploma, 33.5% living in the South-Islands; 1,127,760 deaths were observed, of which 65.2% for avoidable causes (40.4% preventable and 24.9% treatable). Inverse trends between education level and mortality were observed for all causes; comparing the least with the most educated groups, a strong association was observed for preventable (males MRR = 2.39; females MRR = 1.65) and for treatable causes of death (males MRR = 1.93; females MRR = 1.45). The greatest inequalities were observed for HIV/AIDS and alcohol-related diseases (both sexes), drug-related diseases and tuberculosis (males), and diabetes mellitus, cardiovascular diseases, and renal failure (females). Excess risk of preventable and of treatable mortality were observed for the South-Islands.

Conclusions: Socioeconomic inequalities in mortality persist in Italy, with an extremely varied response to policies at the regional level, representing a possible missed gain in health and suggesting a reassessment of priorities and definition of health targets.

Keywords: Avoidable mortality; Education level; Preventable mortality; Socioeconomic inequalities; Treatable mortality.

MeSH terms

Cardiovascular Diseases*
Cause of Death
Educational Status
Female
Humans
Italy / epidemiology
Male
Mortality
Social Class
Socioeconomic Factors