Testi Angela, Ivaldi Enrico
Department of Economics and Quantitative Methods, University of Genoa, Via Vivaldi 5, Genoa, Italy.
Eur J Health Econ. 2009 Jul;10(3):323-8. doi: 10.1007/s10198-008-0136-z. Epub 2008 Nov 19.
Socioeconomic factors are one of the main determinants of health inequalities. However, which component of socioeconomic status affects health most and how that relationship should be measured remains an open question. The aim of this study was to compare material and social deprivation indexes in order to determine which better explains health inequalities within an urban area. Following a review of the literature on small area deprivation indexes, a case study of the Italian city Genoa is presented. The city of Genoa is split into 71 small areas [urbanistic units (UU)], each of which has about 9,500 inhabitants. For each small area, socioeconomic indicators were extracted from the 2001 Census, whereas health indicators were computed from the death registry for 2001-2003. Factorial analyses was used to choose the deprivation variables, which were utilised to create two distinct deprivation indexes referring to material and social deprivation, respectively. Both deprivation indexes are positively correlated with health status proxied by standardised mortality ratios (SMRs) under 65. The material index, however, correlates more highly with SMRs than the social index, and thus the material index is the more suitable measure to explain variations in premature mortality within an urban area. Moreover, the two indexes must be kept distinct.
社会经济因素是健康不平等的主要决定因素之一。然而，社会经济地位的哪个组成部分对健康影响最大，以及这种关系应如何衡量，仍是一个悬而未决的问题。本研究的目的是比较物质匮乏指数和社会剥夺指数，以确定哪一个能更好地解释城市地区的健康不平等现象。在回顾了关于小区域剥夺指数的文献后，本文给出了意大利城市热那亚的一个案例研究。热那亚市被划分为71个小区域[城市单元（UU）]，每个区域约有9500名居民。对于每个小区域，社会经济指标取自2001年人口普查，而健康指标则根据2001 - 2003年死亡登记数据计算得出。采用因子分析来选择剥夺变量，这些变量分别用于创建两个不同的剥夺指数，即物质剥夺指数和社会剥夺指数。两个剥夺指数均与65岁以下标准化死亡率（SMR）所代表的健康状况呈正相关。然而，物质指数与标准化死亡率的相关性高于社会指数，因此物质指数是解释城市地区过早死亡率差异的更合适指标。此外，这两个指数必须保持区分开来。
