National Institute for Health, Migration and Poverty (INMP), Via San Gallicano, 25 a, 00153, Rome, Italy.
National Institute of Statistics (ISTAT), Viale Liegi, 13, 00198, Rome, Italy.
Int J Equity Health. 2017 Jun 12;16(1):98. doi: 10.1186/s12939-017-0596-9.
The effects of the recent global economic and financial crisis especially affected the most vulnerable social groups. Objective of the study was to investigate variation of self-perceived health status in Italians and immigrants during the economic global crisis, focusing on demographic and socioeconomic factors.
Through a cross-sectional design we analyzed the national sample of multipurpose surveys "Health conditions and use of health services" (2005 and 2013) conducted by the Italian National Institute of Statistics (ISTAT). Physical Component Summary (PCS) and Mental Component Summary (MCS) scores, derived from SF-12 questionnaire, were assumed as study outcome, dichotomizing variables distribution at 1 quartile. Prevalence rate ratios (PRR) were estimated through log-binomial regression models, stratified by citizenship and gender, evaluating the association between PCS and MCS with surveys' year, adjusting for age, educational level, employment status, self-perceived economic resources, smoking habits, body mass index.
From 2005 to 2013 the proportion of people not employed or reporting scarce/insufficient economic resources increased, especially among men, in particular immigrants. Compared with 2005 we observed in 2013 among Italians a significant lower probability of worse PCS (PRR = 0.96 both for males and females), while no differences were observed among immigrants; a higher probability of worse MCS was observed, particularly among men (Italians: PRR = 1.26;95%CI:1.22-1.29; immigrants: PRR = 1.19;95%CI:1.03-1.38). Self-perceived scarce/insufficient economic resources were strongly and significantly associated with worse PCS and MCS for all subgroups. Lower educational level was strongly associated with worse PCS in Italians and slightly associated with worse MCS for all subgroups. Being not employed was associated with worse health status, especially mental health among men.
Our findings support the hypothesis that economic global crisis could have negatively affected health status, particularly mental health, of Italians and immigrants. Furthermore, results suggest socioeconomic inequalities increase, in economic resources availability dimension. In a context of public health resources' limitation due to financial crisis, policy decision makers and health service managers must face the challenge of equity in health.
最近的全球经济和金融危机对最弱势群体的影响尤其大。本研究的目的是调查在全球经济危机期间意大利人和移民的自我感知健康状况的变化，重点关注人口统计学和社会经济因素。
通过横断面设计，我们分析了意大利国家统计局（ISTAT）进行的多用途调查“健康状况和卫生服务利用”（2005 年和 2013 年）的全国样本。SF-12 问卷得出的身体成分摘要（PCS）和心理成分摘要（MCS）得分被视为研究结果，将变量分布在第 1 四分位数处进行二分。通过对数二项式回归模型估计患病率比（PRR），按公民身份和性别分层，评估 PCS 和 MCS 与调查年份之间的关联，调整年龄、教育水平、就业状况、自我感知经济资源、吸烟习惯、体重指数。
从 2005 年到 2013 年，失业或报告经济资源不足/匮乏的人数增加，尤其是男性，尤其是移民。与 2005 年相比，我们观察到 2013 年意大利人较差的 PCS 概率显著降低（男性和女性的 PRR 均为 0.96），而移民中没有观察到差异；较差的 MCS 概率更高，特别是男性（意大利人：PRR=1.26；95%CI：1.22-1.29；移民：PRR=1.19；95%CI：1.03-1.38）。自我感知的经济资源不足/匮乏与所有亚组的较差 PCS 和 MCS 强烈且显著相关。较低的教育水平与意大利人的较差 PCS 强烈相关，与所有亚组的较差 MCS 略相关。失业与健康状况较差相关，尤其是男性的心理健康。
我们的研究结果支持这样一种假设，即全球经济危机可能对意大利人和移民的健康状况，特别是心理健康状况产生负面影响。此外，研究结果表明，经济资源获取维度的社会经济不平等加剧。在金融危机导致公共卫生资源有限的背景下，政策制定者和卫生服务管理者必须应对健康公平的挑战。
