Caranci Nicola, Bartolini Letizia, Di Girolamo Chiara
Agenzia sanitaria e sociale regionale, Emilia-Romagna, Bologna;
Agenzia sanitaria e sociale regionale, Emilia-Romagna, Bologna.
Epidemiol Prev. 2020 Sep-Dec;44(5-6 Suppl 1):21-30. doi: 10.19191/EP20.5-6.S1.P021.070.
to present the Longitudinal Study of Emilia-Romagna (SLER) and evaluate whether the effect of the education level on premature mortality is modified by the degree of urbanisation.
closed cohort study.
population aged >=30 years, resident in Emilia-Romagna Region (Northern Italy) and registered in the 2011 Italian Census, followed up until death, emigration, attainment of 75th year of age, or end of 2018.
overall and cause-specific premature mortality (malignant tumours, lung and breast tumours, diseases of the circulatory system, respiratory system and digestive system, road accidents, death of despair, alcohol-related causes).
the study population consisted of 2,579,936 individuals (15,508,972 person-years and 71,213 deaths). The population was equally distributed across the three degrees of urbanisation, but the prevalence of highly educated subjects was lower in the sparsely populated areas than in cities (12.9% vs 27.7%). The higher risk of mortality among the low educated was greatest, particularly among males, in the cities (MRR 1.68; 95%CI 1.62-1.75), lowest in the intermediate density areas (MRR 1.47; 95%CI 1.40-1.55), and not negligible among women. The interaction between education level and degree of urbanisation was significant for all-cause mortality, mortality from cardiovascular diseases, malignant tumours, especially lung cancer, road accidents (only among men). Among women, there were signs of an effect modification on mortality from diseases of respiratory and digestive systems.
this first application of the SLER revealed that the mortality gradient by education level is greater in the cities, especially among men. These results deserve to be further explored through the analysis of other health outcomes and the investigation of the main drivers of the greater socioeconomic disadvantage observed in the cities.
介绍艾米利亚 - 罗马涅纵向研究（SLER），并评估城市化程度是否会改变教育水平对过早死亡的影响。
封闭队列研究。
年龄≥30岁、居住在艾米利亚 - 罗马涅地区（意大利北部）且在2011年意大利人口普查中登记的人群，随访至死亡、移民、年满75岁或2018年底。
总体和特定原因的过早死亡（恶性肿瘤、肺癌和乳腺癌、循环系统疾病、呼吸系统疾病、消化系统疾病、道路交通事故、绝望死亡、与酒精相关的原因）。
研究人群包括2579936人（15508972人年和71213例死亡）。人群在三个城市化程度中分布均匀，但在人口稀少地区，高学历人群的患病率低于城市（12.9%对27.7%）。低学历人群中较高的死亡风险在城市中最大，尤其是男性（相对危险度1.68；95%置信区间1.62 - 1.75），在中等密度地区最低（相对危险度1.47；95%置信区间1.40 - 1.55），在女性中也不可忽视。教育水平和城市化程度之间的相互作用在全因死亡率、心血管疾病死亡率、恶性肿瘤（尤其是肺癌）、道路交通事故（仅男性）方面具有统计学意义。在女性中，有迹象表明呼吸系统和消化系统疾病死亡率存在效应修正。
SLER的首次应用表明，教育水平导致的死亡率梯度在城市中更大，尤其是男性。这些结果值得通过分析其他健康结局以及调查城市中观察到的更大社会经济劣势的主要驱动因素来进一步探索。
