Centre for International and Intercultural Health, University of Bologna (Italy);
Centre for International and Intercultural Health, University of Bologna (Italy).
Epidemiol Prev. 2020 Sep-Dec;44(5-6 Suppl 1):45-53. doi: 10.19191/EP20.5-6.S1.P045.073.
since January 2017, a multidisciplinary research group, involving the Local Health Authority, the Municipality, and the University of Bologna, carried out a city-wide action-research project on health inequalities consisting of an ecological study over the years 2011-2015 based on indicators that are routinely available within health and social services.
to document existing geographical inequalities in health outcomes and use of healthcare services in the city of Bologna (Emilia-Romagna Region, Northern Italy), with the aim to suggest policy action to tackle them.
the results of the first phase of the above-mentioned project were reported: five related to the social determinants of health (exposure) and five related to the social determinants of ill-health (outcomes). For each municipal statistical area, the distribution of the exposures as well as rates and Bayesian Relative Risks of the outcomes were plotted on the city map. To evaluate the association between social determinants and health outcomes, Spearman correlation coefficients were estimated.
residents in the city of Bologna aged >=18 years in the period 2011-2015, grouped into 90 statistical areas.
a North-South divide was apparent for most of the socioeconomic and ill-health indicators, with a high concentration of adverse outcomes in the North-Western part of the city. Adherence to cancer screening represented an exception, being greater in the areas with higher proportion of unfavourable health outcomes. An inverse association between education level and health outcomes was found. Low family income was weakly to moderately correlated with health outcomes. Proportion of residents in council houses and of the teenage foreign population showed a moderate to strong association with all outcomes, but mortality and screening adherence.
an ecological analysis based on data that are routinely collected by local health and social institutions can be effective in revealing the geographical patterns of health inequalities. When accompanied by strategic choices aimed at bridging knowledge and action, this approach may facilitate the direct engagement of local actors towards health equity.
自 2017 年 1 月以来，一个由多学科研究小组组成，涉及当地卫生部门、市政府和博洛尼亚大学的机构，开展了一项全市范围的健康不平等行动研究项目，该项目由基于卫生和社会服务中常规可用指标的 2011-2015 年的生态研究组成。
记录博洛尼亚市（意大利北部艾米利亚-罗马涅地区）现有健康结果和医疗服务使用方面的地理不平等，并旨在提出解决这些不平等的政策行动。
报告了上述项目第一阶段的结果：与健康决定因素（暴露）相关的五项，以及与健康不良决定因素（结果）相关的五项。对于每个市统计区，将暴露分布以及结果的发生率和贝叶斯相对风险绘制在城市地图上。为了评估社会决定因素与健康结果之间的关联，估计了斯皮尔曼相关系数。
2011-2015 年期间，博洛尼亚市年龄>=18 岁的居民，分为 90 个统计区。
大多数社会经济和健康不良指标都表现出南北差距，城市西北部地区不良结果高度集中。癌症筛查的遵守情况是一个例外，在健康结果不利的地区更高。教育水平与健康结果呈负相关。家庭收入低与健康结果呈弱至中度相关。居民在议会住房中的比例和青少年外国人口与所有结果都呈中度至强相关，但与死亡率和筛查遵守率无关。
基于地方卫生和社会机构常规收集的数据进行的生态分析可以有效地揭示健康不平等的地理模式。当与旨在弥合知识和行动差距的战略选择相结合时，这种方法可以促进地方行为体对健康公平的直接参与。
