Petrelli Alessio, Ventura Martina, Di Napoli Anteo, Pappagallo Marilena, Simeoni Silvia, Frova Luisa
National Institute for Health, Migration and Poverty (INMP), Via di San Gallicano, 25/a, 00153, Rome, Italy.
National Institute of Statistics (Istat), Viale Liegi 13, 00198, Rome, Italy.
BMC Public Health. 2024 Mar 11;24(1):757. doi: 10.1186/s12889-024-18205-6.
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.
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.
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.
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.
在意大利，尚未在全国范围内对可避免死亡率的差异进行评估。本研究旨在评估社会经济地位与可避免死亡率之间的关联。
对2011年人口与住房普查的全国封闭队列进行随访，以获取2012 - 2019年的死亡率数据。在30 - 74岁人群中分别评估可预防死亡率和可治疗死亡率的结果。暴露因素为教育水平（小学及以下、初中、高中文凭、大学学位及以上）和居住大区（西北、东北、中部、南岛），通过多变量准泊松回归模型计算调整后的死亡率比（MRR），并对死亡年龄进行了调整。估计了可预防、可治疗和不可避免死亡率以及一些特定病因的不平等相对指数。
该队列包括35,708,459名居民（48.8%为男性，17.5%年龄在65 - 74岁），34%拥有高中学历，33.5%居住在南岛；观察到1,127,760例死亡，其中65.2%是由可避免原因导致的（40.4%为可预防的，24.9%为可治疗的）。所有病因的死亡率均呈现出教育水平与死亡率之间的反向趋势；将受教育程度最低的群体与最高的群体进行比较，可预防死因（男性MRR = 2.39；女性MRR = 1.65）和可治疗死因（男性MRR = 1.93；女性MRR = 1.45）均存在强烈关联。在艾滋病毒/艾滋病和酒精相关疾病（男女皆是）、药物相关疾病和结核病（男性）以及糖尿病、心血管疾病和肾衰竭（女性）方面观察到最大的不平等。南岛地区存在可预防和可治疗死亡率的额外风险。
意大利在死亡率方面的社会经济不平等现象依然存在，各地区对政策的反应差异极大，这可能意味着健康方面的潜在收益未实现，表明需要重新评估优先事项并确定健康目标。
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