Determinants of health disparities between Italian regions

Luisa Franzini,Margherita Giannoni

doi:10.1186/1471-2458-10-296

Abstract

BackgroundAmong European countries, Italy is one of the countries where regional health disparities contribute substantially to socioeconomic health disparities. In this paper, we report on regional differences in self-reported poor health and explore possible determinants at the individual and regional levels in Italy.MethodsWe use data from the "Indagine Multiscopo sulle Famiglie", a survey of aspects of everyday life in the Italian population, to estimate multilevel logistic regressions that model poor self-reported health as a function of individual and regional socioeconomic factors. Next we use the causal step approach to test if living conditions, healthcare characteristics, social isolation, and health behaviors at the regional level mediate the relationship between regional socioeconomic factors and self-rated health.ResultsWe find that residents living in regions with more poverty, more unemployment, and more income inequality are more likely to report poor health and that poor living conditions and private share of healthcare expenditures at the regional level mediate socioeconomic disparities in self-rated health among Italian regions.ConclusionThe implications are that regional contexts matter and that regional policies in Italy have the potential to reduce health disparities by implementing interventions aimed at improving living conditions and access to quality healthcare.

Highlights

Among European countries, Italy is one of the countries where regional health disparities contribute substantially to socioeconomic health disparities
The 7% prevalence of poor health in this Italian sample is consistent with Carrieri [10] and van Doorslaer & Jones [48] who used Bank of Italy data (2004) and the European Community Household Panel (1996) respectively, but were lower than the prevalence reported in the Italian Health Interview Survey [6,38]
The odds ratio of economic disadvantage decreases from 1.21 to 0.99 and is no longer statistically significant, but living in regions with worse living conditions increased the odds of reporting poor health by 41% and living in regions with a larger share of private healthcare expenditures decreased the odds by 6%. These results indicate that poor living conditions and share of private healthcare expenditures mediate the association of regional socioeconomic status to poor health

Summary

Introduction

Among European countries, Italy is one of the countries where regional health disparities contribute substantially to socioeconomic health disparities. Despite having relatively poor average self-reported health, Italy it is one of the Southern European countries with relatively low, but increasing, socioeconomic health inequalities compared to other European countries. The study finds a North-South gradient in self-assessed health, affected mainly by area composition with respect to individual education, and only slightly influenced by contextual factors, such as area level socioeconomic and power resources. Another study, based on a relatively small sample of individual households income and health data from Bank of Italy collected in 2004, has found that, at national level individual income affects positively self-assessed health, there seem not to be a clear socioeconomic gradient in terms of NorthSouth divide [10]. This study, did not consider simultaneously the role of regional and individual level characteristics

Methods

Results

Discussion

Conclusion