The role of contextual socioeconomic circumstances and segregation on mortality: analysis of time variations in the city of Turin, Northwest Italy

Dimensione: px

Iniziare la visualizzazioe della pagina:

Download "The role of contextual socioeconomic circumstances and segregation on mortality: analysis of time variations in the city of Turin, Northwest Italy"

Aloisio Pini
5 anni fa
Visualizzazioni

1 The role of contextual socioeconomic circumstances and segregation on mortalit: analsis of time variations in the cit of Turin, Northwest Ital Chiara Marinacci 1, Moreno Demaria 2, Annibale Biggeri 3, Giuseppe Costa 4 1. S.C. a D.U. Epidemiogia, Azienda Sanitaria Locale TO3 2. Centro regionale per l'epidemiologia e la salute ambientale, Agenzia Regionale per la Protezione Ambientale del Piemonte 3. Dipartimento di Statistica G. Parenti, Università di Firenze 4. Dipartimento di Scienze Cliniche e Biologiche, Università di Torino

2 Background Health disadvantage of residents in socio-economicall deprived neighbourhoods, independentl on individual socioeconomic conditions (Pickett, 2001; Chaix, 2006) Heterogeneit of the associations between contextual deprivation and mortalit (Van Lenthe, 2005) Estimating impact of both material infrastructure and social relations indicators was suggested (Macintre, 2002; Cummins, 2007), to inform different sectors of polic interventions

3 Background Individual and contextual socioeconomic conditions independentl and significantl affected mortalit of Turin residents impact of neighborhood deprivation, stable in the period between 1971 and 2000, among people aged less than 65 (Marinacci et al., 2004)

4 Objective To re-analse mortalit distribution in the period between 1971 and 2000 across Turin areas, tring: To disentangle effects of o individual socioeconomic circumstances, o neighbourhood socioeconomic deprivation o socioeconomic segregation at the wider area-level To evaluate mutual interactions between neighbourhood deprivation and socioeconomic segregation To estimate time variations of socioeconomic segregation

5 Material and methods Data from Longitudinal Stud of Turin Three cohorts of persons aged ears, recorded in censuses of 1971, 1981, and 1991 and followed up for 10 ears after each census. Multilevel Poisson models for general mortalit as a function of time and individual covariates: age, area of birth education (upper secondar or higher, lower secondar, primar or less) housing conditions (large dwelling, small owned, small rented, no indoor bathroom or heating)

6 contextual covariates 92 statistical zones 23 neighbourhoods 10 wards Neighbourhood socioeconomic deprivation cumulating data on education, occupational class, lone-parent families, household ownership, poor house conditions and crowding

7 contextual covariates 92 statistical zones 23 neighbourhoods 10 wards Neighbourhood socioeconomic deprivation Ward level of socioeconomic segregation of individual disadvantage at censuses (lower education & poorer housing) across statistical zones

8 We referred to Ward segregation Unequal (vs. overall) distribution of social groups (disadvantaged vs. advantaged) across statistical zones dissimilarit D k = 0.5 n i k ij. j i... ij. j Probabilit that disadvantaged people will meet members of their own group in their statistical zone nk ij isolation Ik = i i. ij. j Range for both indices k=1, 2, to 10 wards, i = 1,, n k sub-ward units (in our case statistical zones within ward k) j = 1,2 (1=disadvantaged 2=advantaged) 0 1 max segregation

9 Results 1991 deprivation 1991 segregation indices ver advantaged advantaged medium deprived ver deprived isolation (range: ) I quintile II quintile III quintile IV quintile V quintile dissimilarit (range: )

10 Results Mortalit b neighbourhood deprivation and RR* ward segregation: females aged medium vs. rich deprived vs. rich isolation dissimilarit adjusted b deprivation deprivation deprivation adjusted b isolation deprivation adjusted b dissimilarit *RRs adjusted b time, age, area of birth, education and housing conditions

11 Results Mortalit b neighbourhood deprivation and RR* ward segregation: males aged medium vs. rich deprived vs. rich isolation dissimilarit diss 71 diss 81 diss 91 adjusted b deprivation deprivation deprivation adjusted b isolation deprivation adjusted b dissimilarit *RRs adjusted b time, age, area of birth, education and housing conditions

12 Limitations use of administrative boundaries ma not reflect the appropriate scale for deprivation and segregation ignored individual biographies on exposures to multiple contexts over time and place

13 Conclusions Significant increase in death risk with increasing socioeconomic segregation, with time variations among males Significant 9% higher mortalit was confirmed for residents in deprived neighbourhoods, compared to resident in rich areas Higher impact of segregation than material infrastructures, more investments on policies affecting relations among social groups

Documenti analoghi

OSTEOSARCOMA. VIIIa OSTEOSARCOMA 0-14 ANNI. Schede specifiche per tumore. I tumori in Italia Rapporto AIRTUM 2012 TUMORI INFANTILI

OSTEOSARCOMA. VIIIa OSTEOSARCOMA 0-14 ANNI. Schede specifiche per tumore. I tumori in Italia Rapporto AIRTUM 2012 TUMORI INFANTILI I tumori in Italia Rapporto AIRTUM TUMORI INFANTILI OSTEOSARCOMA - ANNI - ANNI INCIDENZA Tasso. Nella classe di età - anni, il tasso di incidenza standardizzato per età è di, casi per milione/anno (IC9%,-,)