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Socioeconomic Inequalities and Self-Rated Health: A Multilevel Study of Italian Elderly

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Abstract

We adopted a multilevel approach in order to provide a comprehensive overview of the main social and economic differences associated with inequalities in self-rated health, according to the territorial context of residence. We focused on the Italian population aged 65 and over, availing of the most recent data on health conditions in Italy. This study proves the persistence in Italy, a modern welfare state that has one of the best overall healthcare systems in the world, of significant, if not enormous, socioeconomic differences in self-perceived health among the elderly. We found that each component of the socioeconomic status is autonomously correlated with individual perceptions of health, highlighting the importance of considering all of the facets of the individual socioeconomic status in measuring the extent of health inequalities. The lack of a network of relationships was also found to be strongly associated with a poor health status for elderly Italians. Our study also documented the presence of a contextual effect. The proposed multilevel modeling proved to be useful in shedding light on relevant aspects in the field of perceived health and for avoiding misleading results.

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Notes

  1. The index of housing conditions is based on the following characteristics reported by individuals about their housing: lack of a bathroom, lack of a heating system, house too small, presence of humidity stains, house in bad conditions, less than one room per component. If all of these negative conditions are present, the value is one. If five out of six negative characteristics are present, the value is two, and so on, until a value of seven is reached, meaning none of the negative conditions (i.e., very good housing conditions).

  2. We acknowledged, however, that although we checked some of the most relevant dimensions of health, owing to a lack of data we were not able to account for mental health.

  3. In order to compare the different services included in the indicator—e.g., use of medication, use of diagnostic tests, general practitioner and specialist doctor visits, territorial attendance, numbers and duration of hospitalizations, and use of rehabilitation services—each service is weighted using the economic value of the single performance, as a measure of its importance.

References

  • Avlund, K., Holstein, B. E., Osler, M., Damsgaard, M. T., Holm-Pedersen, P., & Rasmussen, N. K. (2003). Social position and health in old age: The relevance of different indicators of social position. Scandinavian Journal of Public Health, 31(2), 126–136.

    Article  Google Scholar 

  • Blalock, H. M. (1984). Contextual-effects models: Theoretical and methodological issues. Annual Review of Sociology, 10, 353–372.

    Article  Google Scholar 

  • Blane, D., Davey Smith, G., & Bartley, M. (1993). Social selection: What does it contribute to social class differences in health? Sociology of Health & Illness, 15, 1–15.

    Article  Google Scholar 

  • Borg, V., & Kristensen, T. S. (2000). Social class and self-rated health: Can the gradient be explained by differences in life style or work environment? Social Science and Medicine, 51, 1019–1030.

    Article  Google Scholar 

  • Bryk, A. S., & Raudenbush, S. W. (1992). Hierarchical linear models. Newbury Park, CA: Sage.

    Google Scholar 

  • Carle, A. C. (2009). Fitting multilevel models in complex survey data with design weights: Recommendations. BMC Medical Research Methodology, 9, 49.

    Article  Google Scholar 

  • Carrieri, V. (2008), Disuguaglianze di salute e condizioni socioeconomiche in Italia: Esiste una questione meridionale? Politiche sanitarie, n.1.

  • Cavelaars, A. E. J. M., Kunst, A. E., Geurts, J. J. M., et al. (1998). Differences in self-reported morbidity by educational level: A comparison of 11 Western European countries. Journal of Epidemiology Community Health, 52, 219–227.

    Article  Google Scholar 

  • Costa, G., Marinacci, C., Caiazzo, A., & Spadea, T. (2003). Individual and contextual determinants of inequalities in health: The Italian case. International Journal of Health Services, 33, 635–667.

    Article  Google Scholar 

  • Costa-Font, J. (2008). Housing assets and the socio-economic determinants of health and disability in old age. Health and Place, 14(3), 478–491.

    Article  Google Scholar 

  • Demakokos, P., Nazroo, J., Breeze, E., & Marmot, M. (2008). Socioeconomic status and health: The role of subjective social status. Social Science and Medicine, 67(2), 330–340.

    Article  Google Scholar 

  • Egidi, V., & Spizzichino, D. (2006). Perceived health and mortality: A multidimensional analysis of ECHP Italian Data. Genus, LXII(3–4), 135–154.

    Google Scholar 

  • Egidi, V., & Spizzichino, D. (2007). Dimensioni oggettive e soggettive delle differenze di genere nella salute. In A. Pinnelli, F. Racioppi, & L. Terzera (Eds.), Genere, Famiglia e Salute. Milan, Italy: Franco Angeli Editore.

    Google Scholar 

  • France, G., Taroni, F., & Donatini, A. (2005). The Italian health-care system. Health Economy, 14, 187–202.

    Article  Google Scholar 

  • Giarelli, G. (2009). Modelli esplicativi delle disuguaglianze di salute: una riflessione sociologica. In G. Costa, C. Cislaghi, & N. Caranci (a cura di). (2009). Le disuguaglianze sociali di salute, Problemi di definizione e di misura, Salute e Società (Vol. 1, pp. 58–78). Franco Angeli Editore, Italy.

  • Grilli, L., & Pratesi, M. (2004). Weighted estimation in multilevel ordinal and binary models in the presence of informative sampling designs. Survey Methodology, 30, 93–103.

    Google Scholar 

  • Grundy, E., & Holt, G. (2001). The socioeconomic status of older adults: How should we measure it in studies of health inequalities? Journal of Epidemiology Community Health, 55, 895–904.

    Article  Google Scholar 

  • Grundy, E., & Slogget, A. (2003). Health inequalities in the older population: The role of personal capital, social resources and socio-economic circumstances. Social Science and Medicine, 56, 935–947.

    Article  Google Scholar 

  • Huisman, M., Kunst, A. E., & Mackenbach, J. P. (2003). Socioeconomic inequalities in morbidity among the elderly; a European overview. Social Science and Medicine, 57, 861–873.

    Article  Google Scholar 

  • Idler, E. L., & Benyamini, Y. (1997). Self-rated health and mortality: A review of twenty-seven community studies. Journal of Health and Social Behavior, 38(1), 21–37.

    Article  Google Scholar 

  • ISTAT. (2004). Indagine sui Presidi residenziali socio-assistenziali, Anno 2004.

  • ISTAT. (2007a). Condizioni di salute, fattori di rischio e ricorso ai servizi sanitari. Anno 2005, Statistiche in breve, Roma.

  • ISTAT. (2007b). Nota metodologica dell’Indagine “Condizioni di salute, fattori di rischio e ricorso ai servizi sanitari”—Anno 2005, Statistiche in breve, Roma.

  • Kunst, A. E., Bos, V., Lahelma, E., et al. (2005). Trends in socioeconomic inequalities in self-assessed health in 10 European countries. International Journal of Epidemiology, 34(2), 295–305.

    Article  Google Scholar 

  • Mackenbach, J. P., Stirbu, I., Roskam, A. R., et al. (2008). Socioeconomic inequalities in health in 22 European countries. The New England Journal of Medicine, 358, 2468–2481.

    Article  Google Scholar 

  • Martins, J. O., De la Maisonneuve, C., & Bjornerud, S. (2006). Projections of OECD health and long-term care public expenditures. In Proceedings of the Public Finance Workshop, Perugia, 30 March–1 April 2006, Research Department Banca d’Italia.

  • Mazzuco, S. (2009). Condizioni di salute nelle regioni italiane. In F. Ongaro & S. Salvini (Eds.), Rapporto sulla Popolazione—Salute e Sopravvivenza. Il Mulino, Bologna: Gruppo di Coordinamento per la demografia.

    Google Scholar 

  • McNiece, R., & Majeed, A. (1999). Socioeconomic differences in general practice consultation rates in patients aged 65 and over: Prospective cohort study. British Medical Journal, 319, 26.

    Article  Google Scholar 

  • Molarius, A., Berglund, K., Eriksson, C., Lambe, M., Bordstrom, E., Eriksson, H. G., et al. (2006). Socioeconomic conditions, lifestyle factors, and self-rated health among men and women in Sweden. European Journal of Public Health, 17(2), 125–133.

    Article  Google Scholar 

  • Olsen, K. M., & Dahl, S. (2007). Health differences between European Countries. Social Science and Medicine, 64, 1665–1678.

    Article  Google Scholar 

  • Ongaro, F., & Salvini, S. (2009). Socio-economic conditions and health inequalities in Italy at the beginning of the XXI century. Paper presented at the XLVI Scientific Meeting Sieds, Florence, 28–30 May 2009.

  • Pirani, E., & Salvini, S. (2010). Socioeconomic and territorial inequalities in health: findings for Italian elderly, Working Paper 2010/05, Department of Statistics “G. Parenti”, Firenze University Press. http://www.ds.unifi.it/ricerca/pubblicazioni/working_papers/2010/wp2010_05.pdf.

  • Pirani, E., & Salvini, S. (2011). Investigating socioeconomic differences in health services use: A latent class model for Italian regions. Paper presented at the Giornate di Studio sulla Popolazione, Ancona, 1–4 Feb 2011.

  • Prati, S., & Frova, L. (2011). Sopravvivenza e salute. In S. Salvini & A. De Rose (Eds.), Rapporto sulla Popolazione—L’Italia a 150 anni dall’Unità. Il Mulino, Bologna: Associazione Italiana per gli Studi di Popolazione.

    Google Scholar 

  • Rabe-Hesketh, S., & Skrondal, A. (2006). Multilevel modeling of complex survey data. Journal of the Royal Statistical Society Series A—Statistics in Society, 169, 805–827.

    Article  Google Scholar 

  • Rabe-Hesketh, S., & Skrondal, A. (2008). Multilevel and longitudinal modeling using Stata (2nd ed.). College Station, TX: Stata Press.

    Google Scholar 

  • Rueda, S., Artazcoz, L., & Navarro, V. (2008). Health inequalities among the elderly in Western Europe. Journal of Epidemiology Community Health, 62, 492–498.

    Article  Google Scholar 

  • United Nations. (2009). World population ageing 2009. Department of Economic and Social Affairs, Population Division, ESA/P/WP/212.

  • Vignoli, D., & De Santis, G. (2009). Individual and contextual correlates of economic difficulties in old age in Europe. Population Research Policy Review, 29(4), 481–501.

    Article  Google Scholar 

  • Volkers, A. C., Westert, G. P., & Schellevis, F. G. (2007). Health disparities by occupation, modified by education: A cross-sectional population study. BMC Public Health, 8(7), 196.

    Article  Google Scholar 

  • Voller, F., & Buiatti, E. (2006). Disuguaglianze e stili di vita in Italia, Salute e Territorio, 158.

  • Von dem Knesebeck, O., Luschen, G., Cockerham, W. C., & Siegrist, J. (2003). Socioeconomic status and health among the aged in the United States and Germany: A comparative cross-sectional study. Social Science and Medicine, 57, 1643–1652.

    Article  Google Scholar 

  • Von dem Knesebeck, O., Verde, P. E., & Dragano, N. (2006). Education and health in 22 European countries. Social Science and Medicine, 63, 1344–1351.

    Article  Google Scholar 

  • Yngwe, M. A., Diderichsen, F., Whitehead, M., Holland, P., & Burstrom, B. (2001). The role of income differences in explaining social inequalities in self-rated health in Sweden and Britain. Journal of Epidemiology Community Health, 55, 556–561.

    Article  Google Scholar 

Download references

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Authors and Affiliations

  1. Department of Statistics ‘‘G. Parenti’’, University of Florence, Viale GB Morgagni 59, 50134, Florence, Italy

    Elena Pirani & Silvana Salvini

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  1. Elena Pirani
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  2. Silvana Salvini
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Correspondence to Elena Pirani.

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Pirani, E., Salvini, S. Socioeconomic Inequalities and Self-Rated Health: A Multilevel Study of Italian Elderly. Popul Res Policy Rev 31, 97–117 (2012). https://doi.org/10.1007/s11113-011-9219-0

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