Social inequalities in health within the City of Milan (Lombardy Region, Northern Italy): An ecological assessment.

OBJECTIVES: to document existing geographical inequalities in health in the city of Milan (Lombardy Region, Northern Italy), examining the association between area socioeconomic disadvantage and health outcomes, with the aim to suggest policy action to tackle them. DESIGN: the analysis used an ecological framework; multiple health indicators were considered in the analysis; socioeconomic disadvantage was measured through indicators such as low education, unemployment, immigration status, and housing crowding. For each municipal statistical area, Bayesian Relative Risks of the outcomes (using the Besag-Yorkand-Mollié model) were plotted on the city map. To evaluate the association between social determinants and health outcomes, Spearman correlation coefficients were estimated. SETTING AND PARTICIPANTS: residents in the City of Milan aged between 30 and 75 years who were residing in Milan as of 01.01.2019, grouped in 88 statistical areas. MAIN OUTCOMES MEASURES: all-cause mortality, type-2 diabetes mellitus, hypertension, neoplasms, respiratory diseases, metabolic syndrome, antidepressants use, polypharmacy, and multimorbidity. RESULTS: the results consistently demonstrated a significant association between socioeconomic disadvantage and various health outcomes, with low education exhibiting the strongest correlations. Neoplasms displayed an inverse social gradient, while the relationship with antidepressant use varied. CONCLUSIONS: these findings provide valuable insights into the distribution of health inequalities in Milan and contribute to the existing literature on the social determinants of health. The study highlights the need for targeted interventions to address disparities and promote equitable health outcomes. The results can serve to inform the development of effective public health strategies and policies aimed at reducing health inequalities in the city.

A Home-Care Service for Frail Older Adults: Findings from a Quasi-Experiment in Milan.

Population aging is particularly pronounced in Italy. Recently, home-care services emerged as one of the desirable strategy when dealing with such situations of fragility. In this framework, we present the evaluation of a home-care service which was experimentally implemented by Fondazione Sacra Famiglia and Casa di Cura Ambrosiana in the 2017-2018 biennium. The service consisted of a twice-weekly nursing visit intended to monitor patient health conditions and to gather data constantly supervised by a geriatrician. The eligible population consisted of the users of San Carlo Hospital Emergency Department (91 individuals). Twenty of these individuals had access to the experimental home-care service. The results show the smaller probability of mortality for the treatment group compared to the control group, but similar probabilities in admissions to ER and in hospitalizations. These findings suggest that health home-care policies could reduce mortality by lessening the negative effects of relational isolation.

Boys Do Cry: Age and Gender Differences in Psycho-Physiological Distress during the COVID-19 Pandemic in Italy.

This article contributes to the quality of life literature by investigating gender and age gaps in psycho-physiological distress during the COVID-19 pandemic in Italy. Specifically, we investigate whether women experienced higher levels of distress than men, and if such gap can be explained by a greater negative reaction of women in the experience of a negative COVID-19 related event, such as the illness or death of a relative. Moreover, we explore whether age moderated or amplified the effect of a negative event on distress among women and men. To do so we rely on an ad hoc survey carried out between April 2020 and June 2021 in Italy, the first European country to be hit by the pandemic. Our results indicate that subjects who experienced the hospitalization or, more so, the death of a family member during the pandemic were more exposed to psycho-psychological distress compared to subjects who were not directly touched by COVID-19. Moreover, our results show that while women were on average more likely to express feelings of distress than men in absence of evident stressors, this gap disappeared among subjects who experience the death of a relative. Furthermore, our results indicate that experiencing a negative COVID-19 related event led to an increase in distress among all respondents except older men, who appeared to be the most resilient to the manifestation of any sign of distress. These results speak to important age and gender differences in the feelings and externalization of grief in the Italian context.

Nordic paradox in action: The complicated relation between social mobility and health inequalities in an international comparative study.

AIMS: Socio-economic inequalities originate from several channels, one of which is family origins, with clear effects on people's health. This paper aims to evaluate the role played by social mobility in determining health inequalities, relying on Blau and Duncan's status attainment model and focusing specifically on two moments of social reproduction of inequalities: one inter-generational, based on the transmission of resources from the family of origin, the other intra-generational, related to the capitalisation of economic resources to maximise well-being. METHODS: Multi-group models of structural equations were used to examine the direct and indirect effects of parental cultural background, education and economic conditions of respondents on self-perceived health in 28 countries, relying on the European Social Survey (N=38,879). RESULTS: Overall, the results confirmed the presence of an inter-generational transmission of social and health status. Different models of transmission of health inequalities emerged among the countries considered. Countries characterised by a social democratic welfare regime showed higher social mobility and fewer health inequalities, although in correspondence with a prominent role of economic factors in determining health conditions. On the other hand, in countries where social mobility is lower, health inequalities are more pronounced, yet driven by factors others than economics, such as socio-cultural origins. CONCLUSIONS: The presence of a higher economic-health gradient in social democratic countries - notwithstanding their egalitarian and universal welfare policies - provides support for the existence of a Nordic paradox in relation to health inequalities.

The impact of school closure intervention during the third wave of the COVID-19 pandemic in Italy: Evidence from the Milan area.

BACKGROUND: In February 2021, the spread of a new variant of SARS-CoV-2 in the Lombardy Region, Italy caused concerns about school-aged children as a source of contagion, leading local authorities to adopt an extraordinary school closure measure. This generated a debate about the usefulness of such an intervention in light of the trade-off between its related benefits and costs (e.g. delays in educational attainment, impact on children and families' psycho-physical well-being). This article analyses the epidemiological impact of the school closure intervention in the Milan metropolitan area. METHODS: Data from the Agency for Health Protection of the Metropolitan City of Milan allowed analysing the trend of contagion in different age classes before and after the intervention, adopting an interrupted times series design, providing a quasi-experimental counterfactual scenario. Segmented Poisson regression models of daily incident cases were performed separately for the 3-11-year-old, the 12-19-year-old, and the 20+-year-old age groups, examining the change in the contagion curves after the intervention, adjusting for time-varying confounders. Kaplan-Meier survival curves and Cox regression were used to assess the equality of survival curves in the three age groups before and after the intervention. RESULTS: Net of time-varying confounders, the intervention produced a daily reduction of the risk of contagion by 4% in those aged 3-11 and 12-19 (IRR = 0·96) and by 3% in those aged 20 or more (IRR = 0·97). More importantly, there were differences in the temporal order of contagion decrease between the age groups, with the epidemic curve lowering first in the school-aged children directly affected by the intervention, and only subsequently in the adult population, which presumably indirectly benefitted from the reduction of contagion among children. CONCLUSION: Though it was not possible to completely discern the effect of school closures from concurrent policy measures, a substantial decrease in the contagion curves was clearly detected after the intervention. The extent to which the slowdown of infections counterbalanced the social costs of the policy remains unclear.

The health of Italians before and after the economic crisis of 2008.

This article examines the relationship between the financial crisis of 2008 and the health of Italians using aggregate and individual health indicators in correlation with the socioeconomic changes which have occurred in the Italian population. First, the study contextualises the changes referring to some important health indicators (life expectancy, death and suicide rates). Then, the main hypothesis on the relation between worsened individual health conditions and socioeconomic deterioration is tested. For this purpose, individual data from 2005 to 2013 stemming from Health Condition and Use of Health Services surveys (Italian National Institute of Statistics) are analysed. The results show that the social categories most severely affected by the crisis, in both employment and economic terms, were basically the same as those that experienced a worsening of their physical and psychological health conditions. These categories of people have a low level of educational attainment, live in southern and insular regions and are most often men.

Neighbourhood property value and type 2 diabetes mellitus in the Maastricht study: A multilevel study.

OBJECTIVE: Low individual socioeconomic status (SES) is known to be associated with a higher risk of type 2 diabetes mellitus (T2DM), but the extent to which the local context in which people live may influence T2DM rates remains unclear. This study examines whether living in a low property value neighbourhood is associated with higher rates of T2DM independently of individual SES. RESEARCH DESIGN AND METHODS: Using cross-sectional data from the Maastricht Study (2010-2013) and geographical data from Statistics Netherlands, multilevel logistic regression was used to assess the association between neighbourhood property value and T2DM. Individual SES was based on education, occupation and income. Of the 2,056 participants (aged 40-75 years), 494 (24%) were diagnosed with T2DM. RESULTS: Individual SES was strongly associated with T2DM, but a significant proportion of the variance in T2DM was found at the neighbourhood level (VPC = 9.2%; 95% CI = 5.0%-16%). Participants living in the poorest neighbourhoods had a 2.38 times higher odds ratio of T2DM compared to those living in the richest areas (95% CI = 1.58-3.58), independently of individual SES. CONCLUSIONS: Neighbourhood property value showed a significant association with T2DM, suggesting the usefulness of area-based programmes aimed at improving neighbourhood characteristics in order to tackle inequalities in T2DM.

Poverty and private health expenditures in Italian households during the recent crisis.

The global financial crisis that began in 2008 had an overall effect on the health behaviours of Italian households. Aggregate private health expenditures have decreased while the citizens have increasingly been asked to share health costs. The reduction of households' health expenditure could have serious consequences for health, especially if it concerns the most vulnerable people. The aim of this paper is to analyse the relation between poverty and household health expenditure, considering regional and social group variations. The data used stem from the "Family Expenditure Survey" collected by the Italian Statistical Institute (ISTAT) from 1997 to 2013. Results of multivariate analysis controlling for potential socio-demographic confounders show that the propensity to spend for poor families is decreased in the last years compared to not poor households. Meanwhile, among the households who spend, the average expenditure in euro seems to have been more stable over time. This is an alarming signal for the health of the most vulnerable households. These conditions could result in a gradual deterioration of health in poor families, which is likely to increase the burden on health systems in future. Hence, at this moment public intervention does not seem able to alleviate this situation.

The role of social and cognitive factors in individual gambling: An empirical study on college students.

Most of the studies on the determinants of individual gambling behaviour rely on cognitive theories. In our study, we argue that, besides cognitive factors, several social factors might play an important role as well. We analyse data from an ad hoc webmail survey conducted on about 2000 undergraduate students enrolled in a large public university in the Northern Italy in the academic year 2012-13. Using a variety of statistical techniques (standard regression models, boosted regression trees and structural equations models), we show that social variables affect both participation in gambling in the past year and latent gambling propensity. In particular, controlling for several proxies for individual cognitive ability and understanding of probability, gambling propensity is positively affected by the degree of gambling in the social surrounding (parents, peers, neighbourhood) and the acceptability of gambling activities to the individual. Moreover, in our sample of college students the role of social factors appears to be larger than that of cognitive factors, and this is consistent across different types of models and specifications.

Changes in the labour market and health inequalities during the years of the recent economic downturn in Italy.

There is widespread concern that episodes of unemployment and unstable working conditions adversely affect health. We add to the debate by focusing on the relationship between work trajectory and the self-reported health of Italian men and women during the present economic downturn. Relying on Italian data in the EU-SILC project (from 2007 to 2010), our sample includes all individuals aged 30 to 60 in 2010, and uses multivariate binomial regression models for preliminary analyses and the Structural Equations modelling (SEM) to observe the cumulative effects of health status according to different job trajectories. Our main findings show similar pictures for men and women. Individuals who are unemployed, ejected or in precarious occupational positions have a higher risk of worsening their health status during these years.

Social inequalities and pharmaceutical cost sharing in Italian regions.

In recent years, Italian citizens have increasingly been asked to share pharmaceutical costs, but at the same time, households' medicines expenditure has decreased. Cost-sharing policies have to be assessed not just in terms of limitation of moral hazard and revenue to the state, but also for equal opportunities for citizen users accessing health services. The aim of this article is to analyze how Italian co-payment policies ("ticket") on medicines may affect pharmaceutical expenditure of households, considering territorial and social groups variation. We reviewed the per capita private spending on medicines of Italian regions, separating pharmaceutical outlay and "ticket." Across the period 2001-2010 we found that the overall per capita private spending on medicines remained substantially stable, although medicine expenditure decreases while the "ticket" increases. When cost sharing rises, out-of-pocket spending on medicines by poorer families seems to remain unchanged; however, poorer families seem to reduce their pharmaceutical expenditure. Our analysis suggests that applying co-payment in Italy is partly successful, in terms of greater revenue to the health system, but in the last few years, cost-sharing increases would seem to have rebounded negatively on more vulnerable families, due to the economic crisis.