Socio-Economic Deprivation & Health Inequalities in Genoa, Italy: A Longitudinal Study, Slide di Statistica

Scarica Socio-Economic Deprivation & Health Inequalities in Genoa, Italy: A Longitudinal Study e più Slide in PDF di Statistica solo su Docsity! ROYAL STATISTICAL SOCIETY DATA | EVIDENCE | DECISIONS RSS 2017 International conference Glasgow 5-7/09/2017 Measuring Changes Over Time in Socio- Economic Deprivation and Health. The case study of Genoa, Italy Stefano Landi!*, Enrico Ivaldi, Angela Testi! ‘Dipartimento di Economia, Università di Genova ?Dipartimento di Scienze Politiche, Università di Genova ®Dipartimento di Management, Università Cà Foscari Venezia What determines our health? 4 Age 85 Life expectancy and disability-free life expectancy at birth by neighbourhood income deprivation, 1999-2003 80 75 70 653 60 50 55 i 45 Most deprived 5 10015 20 25 30 35 40. 45 50 55 60 65 70 75 80 85 90 95 100 Neighbourhood Income Deprivation { o Loast deprived (Population Percentiles) MD Life expectancy MB DFLE BM Pension age increase 2026-2046 Source: Office for National Statistics? Social determinants of health 7 stops from Westminster to Canning Town 7 years lost, one for each stop Weafminster Canad Bermondsey | a Greenwich Water Waterloo Southwark London Underground | Jubilee Line (pH Department QD - ofHealth London Hoalth Fonte: Analysis by London Health Observatory using Office for National Statistics data revised for 2002- Diagram produced by Department of Health Ss A ocial determinants of health l ti dirò chi sei» 45 minutes on the tram that tells you how much you will live 5 month lost every km Il Venerdì, 3 giugno 2016 G.Costa, Studio Longitudinale torinese > Is health determined by genetic code or zip code? (Slade-Sawyer 2014) ocial determinants of health I | 1 (<< — * Health status differences due to socio- economic conditions can be considered unfair because they could be avoided by employing active social policies, as literature points out (Mackenbach 2010) Fisso Soriano sons PA easure Socio-economic status a Deprivation Townsend (1987) defines deprivation as ‘a state of observable and demonstrable disadvantage relative to the local community or the wider society or nation to which an individual, family or group belongs’ Poverty vs Deprivation Economic resources vs life fully lived easure Deprivation I ( M Me * Deprivation index ‘‘measure the proportion of households... with a combination of circumstances indicating low living standards, or a high need for services, or both"'. * Small area deprivation index literature (Jarman 1983, Towsend 1987, Carstairs and Morris 1991, ...... Testi and Ivaldi 2010; Caranci et al. 2010, Panczak 2012, Atkinson et al., 2014, Pampalon et al., 2014) >lt is necessary to define the: @ input variables used for measuring deprivation, @® geographical scale, @® method to aggregate input variables into an index. £ ( : Measure deprivation Input variables: Census data (‘91-'01 -'11) Indicator Definition House ownership % of households living in rented houses Unemployment rate % of unemployed people compared to total workforce % of people with a degree lower or equal to primary education “licenza media”, middle school Overcrowding average number of occupants per room Low education The variables are the results of an explorative factorial analyses, performed on all census variables already utilised in the most common deprivation indexes proposed by the literature Notes for overtime comparisons: The society changes and the relative importance of particular indicators may change The variables selection have to take care of this. Measure deprivation 7 * Aggregation Methods: O Additive aggregation method O MPI (Mazziotti-Pareto-Index) O Pena distance method I | (7 — Aggregation Methods 77 Additive aggregation method 4 GDI; = y ij Tj) 7 0; Characteristics: Variables are standardized to avoid that the lack of homogeneity in terms of units of measurement leads someone to have greater weight than the other. I | (7 — Aggregation Methods A Mazziotta Pareto Index - MPI e MPI; = Hz; _ 07;CVz; ij _ . . dia = _ 4 (ij bj) 73 07;CVz, => funzione di penalità z;= 100 + Xj Ca 10 Characteristics: * Itcontainsa function (0,,cv,,) to penalize the units with “unbalanced” values of the partial composite indices. * It favors the areas that, mean being equal, have a greater balance among the different dimensions of deprivation (Mazziotta and Pareto 2012) Measure Health status Relative risk of premature mortality in a UU compared to the total population of the city (Cadum, Costa et al. 1999). Standard Mortality Ratio (SMR) <65 years SMRs are computed, for each UUs standardizing for sex and age, as the ratio between the observed premature deaths (0-65 age group) and the expected ones, i.e. the deaths that would have happened if each area had the same risk of the whole town. SMR = 1SMR> 1SMR <1 RESULTS Urban Units and Ranking 1991 2001 2011 Ranking vu vudeser Index Ranking vu uudescr Index Ranking uv uudeser Index 1 395. Vincenzo 3,27302 E. Equeo ra 1 65 Puggia 1,122642 2 64 Lido 3,300795 Di SS Manin) IR? 2 395. Vincenzo 1,165851 3 62 Albara 3,330522 È 65 Puggia DSESTe8 3 41 Foce 1,287433 4 65 Puggia 3,405647 5 a sms 4 A0Cerignano 1,298606 5 38 Manin 3,49061 È ma SSI08 5 38 Manin 1,299394 6 40 Cerignano 3,501693 San 6 37 Castelletto 1,373294 7 63San Giuliano 3,654305 i SE 1,60886 7 62 Albaro 1,527355 8 41 Foce 3,75197 8 41 Foce 1887977 8 63San Giuliano —1,569867 9 37 Castelletto 3,752534 9 40Carignano —1,888587 9 64 Lido 1,608812 10 68 Quartara 3,988022 10 68 Quertara 2,18487 10 42 Brignole 1,6989585 1991 2001 2011 Ranking uu uudescr Index Ranking uu uudeser mas Ranking uu uvdeser | Index 6i 16Teglia 8,649506 61 54 Doria 5,527459 6 22 Cornigliano 4,444812 62 22 Cornigliano 8,86873 62 51 Montesignano 5,528994 62 19 Morego 4,5242041 63 51 Montesignano 8,9198636 63 22 Cornigliano 5,613198 6 23 Campi 4,634545 64 34 Magdalena 9,0548382 64 33Prè 5,65206 64 205. Quirico 4,6898956 65 18 Bolzaneto 9,31389 65 205. Quirico 5,720005 65 16Teglia 4,6986765 66 205. Quirico 9,644545 66 16Teglia 5,913235 66 5 Pra' 5,065412 67 33Prè 9,903542 67 sPra' 5,991886 67 525. Eusebio ——5,21263 68 35 Molo 9,9730993 68 525, Eusebio 6,831749 68 33prè 5,434461 63 psi Berato PO ZOO 69 18 Bolzaneto 7,0286785 69 17 Begato 5,721184 70 525. Eusebio 10,50968 70 17 Begato 7,074104 70 18 Bolzaneto 6,102962 71 3 Ca' Nuova 16,01764 - 308 Nuova 10,0851 7 3Ca' Nuova 8,7448505 Comparing rankings over 20 years 8 5 I i") ll] 0" | at | lin sli | n "rr 8 Changes in deprivation in Genoa? Average GDI score- Genova GDI scores g 6 5 E 3 2 1 0 1991 2001 2011 Diff Number Mean SD Min Max Max-Min 1991 71 6,8147 2,17262 3,27 16,02 12,74 2001 71 4,1417 1,68398 1,37 11,53 10,16 2011 71 3,3619 1,30200 1,12 8,74 762 Changes in deprivation in Genoa? UUSs improvement More than Less than average avarage Worsened 41 0 281 ‘91-'01 '01-'11 GENOA DEPRIVATION INDEX (variation 1991-2001) BM UUSs worsened (] UUs imporved less than city average MM UUS improved more than city average SCALE LUI um Classes of deprivation # The GDI distribution for UU was grouped into 6 deprivation classes for each year using the K-Means clustering MacQueen algorithm (1967) 18 16 14 12 10 zona ricca zona benestante non deprivata bassa deprivazione Punteggio GDI Co » n media deprivazione alta deprivazione Mi1991 M2001 M2011 Urban units grouped for deprivation class 1991 GENOA DEPRIVATION INDEX (year 1991) BI class 6 - High deprivation [DD] class 3 - Not deprived MM class 5 - Middle deprivation IMM class 2 - Affluent [DD] class 4 - Low deprivation — MR class 1 - Very affluent SCALA 1851 km Urban units grouped for deprivation class 2001 GENOA DEPRIVATION INDEX (year 2001) IMI class 6 - High deprivation []] class 3 - Not deprived IM class 5 - Middle deprivation IM class 2 - Affluent [D class 4 - Low deprivation = class 1 - Very affluent SCALA 9551 um Association between Deprivation and SMR Pearson p GDI SMR 1991 SMR 2001 SMR 2011 VaVe[e[1u\Vo) 0,37 0,58 0,47 MPI 0,34 0,58 0,47 DP2 0,4 0,62 0,48 The association between the two dimensions persists over time. Deprivation classes and SMR Classes Definition SMR<65-1991 | SMR<65-2001 | SMR<65-2011 (C.1. 95%) (C.1. 95%) (CI. 95%) 1 Most affluent 0,78 0,32 0,75 (0,71-0,85) (0,74-0,90) (0,67-0,84) 2 0,93 0,92 0,95 (0,86-0,99) (0,86-0,98) (0,88-1,01) 3 0,96 1,06 1,08 (0,91-1,01) (0,99-1,14) (0,98-1,12) 4 1,11 1,11 1,18 (1,05-1,17) (1,03-1,20) (1,06-1,32) 5 1,36 1,32 1,27 (1,23-1,49) (1,12-1,55) (1,15-1,65) 25 SMR ce È Ù n ° © 0 Deprivation classes and SMR SMR per anni e classe di deprivazione 1991 2001 mi m2 m3 84 m5 m6 2011