Advertisement

Social Indicators Research

, Volume 139, Issue 2, pp 745–785 | Cite as

Measuring Change Over Time in Socio-economic Deprivation and Health in an Urban Context: The Case Study of Genoa

  • Stefano Landi
  • Enrico Ivaldi
  • Angela Testi
Original Research

Abstract

The inverse relationship between socioeconomic and health status has been well established in the literature. Disparities in health status due to socioeconomic conditions are unfair and can be prevented through appropriate health and social policies. The relation between socioeconomic factors and health outcomes can be proven at both the individual and geographic level. In this study, we follow the second stream of literature. The objective of the study is to measure how deprivation changes over time in an urban context, finding out whether socioeconomic inequalities association with health outcomes endure over time. To do so, a census-based deprivation index (GDI—Genoa Deprivation Index) have been developed using three aggregation methods—additive, Mazziotta–Pareto, and Pena distance. The innovation of the work is the attempt to evaluate deprivation over time, trying to formalize a methodological path replicable in other situation. Health status has been assessed using the standardized (premature) mortality ratios. The findings reveal that although deprivation inequalities continue to exist in Genoa, global levels have been decreasing. In addition, the rate of premature mortality has shown improvements. Despite this, GDI scores continue to be associated with premature deaths: individuals living in deprived areas report consistently high standardised mortality ratios.

Keywords

Deprivation Health status Mazziotta–Pareto Genoa Deprivation Index Standardized mortality ratios Deprivation over time Health inequalities Socioeconomic inequalities 

References

  1. Adler, E. A., & Newman, K. (2002). Socioeconomic disparities in health: Pathways and policies. Health Affairs, 21(2), 60–76.CrossRefGoogle Scholar
  2. Allik, M., Brown, D., Dundas, R., & Leyland, A. H. (2016). Developing a new small-area measure of deprivation using 2001 and 2011 census data from Scotland. Health & Place, 39, 122–130.CrossRefGoogle Scholar
  3. Andersen, K. K., Steding-Jessen, M., Dalton, S. O., & Olsen, T. S. (2014). Socioeconomic position and incidence of ischemic stroke in Denmark 2003–2012: A nationwide hospital-based study. Journal of the American Heart Association, 3(4), 1–6.CrossRefGoogle Scholar
  4. Atkinson, J., Salmond, C., & Crampton, P. (2014). NZDep2013 index of deprivation. Wellington: The Department of Public Health, University of Otago.Google Scholar
  5. Barnett, S., Roderick, P., Martin, D., & Diamond, I. (2001). A multilevel analysis of the effects of rurality and social deprivation on premature limiting long term illness. Journal of Epidemiology Community Health, 55(1), 44–51.CrossRefGoogle Scholar
  6. Bartley, M., & Blane, D. (1994). Commentary: Appropriateness of deprivation indices must be ensured. BMJ, 309(6967), 1479.CrossRefGoogle Scholar
  7. Basta, N. O., James, P. W., Gomez-Pozo, B., Craft, A. W., Norman, P. D., & McNally, R. J. Q. (2014). Survival from teenage and young adult cancer in northern England, 1968–2008. Pediatric Blood & Cancer, 61(5), 901–906.CrossRefGoogle Scholar
  8. Bell, N., & Hayes, M. V. (2012). The Vancouver area neighbourhood deprivation index (VANDIX): A census-based tool for assessing small-area variations in health status. Canadian Journal Public Health/Revue Canadienne de Sante’e Publique, 103(8 Suppl. 2), S28–S32.Google Scholar
  9. Benach, J., & Yasui, Y. (1999). Geographical patterns of excess mortality in Spain explained by two indices of deprivation. Journal of Epidemiology and Community Health, 53(7), 423–431.CrossRefGoogle Scholar
  10. Bertin, M., Chevrier, C., Pelé, F., Serrano-Chavez, T., Cordier, S., & Viel, J. F. (2014). Can a deprivation index be used legitimately over both urban and rural areas? International Journal of Health Geographics, 13(1), 22.CrossRefGoogle Scholar
  11. Boarini, R., & Mira d’Ercole, M. (2006). Measures of material deprivation in OECD Countries. OECD social employment and migration, Working Papers, No. 37, Sussex, OECD Publishing.Google Scholar
  12. Bond Huie, S. A., Krueger, P. M., Rogers, R. G., & Hummer, R. A. (2003). Wealth, race and mortality. Social Science Quarterly, 84(3), 667–684.CrossRefGoogle Scholar
  13. Boyle, P., Gatrell, A., & Duke-Williams, O. (1999). The effect on morbidity of variability in deprivation and population stability in England and Wales: An investigation at small-area level. Social Science and Medicine, 49(6), 791–799.CrossRefGoogle Scholar
  14. Boyle, P., Norman, P., & Popham, F. (2009). Social mobility: Evidence that it can widen health inequalities. Social Science and Medicine, 68(10), 1835–1842.CrossRefGoogle Scholar
  15. Burrows, S., Auger, N., Roy, M., & Alix, C. (2010). Socio-economic inequalities in suicide attempts and suicide mortality in Quebec, Canada, 1990–2005. Public Health, 124(2), 78–85.CrossRefGoogle Scholar
  16. Cadum, E., Costa, F., Biggeri, A., & Martuzzi, M. (1999). Deprivazione e mortalità: Un indice di deprivazione per l’analisi delle disuguaglianze su base geografica. Epidemiologia e Prevenzione, 23(3), 175–187.Google Scholar
  17. Caranci, N., Biggeri, A., Grisotto, L., Pacelli, B., Spadea, T., & Costa, G. (2010). The Italian deprivation index at census block level: Definition, description and association with general mortality. Epidemiologia e Prevenzione, 34(4), 167–176.Google Scholar
  18. Carstairs, V., & Morris, R. (1991). Deprivation and health in Scotland. Aberdeen: Aberdeen University Press.Google Scholar
  19. Davey Smith, G., Whitley, E., Dorling, D., & Gunnel, D. (2001). Area based measures of social and economic circumstances: Cause specific mortality patterns depend on the choice of index. Journal of Epidemiology and Community Health, 55(2), 149–150.CrossRefGoogle Scholar
  20. De Muro, P., Mazziotta, M., & Pareto, A. (2007). Composite indices for multidimensional development and poverty: An application to MDG indicators. Wye City Group Meeting, Rome, Italy. http://www.fao.org/es/ess/rural/wye_city_group.
  21. Deaton, A., & Lubotsky, D. (2003). Mortality, inequality and race in American cities and states. Social Science and Medicine, 56(6), 1139–1153.CrossRefGoogle Scholar
  22. Exeter, D. J., Boyle, P. J., & Norman, P. (2011). Deprivation (im)mobility and cause-specific premature mortality in Scotland. Social Science and Medicine, 72(3), 389–397.CrossRefGoogle Scholar
  23. Exeter, D. J., Feng, Z., Flowerdew, R., & Boyle, P. J. (2005). Shrinking areas and mortality: An artefact of deprivation effects? Journal of Epidemiology and Community Health, 59(11), 924–926.CrossRefGoogle Scholar
  24. Forrest, R., & Gordon, D. (1993). People and places: A 1991 Census atlas of England. Bristol: University of Bristol, SAUS.Google Scholar
  25. Friedman, M. (1937). The use of ranks to avoid the assumption of normality implicit in the analysis of variance. Journal of the American Statistical Association, 32(200), 675–701.CrossRefGoogle Scholar
  26. Gilthorpe, M. S., & Wilson, R. C. (2003). Rural/urban differences in the association between deprivation and healthcare utilisation. Social Science and Medicine, 57(11), 2055–2063.CrossRefGoogle Scholar
  27. Gotsens, M., Mari-Del’Olmo, M., Perez, K., et al. (2013). Socioeconomic inequalities in injury mortality in small areas of 15 European cities. Health & Place, 24, 165–177.CrossRefGoogle Scholar
  28. Gregory, I. N. (2002). The accuracy of areal interpolation techniques: Standardising 19th and 20th century census data to allow long-term comparisons. Computers, Environment and Urban Systems, 26(4), 293–314.CrossRefGoogle Scholar
  29. Hagedoorn, P., Vandenheede, H., Vanthomme, K., Willaert, D., & Gadeyne, S. (2016). A cohort study into head and neck cancer mortality in Belgium (2001–11): Are individual socioeconomic differences conditional on area deprivation? Oral Oncology, 61, 76–82.CrossRefGoogle Scholar
  30. Hartigan, J. A., & Wong, M. A. (1979). Algorithm AS136: A K-means clustering algorithm. Journal of the Royal Statistical Society: Series C (Applied Statistics), 28(1), 100–108.Google Scholar
  31. Havard, S., Deguen, S., Bodin, J., Louis, K., Laurent, O., & Bard, D. (2008). A small-area index of socioeconomic deprivation to capture health inequalities in France. Social Science and Medicine, 67(12), 2007–2016.CrossRefGoogle Scholar
  32. Haynes, R., Gale, S., Lovett, A., & Bentham, G. (1996). Unemployment rate as an updatable health needs indicator for small areas. Journal of Public Health Medicine, 18(1), 27–32.CrossRefGoogle Scholar
  33. Hoffmann, R., et al. (2014). Social differences in avoidable mortality between small areas of 15 European cities: An ecological study. International Journal of Health Geographics, 13(1), 8.CrossRefGoogle Scholar
  34. Ivaldi, E., & Testi, A. (2011). Genoa index of deprivation (GDI): An index of material deprivation for geographical areas. In C. M. Baird (Ed.), Social indicators: Statistics, trends and policy development. Hauppauge, New York: Nova Science Publishers.Google Scholar
  35. Ivaldi, E., Bonatti, G, & Soliani, G. (2017). An indicator for the measurement of political participation: The case of Italy. Social Indicator Research, 132(2), 605–620.CrossRefGoogle Scholar
  36. Jackson, C., Jones, M., & Mishra, G. D. (2014). Educational and homeownership inequalities in stroke incidence: A population-based longitudinal study of mid-aged women. The European Journal of Public Health, 24(2), 231–236.CrossRefGoogle Scholar
  37. Jarman, B. (1983). Identification of underprivileged areas. British Medical Journal, 286(6385), 1705–1709.CrossRefGoogle Scholar
  38. Kelleher, C., Timoney, A., Friel, S., & McKeown, D. (2002). Indicators of deprivation, voting patterns and health status at area level in the Republic of Ireland. Journal of Epidemiology and Community Health, 56(1), 36–44.CrossRefGoogle Scholar
  39. Lalloué, B., Monnez, J. M., Padilla, C., Kihal, W., Le Meur, N., Zmirou-Navier, D., et al. (2013). A statistical procedure to create a neighborhood socioeconomic index for health inequalities analysis. International Journal for Equity in Health, 12(1), 21.CrossRefGoogle Scholar
  40. Mackenbach, J. P. (2010). Has the English strategy to reduce health inequalities failed? Social Science and Medicine, 71(7), 1249–1253.CrossRefGoogle Scholar
  41. Mackenbach, J. P. (2012). The persistence of health inequalities in modern welfare states: The explanation of a paradox. Social Science and Medicine, 75(4), 761–769.CrossRefGoogle Scholar
  42. Mackenbach, J. P., Bos, V., Andersen, O., Cardano, M., Costa, G., Harding, S., et al. (2003). Widening socioeconomic inequalities in mortality in six Western European countries. International Journal of Epidemiologic, 32(5), 830–837.CrossRefGoogle Scholar
  43. Mackenbach, J. P., Stirbu, I., Roskam, A. J., et al. (2008). Socioeconomic inequalities in health in 22 European countries. New England Journal of Medicine, 358(23), 2468–2481.CrossRefGoogle Scholar
  44. Mazziotta, C., Mazziotta, M., Pareto, A., & Vidoli, F. (2010a). La sintesi di indicatori territoriali di dotazione infrastrutturale: Metodi di costruzione e procedure di ponderazione a confronto. Rivista di Economia e Statistica del Territorio, 1, 1–33.Google Scholar
  45. Mazziotta, M., & Pareto, A. (2007). Un indicatore sintetico di dotazione infrastrutturale: il metodo delle penalita` per coefficiente di variazione. In Lo sviluppo regionale nell’Unione Europea—Obiettivi, strategie, politiche. Atti della XXVIII Conferenza Italiana di Scienze Regionali, AISRe, Bolzano.Google Scholar
  46. Mazziotta, M., & Pareto, A. (2011). Un indice sintetico non compensativo per la misura della dotazione infrastrutturale: Un’applicazione in ambito sanitario. Rivista di Statistica Ufficiale, 13(1), 63–79.Google Scholar
  47. Mazziotta, M., & Pareto, A. (2012). A non-compensatory approach for the measurement of the quality of life. In F. Maggino & G. Nuvolati (Eds.), Quality of life in Italy. Social Indicator Research Series 48 (pp. 27–40). Dordrecht: Springer.Google Scholar
  48. Mazziotta, M., Pareto, A., & Talucci, V. (2010b). La costruzione di indicatori di disuguaglianza sociale: Il caso delle regioni italiane. XXXI Conferenza Italiana di Scienze Regionali. http://www.grupposervizioambiente.it/aisre_sito/doc/papers/Mazziotta_Pareto_Talucci_AISRE.pdf.
  49. Mishra, S. K. (2012). A note on the indeterminacy and arbitrariness of Pena’s method of construction of synthetic indicator. SSRN. http://ssrn.com/abstract=2026293.
  50. Montero, J. M., Chasco, C., & Larraz, B. (2010). Building an environmental quality index for a big city: A spatial interpolation approach combined with a distance indicator. Journal of Geographical Systems, 12(4), 435–459.CrossRefGoogle Scholar
  51. Munda, G., & Nardo, M. (2005). Non-compensatory composite indicators for ranking countries: A defensible setting (p. 21833). EUR: EUR Report.Google Scholar
  52. Nardo, M., Saisana, M., Saltelli, A., Tarantola, S., Hoffman, A., & Giovannini, E. (2005). Handbook on constructing composite indicators: Methodology and user guide. Paris: OECD Publishing.Google Scholar
  53. Nayak, P. & Mishra, S. K. (2012). Efficiency of Pena’s P2 distance in construction of human development indices. MPRA—Munich Personal RePEc Archive, Paper 39022.Google Scholar
  54. Noble, M., Barnes, H., Wright, G., & Roberts, B. (2010). Small area indices of multiple deprivation in South Africa. Social Indicators Research, 95(2), 281–297.CrossRefGoogle Scholar
  55. Norman, P. (2010). Identifying change over time in small area socio-economic deprivation. Applied Spatial Analysis and Policy, 3(2–3), 107–138.CrossRefGoogle Scholar
  56. Norman, P., Gregory, I., Dorling, D., & Baker, A. (2008). Geographical trends in infant mortality: England and Wales, 1970–2006. Health Statistics Quarterly, 40, 18–29.Google Scholar
  57. O’Reilly, G., O’Reilly, D., Rosato, M., & Connolly, S. (2007). Urban and rural variations in morbidity and mortality in Northern Ireland. BMC Public Health, 7(1), 123.CrossRefGoogle Scholar
  58. Panczak, R., Galobardes, B., Voorpostel, M., Spoerri, A., Zwahlen, M., & Egger, M. (2012). A Swiss neighbourhood index of socioeconomic position: Development and association with mortality. Journal of Epidemiology and Community Health, 66(12), 1129–1136.CrossRefGoogle Scholar
  59. Peña, J. B. (1977). Problemas de la medicio´n del bienestar y conceptos afines (Una aplicacio´n al caso espanol). Madrid: Instituto Nacional de Estadı´stica (INE).Google Scholar
  60. Petrelli, A., Gnavi, R., Marinacci, C., & Costa, G. (2006). Socioeconomic inequalities in coronary heart disease in Italy: A multilevel population-based study. Social Science and Medicine, 63(2), 446–456.CrossRefGoogle Scholar
  61. Regidor, E., Lostao, L., Pascual, C., Martínez, D., Calle, M. E., & Domínguez, V. (2005). Income in large residential areas and premature mortality in six countries of the European Union. Health Policy, 75(1), 99–108.CrossRefGoogle Scholar
  62. Saisana, M., Saltelli, A., & Tarantola, S. (2005). Uncertainty and sensitivity analysis techniques as tools for the quality assessment of composite indicators. Journal of the Royal Statistical Society: Series A (Statistics in Society), 168(2), 307–323.CrossRefGoogle Scholar
  63. Salzman, J. (2003). Methodological choices encountered in the construction of composite indices of economic and social well-being. Ottawa: Centre for the Study of Living Standards.Google Scholar
  64. Santana, P., Costa, C., Marí-Dell’Olmo, M., Gotsens, M., & Borrell, C. (2015). Mortality, material deprivation and urbanization: Exploring the social patterns of a metropolitan area. International Journal for Equity in Health, 14(1), 1–13.CrossRefGoogle Scholar
  65. Schroeder, J. P. (2007). Target-density weighting interpolation and uncertainty evaluation for temporal analysis of census data. Geographical Analysis, 39(3), 311–335.CrossRefGoogle Scholar
  66. Sen, A. (1987). On ethics and economics. Oxford: Basil Blackwell.Google Scholar
  67. Senior, M. L. (2002). Deprivation indicators. In P. Rees, D. Martin, & P. Williamson (Eds.), The census data system (pp. 123–137). Chichester: Wiley.Google Scholar
  68. Smits, J. P. J. M., Westert, G. P., & Van Den Bos, G. A. M. (2002). Socioeconomic status of very small areas and stroke incidence in the Netherlands. Journal of Epidemiology and Community Health, 56(8), 637–640.CrossRefGoogle Scholar
  69. Somarriba, N., & Pena, B. (2009). Synthetic indicators of quality of life in Europe. Social Indicators Research, 94(1), 115–133.CrossRefGoogle Scholar
  70. Spadea, T., Zengarini, N., Kunst, A., Zanetti, R., Rosso, S., & Costa, G. (2010). Cancer risk in relationship to different indicators of adult socioeconomic position in Turin, Italy. Cancer Causes Control, 21(7), 1117–1130.CrossRefGoogle Scholar
  71. Strand, B. H., Groholt, E. K., Steingrimmsdottir, O. A., Blakely, T., Graff-Iversen, S., & Naess, O. (2010). Educational inequalities in mortality over four decades in Norway: Prospective study of middle aged men and women followed for cause specific mortality, 1960–2000. BMJ, 340, c654.CrossRefGoogle Scholar
  72. Stringhini, S., Sabia, S., Shipley, M., Brunner, E., Nabi, H., Kivimaki, M., et al. (2010). Association of socioeconomic position with health behaviors and mortality. JAMA, 303(12), 1159–1166.CrossRefGoogle Scholar
  73. Su, S., Gong, Y., Tan, B., Pi, J., Weng, M., & Cai, Z. (2016). Area social deprivation and public health: Analyzing the spatial non-stationary associations using geographically weighed regression. Social Indicators Research. doi: 10.1007/s11205-016-1390-6.Google Scholar
  74. Testi, A., & Ivaldi, E. (2009). Material versus social deprivation and health: A case study of an urban area. The European Journal of Health Economics, 10(3), 323.CrossRefGoogle Scholar
  75. Townsend, P. (1987). Deprivation. Journal of Social Policy, 16(2), 125–146.CrossRefGoogle Scholar
  76. Townsend, P., Phillimore, P., & Beattie, A. (1988). Health and deprivation: Inequality and the North. London: Croom Helm.Google Scholar
  77. Van Doorslaer, E. (1997). Socioeconomic inequalities in health: Measurement, computation and statistical inference. Journal of Econometrics, 77(1), 87–103.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2017

Authors and Affiliations

  1. 1.Department of Economics and Business StudiesUniversity of GenoaGenoaItaly
  2. 2.Department of Political ScienceUniversity of GenoaGenoaItaly
  3. 3.Department of ManagementUniversity “Ca’ Foscari” VeniceVeniceItaly

Personalised recommendations