RT Journal Article
SR Electronic
T1 Socioeconomic inequalities in health status and survival: a cohort study in Rome
JF BMJ Open
JO BMJ Open
FD British Medical Journal Publishing Group
SP e055503
DO 10.1136/bmjopen-2021-055503
VO 12
IS 8
A1 Dei Bardi, Luca
A1 Calandrini, Enrico
A1 Bargagli, Anna Maria
A1 Egidi, Viviana
A1 Davoli, Marina
A1 Agabiti, Nera
A1 Cesaroni, Giulia
YR 2022
UL http://bmjopen.bmj.com/content/12/8/e055503.abstract
AB Objectives To analyse the association between individual and contextual socioeconomic position (SEP) with health status and to investigate the role of SEP and baseline health status on survival.Design Cross-sectional and cohort study.Setting Rome, Italy.Participants, primary and secondary outcomes We selected the 25–99 year-olds included in the Rome 2011 census cohort. As a measure of health status on the census reference date (09 October 2011), we used the presence of chronic or rare conditions from the Disease-Related Co-payment Exemption Registry, a database implemented to provide free care to people with chronic or rare diseases. We used logistic regression to analyse the association between both individual (educational attainment) and contextual SEP (neighbourhood real estate price quintiles) with baseline health status. We analysed the role of SEP and the presence of chronic or rare conditions on 5-year survival (until 31 December 2016) using accelerated failure time models with Weibull distribution, reporting time ratios (TRs; 95% CI).Results In middle-aged, subjects with low SEP (either individual or contextual) had a prevalence of chronic conditions comparable with the prevalence in high SEP individuals 10 years older. Adjusted logistic models confirmed the direct association between SEP and baseline health status in both women and men. The lowest educated were up to 67% more likely to have a chronic condition than the highest educated, while the difference was up to 86% for lowest versus highest contextual SEP. Low SEP and the presence of chronic conditions were associated with shorter survival times in both sexes, lowest versus highest educated TR was TR=0.79 for women (95% CI: 0.77 to 0.81) and TR=0.71 for men (95% CI: 0.70 to 0.73). The contextual SEP shrunk survival times by about 10%.Conclusion Inequalities were present in both baseline health and survival. The association between SEP and survival was independent of baseline health status.No data are available. The data sets analysed during the current study are not publicly available due to privacy policies.