Top

Journal of Public Health

Published in:

01-02-2019 | Original Article

The role of individual characteristics and municipalities in social inequalities in perceived health (Italy, 2010–2012): a multilevel study

Authors: Simone Sarti, F. Biolcati-Rinaldi, A. Vitalini

Published in: Journal of Public Health | Issue 1/2019

Abstract

Backgrounds

The empirical evidence shows discordant results regarding the role of local contexts on individual health. This article considers the role of the municipal socio-economic contexts on self-rated health in Italy, taking into account some individual variables.

Methods

Multilevel model software (MlwiN) is used to fit multilevel linear regression models of perceived health. Individual data are from the Italian surveys on “Aspects of Daily Life” 2010, 2011 and 2012, collected by the Italian National Institute of Statistics (Istat). In addition, municipality-level social, demographic and economic characteristics are from the 2011 Census and the database “Atlas of Italian Municipalities” (Istat).

Results

The main findings of this study confirm that, controlling for age and gender at the individual level, poor health is influenced by socio-economic positions: lower education, not working or looking for employment and disadvantaged family social class predict higher perceived health. The individual level explains the 70.1% heterogeneity in self-assessed health, the family level 25.6% and the municipality level only 4.3%. The additional influence of the socio-economic context is, conversely, of little substantive importance.

Conclusions

Finally, by showing that variability in health relates mainly to individual characteristics, this study suggests that intervention to mitigate social inequalities in health should focus on structural factors, such as education and the labour market.

Bell ML, Zanobetti A, Dominici F (2013) Evidence on vulnerability and susceptibility to health risks associated with short-term exposure to particulate matter: a systematic review and meta-analysis. Am J Epidemiol 178(6):865–876 first published online July 25, 2013. https://doi.org/10.1093/aje/kwt090 CrossRefPubMedPubMedCentral

Cummins S, Stafford M, Macintyre S, Marmot M, Ellaway A (2005) Neighbourhood environment and its association with self-rated health: evidence from Scotland and England. J Epidemiol Community Health 59(3):207–213CrossRefPubMedPubMedCentral

Diez Rouz AV (2001) Investigating neighborhood and area effects on health. Am J Public Health 91(11):1783–1789CrossRef

Egidi V, Spizzichino D (2006) Perceived health and mortality: a multidimensional analysis of ECHP Italian data, Genus LXII, n. 3–4

Erikson R, Goldthorpe JH (1992) The constant flux. Clarendon Press, Oxford, p 1992

Fayers PM, Sprangers MAG (2002) Understanding self-rated health. Lancet 359:9302

Goldstein H (2011) Multilevel statistical models (Vol. 922), Wiley

Goldthorpe JH (2009) Analysing social inequality: a critique of two recent contributions from economics and epidemiology. Eur Sociol Rev. https://doi.org/10.1093/esr/jcp046

Haslam SA, Jette J, Postmes T, Haslam C (2009) Social identity, health and well-being: an emerging agenda for applied psychology, Appl Psychol-Int Rev 58, (1), 1–23. doi: https://doi.org/10.1111/j.1464-0597.2008.00379.x

Hox JJ (2010) Multilevel analysis: Techniques and applications, Taylor & Francis

Istat (2006) Il sistema di indagini sociali multiscopo, Roma

Jylhä M (2009) What is self-rated health and why does it predict mortality? Towards a unified conceptual model. Soc Sci Med 69:307–316CrossRefPubMed

Lucchini M, Sarti S, Tognetti M (2009) I welfare regionali e le differenze territoriali nelle disuguaglianze di salute, Dimensioni della disuguaglianza in Italia: povertà, salute, abitazione, (edit by) A.Brandolini, C.Saraceno and A.Schizzerotto, Bologna, Il Mulino, 165–189

Macintyre S, Ellaway A, Cummins S (2002) Place effects on health: how can we conceptualise, operationalise and measure them? Soc Sci Med 55:125–139CrossRefPubMed

Mackenbach JP, Stirbu I, Roskam AJR, Schaap MM, Menvielle G, Leinsalu M, Kunst AE (2008) Socioeconomic inequalities in health in 22 European countries. N Engl J Med 358(23):2468–2481CrossRefPubMed

Marinacci C, Spadea T, Biggeri A, Demaria M, Caiazzo A, Costa G (2004) The role of individual and contextual socioeconomic circumstances on mortality: analysis of time variations in a city of north-West Italy. J Epidemiol Community Health 58:199–207CrossRefPubMedPubMedCentral

Marinacci C, Ferracin E, Landriscina T, Cislaghi C, Gargiulo L, Costa G (2010) Differenze geografiche o differenze sociali, Rapporto OsservaSalute 473–484

Marmot M (2005) Social determinants of health inequalities. Lancet 365(9464):1099–1104CrossRefPubMed

Marmot M (2015). The health gap: the challenge of an unequal world. Bloomsbury Publishing

Phelan J, Link BG, Tehranifar P (2010) Social conditions as fundamentalcauses of health inequalities: theory, evidence, and policy implica-tions. J Health Soc Behav 51:S28–S40CrossRefPubMed

Pickett K, Pearl M (2001) Multilevel analyses of neighbourhood socio-economic context and health outcomes: a critical review. J Epidemiol Community Health 55:111–122CrossRefPubMedPubMedCentral

Piombo S (2013) Multilevel analysis in household surveys: an application to health condition data, PhD Dissertation Thesis, University of Bologna

Ross CE, Wu C (1996) Education, age, and the cumulative advantage in health. J Health Soc Behav 37:104–120CrossRefPubMed

Sarti S, Zella S (2016) Changes in the labour market and health inequalities during the years of the recent economic downturn in Italy. Int J Soc Sci Res 57:116–132

Schaefer-McDaniel N, O’Brien Caughy M, O’Campo P, Gearey W (2010) Examining methodological details of neighbourhood observations and the relationship to health: a literature review. Soc Sci Med 70(2):277–292CrossRefPubMed

Subramian SV, Kawachi I, Kennedy BP (2001) Does the state you live in make a difference?Multilevel analysis of self-rated health in the US. Soc Sci Med 53:9–19. https://doi.org/10.1016/S0277-9536(00)00309-9 CrossRef

Tremblay S, Ross NA, Berthelot JM (2002) Regional socio-economic context and health. Public Health Rep 13:1–12

Wilkinson RG, Pickett KE (2009) Income inequality and social dysfunction. Annu Rev Sociol 35:493–511CrossRef

Willson AE, Shuey KM, Elder GH Jr (2007) Cumulative advantage processes as mechanisms of inequality in life course health. AJS 112(6):1886–1924

World Bank (2017) World Bank Open Data. Available at: https://data.worldbank.org/

Title: The role of individual characteristics and municipalities in social inequalities in perceived health (Italy, 2010–2012): a multilevel study
Authors: Simone Sarti
F. Biolcati-Rinaldi
A. Vitalini
Publication date: 01-02-2019
Publisher: Springer Berlin Heidelberg
Published in: Journal of Public Health / Issue 1/2019
Print ISSN: 2198-1833
Electronic ISSN: 1613-2238
DOI: https://doi.org/10.1007/s10389-018-0933-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

The role of individual characteristics and municipalities in social inequalities in perceived health (Italy, 2010–2012): a multilevel study

Abstract

Backgrounds

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Backgrounds

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2019

Lifestyle habits and well-being among primary health physicians in western Saudi Arabia

Exploring cross-generational physical activity: who are the gate-keepers?

Comparing single-level and multilevel regression analysis for risk adjustment of treatment outcomes in common mental health disorders

Implementing a regression discontinuity design to explore the heterogeneous effects of obesity on labour income: the case of Mexico

The methanol content of illicit alcoholic beverages seized in a low socio-economic area of Tel-Aviv: public health impact and policy implications

Tracking the efficacy of the test and treat model of HIV prevention in India using National Family Health Surveys (2005–16)