Inequality in health: socioeconomic differentials in mortality in Rome, 1990-95

Study objective-Population groups with a lower socioeconomic status (SES) h ave a greater risk of disease and mortality. The aim of this study was to i nvestigate the relation between SES and mortality in the metropolitan area of Rome during the six year period 1990-1995, and to examine variations in mortality differentials between 1990-92 and 1993-95. Design-Rome has a population of approximately 2 800 000, with 6100 census t racts (CTs). During the study period, 149 002 deaths occurred among residen ts. The cause-specific mortality rates were compared among four socioeconom ic categories defined by a socioeconomic index, derived from characteristic s of the CT of residence. Main results-Among men, total mortality and mortality for the major causes of death showed an inverse association with SES. Among 15-44 year old men, the strong positive association between total mortality and low SES was att ributable to AIDS and overdose mortality. Among women, a positive associati on with lower SES was observed for stomach cancer, uterus cancer and cardio vascular disease, whereas mortality for lung and breast cancers was higher in the groups with higher SES. Comparing the periods 1990-92 and 1993-95, d ifferences in total mortality between socioeconomic groups widened in both sexes. Increasing differences were observed for tuberculosis and lung cance r among men, and for uterus cancer, traffic accidents, and overdose mortali ty among women. Conclusions-The use of an area-based indicator of SES limits the interpreta tions of the findings. However, despite the possible limitations, these res ults suggest that social class differences in mortality in Rome are increas ing. Time changes in lifestyle and in the prevalence of risk behaviours may produce differences in disease incidence. Moreover, inequalities in the ac cess to medical care and in the quality of care may contribute to an increa sing differentials in mortality.