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The European Journal of Public Health Advance Access published online on June 23, 2005
The European Journal of Public Health, doi:10.1093/eurpub/cki007
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© The Author 2005. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved
Received August 21, 2003
Accepted April 1, 2004

Article

Income inequality and mortality in Italy

Enrico Materia 1*, Laura Cacciani 1, Giulio Bugarini 2, Giulia Cesaroni 3, Marina Davoli 3, Maria Paola Mirale 2, Loredana Vergine 2, Giovanni Baglio 1, Giuseppe Simeone 2, and Carlo A. Perucci 3

1 1 Agenzia di Sanità Pubblica, Regione Lazio, Rome, Italy
2 2 Unità Operativa Studi di Politica Tributaria, SOGEI, Rome, Italy
3 3 Dipartimento di Epidemiologia, ASL RME, Rome, Italy

* To whom correspondence should be addressed.
Enrico Materia, E-mail: materia{at}asplazio.it


  Abstract

Background: The relationship between income inequality and health remains controversial in terms of whether or not it exists and, if so, its extent and the mechanisms involved. This study examines the relationship between income inequality, as indicated by the Gini coefficient, and mortality in Italy. Methods: Cross-sectional ecological study on the 57 138 489 inhabitants living in the 95 provinces existing in Italy in 1994. Multivariate weighted regression analysis of total and age-specific mortality, income inequality, gender, and interaction between income inequality and median income or geographical area. Results: A positive association between income inequality and total mortality was observed for both genders in provinces with a low per capita income and in Southern and Central Italy. The effect was present for infants and for persons over 24 years of age; it was marked for the elderly, particularly women. A negative association with mortality was observed for males living in the North-west. Interactions between income inequality and median income, and between income inequality and geographical area were found. Conclusion: In Italy, the relationship between income inequality and health is mixed and not universal, in so far as a positive association was observed only in provinces with lower absolute income. Elderly persons living in Southern Italy represent the population subgroup most vulnerable to unequal income distribution. Income inequality can, in part, explain the historically higher mortality among women in Southern Italy compared to women in the North. These results indicate that income inequality affects the health of population subgroups differentially.

Keywords: income inequality; Gini coefficient; mortality.
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