Skip to main content

Advertisement

Log in

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

  • Original Research
  • Published:
Social Indicators Research Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  • Adler, E. A., & Newman, K. (2002). Socioeconomic disparities in health: Pathways and policies. Health Affairs, 21(2), 60–76.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Atkinson, J., Salmond, C., & Crampton, P. (2014). NZDep2013 index of deprivation. Wellington: The Department of Public Health, University of Otago.

    Google Scholar 

  • 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.

    Article  Google Scholar 

  • Bartley, M., & Blane, D. (1994). Commentary: Appropriateness of deprivation indices must be ensured. BMJ, 309(6967), 1479.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Boyle, P., Norman, P., & Popham, F. (2009). Social mobility: Evidence that it can widen health inequalities. Social Science and Medicine, 68(10), 1835–1842.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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 

  • 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 

  • Carstairs, V., & Morris, R. (1991). Deprivation and health in Scotland. Aberdeen: Aberdeen University Press.

    Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

  • Deaton, A., & Lubotsky, D. (2003). Mortality, inequality and race in American cities and states. Social Science and Medicine, 56(6), 1139–1153.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Forrest, R., & Gordon, D. (1993). People and places: A 1991 Census atlas of England. Bristol: University of Bristol, SAUS.

    Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Jarman, B. (1983). Identification of underprivileged areas. British Medical Journal, 286(6385), 1705–1709.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Mackenbach, J. P. (2010). Has the English strategy to reduce health inequalities failed? Social Science and Medicine, 71(7), 1249–1253.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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 

  • 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.

  • 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 

  • 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 

  • 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.

  • 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.

  • 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.

    Article  Google Scholar 

  • Munda, G., & Nardo, M. (2005). Non-compensatory composite indicators for ranking countries: A defensible setting (p. 21833). EUR: EUR Report.

    Google Scholar 

  • 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 

  • 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.

  • 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.

    Article  Google Scholar 

  • Norman, P. (2010). Identifying change over time in small area socio-economic deprivation. Applied Spatial Analysis and Policy, 3(2–3), 107–138.

    Article  Google Scholar 

  • 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 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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 

  • 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.

    Article  Google Scholar 

  • Schroeder, J. P. (2007). Target-density weighting interpolation and uncertainty evaluation for temporal analysis of census data. Geographical Analysis, 39(3), 311–335.

    Article  Google Scholar 

  • Sen, A. (1987). On ethics and economics. Oxford: Basil Blackwell.

    Google Scholar 

  • 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 

  • 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.

    Article  Google Scholar 

  • Somarriba, N., & Pena, B. (2009). Synthetic indicators of quality of life in Europe. Social Indicators Research, 94(1), 115–133.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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 

  • 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.

    Article  Google Scholar 

  • Townsend, P. (1987). Deprivation. Journal of Social Policy, 16(2), 125–146.

    Article  Google Scholar 

  • Townsend, P., Phillimore, P., & Beattie, A. (1988). Health and deprivation: Inequality and the North. London: Croom Helm.

    Google Scholar 

  • Van Doorslaer, E. (1997). Socioeconomic inequalities in health: Measurement, computation and statistical inference. Journal of Econometrics, 77(1), 87–103.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Stefano Landi.

Appendices

Appendix 1

See Table 8.

Table 8 Variables descriptive statistics sorted by year and UUs

Appendix 2

See Tables 9, 10, 11, 12, 13, 14, 15, 16 and 17.

Table 9 GDIs 2011—DP2 method
Table 10 GDIs 2001—DP2 method
Table 11 GDIs 1991—DP2 method
Table 12 GDIs 2011—additive method
Table 13 GDIs 2001—additive method
Table 14 GDIs 1991—additive method
Table 15 GDIs 2011—MPI
Table 16 GDIs 2001—MPI
Table 17 GDIs 1991—MPI

Appendix 3

See Fig. 6.

Fig. 6
figure 6

UUs rankings. Differences in rank for each UUs from 1991 to 2011

Appendix 4

See Table 18.

Table 18 Test di Friedman

Appendix 5

See Figs. 7 and 8.

Fig. 7
figure 7

GDIs scores improvement with respect to the global Genoa improvement for each UUs. 1991–2001

Fig. 8
figure 8

GDIs scores improvement with respect to the global Genoa improvement for each UUs. 2001–2011

Appendix 6

See Table 19.

Table 19 Inhabitants for deprivation classes

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Landi, S., Ivaldi, E. & Testi, A. Measuring Change Over Time in Socio-economic Deprivation and Health in an Urban Context: The Case Study of Genoa. Soc Indic Res 139, 745–785 (2018). https://doi.org/10.1007/s11205-017-1720-3

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11205-017-1720-3

Keywords

Navigation