Determinants of Health Disparities in Italian Regions

There is an extensive literature on regional disparities in health, but much of thisliterature focuses on the United States. Among European countries, Italy is the country whereregional health disparities contribute the most to socioeconomic health disparities. In this paper,we report on regional differences in self-reported poor health and explore possible determinantsat the individual and regional levels in Italy. We use data from the “Indagine Multiscopo sulle Famiglie”, a survey of aspects ofeveryday life in the Italian population, to estimate multilevel logistic regressions that model poorself-reported health as a function of individual and regional socioeconomic factors. Next we usethe causal step approach to test if living conditions, healthcare characteristics, social isolation,2and health behaviors at the regional level mediate the relationship between regionalsocioeconomic factors and self-rated health. We find that residents living in regions with more poverty, more unemployment, andmore income inequality are more likely to report poor health and that poor living conditions andprivate share of healthcare expenditures at the regional level are determinants of socioeconomicdisparities in self-rated health among Italian regions. The implications are that regional contexts matter and that regional policies in Italyhave the potential to reduce health disparities by implementing interventions aimed at improvingliving conditions and access to quality healthcare.health inequality, Italy, self-reported health, regional health disparities

Self-rated health and trust in low-income Mexican-origin individuals in Texas

http://dx.doi.org/10.1016/j.socscimed.2008.09.03

Distressing Projections for the Health of American Children: Are They Inevitable?

A commentary on Murdock et al.\u27s article, Poverty, Educational Attainment and Health Among America’s Children: Current and Future Effects of Population Diversification and Associated Socioeconomic Change

Determinants of health disparities between Italian regions

<p>Abstract</p> <p>Background</p> <p>Among European countries, Italy is one of the countries where regional health disparities contribute substantially to socioeconomic health disparities. In this paper, we report on regional differences in self-reported poor health and explore possible determinants at the individual and regional levels in Italy.</p> <p>Methods</p> <p>We use data from the "Indagine Multiscopo sulle Famiglie", a survey of aspects of everyday life in the Italian population, to estimate multilevel logistic regressions that model poor self-reported health as a function of individual and regional socioeconomic factors. Next we use the causal step approach to test if living conditions, healthcare characteristics, social isolation, and health behaviors at the regional level mediate the relationship between regional socioeconomic factors and self-rated health.</p> <p>Results</p> <p>We find that residents living in regions with more poverty, more unemployment, and more income inequality are more likely to report poor health and that poor living conditions and private share of healthcare expenditures at the regional level mediate socioeconomic disparities in self-rated health among Italian regions.</p> <p>Conclusion</p> <p>The implications are that regional contexts matter and that regional policies in Italy have the potential to reduce health disparities by implementing interventions aimed at improving living conditions and access to quality healthcare.</p

Editors’ Introduction. Futures: Imagining the World of Tomorrow

From 12 to 17 September 2016 in Cuneo (Italy) took place the 9th edition of the international Summer School organized by the Centro Studi sul Pensiero Contemporaneo (CeSPeC). The event revolved around the topic of the “future”, which was analysed from different interdisciplinary perspectives and gave rise to stimulating conversation. In this introduction we provide an overview of the topic and of the reflections stemming from that event

Culture and the Social Context of Health Inequalities

There is a great deal of recent interest and debate concerning the linkages between inequality and health cross-nationally. The U.S. National Institutes of Health recommended in 2001 that any new research on health disparities should include social and cultural systems as units of analysis. Nevertheless, many public health interventions and policies continue to decontextualize risk factors from the social environment. Exposures to social and health inequalities probably vary as a consequence of different cultural contexts. To identify the processes that cause social and health inequalities, it is important to understand culture\u27s influence. Navarro\u27s research on political institutions and inequality illustrates the role of cultural context, although indirectly. Policies reflect cultural values because politicians typically translate their constituents\u27 dominant values into policy. Political systems and structural inequality are institutionalized manifestations of cultural differences that intervene between dominant cultural dimensions at the societal level and health. The authors present a theoretical framework that combines constructs from sociological theory and cross-cultural psychology to identify potential pathways leading from culture and social structure to social and health inequalities. Only when all levels are taken into consideration is it possible to come up with effective, sustainable policies and interventions

The Cultural Production of Health Inequalities: A Cross-Sectional, Multilevel Examination of 52 Countries

In a 2001 report, the U.S. National Institutes of Health called for more integration of the social sciences into health-related research, including research guided by theories and methods that take social and cultural systems into consideration. Based on a theoretical framework that integrates Hofstede\u27s cultural dimensions with sociological theory, the authors used multilevel modeling to explore the association of culture with structural inequality and health disparities. Their results support the idea that cultural dimensions and social structure, along with economic development, may account for much of the cross-national variation in the distribution of health inequalities. Sensitivity tests also suggest that an interaction between culture and social structure may confound the relationship between income inequality and health. It is necessary to identify important cultural and social structural characteristics before we can achieve an understanding of the complex, dynamic systems that affect health, and develop culturally sensitive interventions and policies. This study takes a step toward identifying some of the relevant cultural and structural influences. More research is needed to explore the pathways leading from the sociocultural environment to health inequalities

Future expenditure risk of silent members: a statistical analysis

Silent-members are members of a medical health plan who submit no claims for healthcare services in a benefit year despite 12 months of continuous-enrollment. This study was conducted to evaluate the future expenditure risk of commercial-insured members who avoid all medical care despite coverage. In order to determine if the silent-members were at greater risk, we compared them to members who received care in the anchor year (2009) but had low-expenditures. The low-expenditure members were assumed to represent persons without significant medical conditions and without care-avoidance behaviors. We examined the claims experience of a cohort of silent members in the 2 years after the silent year (2009) and compared it with the corresponding claims experience for a cohort of low-expenditure members from the same anchor year (2009). Members of commercial health plans (BCBS of Texas) were selected based on continuous-enrollment in 2009. Two sub-groups were identified based on annual claims expenditure: Care avoiders were members with 12 months continuous-enrollment and no medical claims, and are thus referred to as “silent members” in the insurance industry. Low-Expenditure members were those with 12 months continuous-enrollment and total PMPY (per member per year) annual medical claims expenditure in the lowest 10th percentile of members with claims experience. “Low-expenditure” members served as a comparison group to the “silent members”, under the assumption that such claimants were using benefits for minor healthcare issues as needed. Key variables were enrollment and expenditures. Enrollment data identified demographics and continuous-enrollment. Medical claims data were used to calculate utilization and expenditures. All claims data were de-identified and no consent was required, as approved by the Institutional Review Board. No research involved human subjects. Multivariate logistic regression models were applied. Silent members who seek care in subsequent years have a greater probability of becoming high-expenditure claimants than those with low-expenditure experience. For silent members who subsequently seek treatment, the probability of becoming high-expenditure is significantly greater than low-expenditure members from the anchor year. The implications of future high costs for silent members who become claimants may support the need for additional research to address the risks of care avoidance behaviors.https://doi.org/10.1186/s12913-016-1552-

Geographic Variations and the associated Factors in adherence to and Persistence With adjuvant Hormonal therapy For the Privately insured Women aged 18-64 With Breast Cancer in Texas

The purpose of this study is to examine the geographical patterns of adjuvant hormonal therapy adherence and persistence and the associated factors in insured Texan women aged 18-64 with early breast cancer. A retrospective cohort study was conducted using 5-year claims data for the population insured by the Blue Cross Blue Shield of Texas (BCBSTX). Women diagnosed with early breast cancer who were taking tamoxifen or aromatase inhibitors (AIs) for adjuvant hormonal therapy with at least one prescription claim were identified. Adherence to adjuvant hormonal therapy and persistence with adjuvant hormonal therapy were calculated as outcome measures. Women without a gap between two consecutively dispensed prescriptions of at least 90 days were considered to be persistently taking the medications. Patient-level multivariate logistic regression models with repeated regional-level adjustments and a Cox proportional hazards model with mixed effects were used to determine the geographical variations and patient-, provider-, and area-level factors that were associated with adjuvant hormonal therapy adherence and persistence. Of the 938 women in the cohort, 627 (66.8%) initiated adjuvant hormonal therapy. Most of the smaller HRRs have significantly higher or lower rates of treatment adherence and persistence rates relative to the median regions. The use of AHT varies substantially from one geographical area to another, especially for adherence, with an approximately two-fold difference between the lowest and highest areas, and area-level factors were found to be significantly associated with the compliance of AHT. There are geographical variations in AHT adherence and persistence in Texas. Patient-level and area-level factors have significant associations explaining these patterns