Socioeconomic disparities in mortality among older people in Sicily

Objective: to construct a composite municipal index of socioeconomic position (SEP) and to describe socioeconomic disparities in mortalily within Sicilian elderly inhabitants (age 65+). Design: 2001 Sicily Census data were used to develop a 5-level SEP index for the 390 municipalities of the Region. Education, occupation, housing tenure, family composition and immigration were considered in order to perform a factor analysis. We used Sicilian Mortality Registry data to compute standardized mortality rates by gender. The SEP index was used for mortality from all causes and for most common causes of death in elderly population. Rates, with 95% confidence intervals were computed to compare mortality in each level of SEP to the highest level. Results: there were socioeconomic disparities both in overall and in cause-specific mortality Progressively higher mortality rates with lower SEP were observed for overall mortality (ratio between extreme categories: 1.16 in men, 1.14 in women), as well for mortality from cardiovascular diseases in both genders (ratio between extreme categories: 1.12 in men, 1.09 in women), from respiratory disease in men (ratio between extreme categories: 1.20), and from endocrine glands diseases in women (ratio between extreme categories: 1.35). For deaths from cancer and from diseases of the digestive system mortalities, in both genders, we found higher risks within the lowest SEP level as compared to the highest, Cardiovascular diseases contributed the most to the socioeconomic differences in overall mortality. Conclusion: Within the Sicilian elderly population, socioeconomic position is associated with mortality. The highest mortality rates were observed in the most disadvantaged municipalities. Moreover, mortality rates were oddly distributed by gender. (Epidemiol Prev 2009; 33 (4-5): 169-75)