Mortality: socioeconomic inequalities in the Census cohorts of the Italian Network of Longitudinal Metropolitan Studies

OBJECTIVES: to explore possible differences in the intensity (and direction) of social inequalities in mortality in five cities of the Italian network of Longitudinal Metropolitan Studies, based on four dimensions of the socioeconomic position. DESIGN: multicentre longitudinal study, closed cohorts. SETTING AND PARTICIPANTS: all subjects aged 30-69 years and residing in Turin, Bologna, Modena, Reggio Emilia, and Venice on 21.10.2001, with a mortality follow-up at 31.12.2013. MAIN OUTCOME MEASURES: mortality from all causes, cardiovascular diseases, breast cancer (women only), and alcohol- and smoking-related causes, by education, household and housing conditions, and occupational class (indicators of socioeconomic status, SES), compared by means of the mortality rate ratios and the relative index of inequality, adjusted by age and period and stratified by gender and city. RESULTS: for all the causes of death investigated, an independent impact of the SES indicators, of variable intensity and direction by gender and by city, was observed; greater weight of education and occupational class among men and of the household and housing conditions among women, for general mortality and cardiovascular diseases; greater weight of the household and material dimensions for causes related to lifestyles. CONCLUSIONS: the independent effect on health of the different dimensions of SES leads back to the different mechanisms of generation of health inequalities, involving the different sectors of the city policies. Comparative studies of this kind help to make the decision-making path more aware, suggesting priorities for increasingly intersectoral and specific interventions for outcome, gender, and city context.