The main causes of death contributing to absolute and relative socio-economic inequality in Italy

Objectives: Monitoring socio-economic inequality has become a priority for many governments, especially after the socio-economic changes that followed the 2008 financial crisis. This study aimed at detecting the causes of death with the largest socio-economic inequality in relative and absolute terms in Italy. Study design: This is a historical cohort study. Methods: We used two regression-based measures of socio-economic inequality, the relative index of inequality (RII) and the slope index of inequality (SII), to rank the causes of death with the highest relative and absolute socio-economic inequality. We obtained these measures on a large census-based cohort study with more than 35 million individuals and 452,273 deaths registered in the period 2012–2014. Results: The causes with the highest relative socio-economic inequality were the following: laryngeal cancer (RII: 6.1, 95% confidence interval [CI]: 4.8–7.78), AIDS/HIV (RII: 4.8, 95% CI: 3.1–7.4), chronic liver disease (RII: 4.8, 95% CI: 3.2–7.3), and chronic lower respiratory diseases (RII: 4.8, 95% CI: 3.5–6.5) in men, and diabetes (RII: 6.2, 95% CI: 4.8–7.9), AIDS/HIV (RII: 4.5, 95% CI: 2.7–7.7), genitourinary system (RII: 3.8, 95% CI: 2.6–5.4) and chronic liver diseases (RII: 3.6, 95% CI: 2.9–4.5) in women. In absolute terms, lung cancer and ischemic heart diseases contributed more to the overall socio-economic inequality in men, whereas diabetes and ischemic heart diseases accounted for most of the socio-economic inequality in women. Conclusions: Our findings call for effective policies to reduce the disparities in mortality from ischemic heart diseases, lung cancer, and diabetes taking into account the sex-specific pattern of inequality.