Viviana Egidi

Mortality From Alzheimer’s Disease, Parkinson’s Disease, and Dementias in France and Italy: A Comparison Using the Multiple Cause-of-Death Approach

Objective: We perform an in-depth analysis of all death certificates collected in France and Italy with an entry of Parkinson’s disease (PD), Alzheimer’s disease (AD), or another dementia. Method: Data are for 2008. We measure how frequently these conditions are the underlying cause of death. We then examine what other causes are reported on the certificates. Results: In both countries, AD is the underlying cause for about 6 in 10 certificates with an AD entry. The proportion is lower for PD and dementia, but higher in France than in Italy. Many contributing causes reflect the circumstances surrounding the end of life in AD, PD, and dementia, often characterized by bed confinement and frailty. Discussion: Our research highlights several consequences of the conditions under study that could be targeted by public health policy. It also speaks to the existence of differences in diagnosis/certification practices that may explain differences in mortality levels.

Educational differentials in disability vary across and within welfare regimes: a comparison of 26 European countries in 2009

Background Social differentials in disability prevalence exist in all European countries, but their scale varies markedly. To improve understanding of this variation, the article focuses on each end of the social gradient. It compares the extent of the higher disability prevalence in low social groups (referred to as disability disadvantage) and of the lower prevalence in high social groups (disability advantage); country-specific advantages/disadvantages are discussed regarding the possible influence of welfare regimes. Methods Cross-sectional disability prevalence is measured by longstanding health-related activity limitation (AL) in the 2009 European Statistics on Income and Living Conditions (EU-SILC) across 26 countries classified into four welfare regime groups. Logistic models adjusted by country, age and sex (in all 30–79 years and in three age-bands) measured the country-specific ORs across education, representing the AL-disadvantage of low-educated and AL-advantage of high-educated groups relative to middle-educated groups. Results The relative AL-disadvantage of the low-educated groups was small in Sweden (eg, 1.2 (1.0–1.4)), Finland, Romania, Bulgaria and Spain (youngest age-band), but was large in the Czech Republic (eg, 1.9 (1.7–2.2)), Denmark, Belgium, Italy and Hungary. The high-educated groups had a small relative AL-advantage in Denmark (eg, 0.9 (0.8–1.1)), but a large AL-advantage in Lithuania (eg, 0.5 (0.4–0.6)), half of the Baltic and Eastern European countries, Norway and Germany (youngest age-band). There were notable differences within welfare regime groups. Conclusions The country-specific disability advantages/disadvantages across educational groups identified here could help to identify determining factors and the efficiency of national policies implemented to tackle social differentials in health.

Obesity-related mortality in France, Italy, and the United States: a comparison using multiple cause-of-death analysis

ObjectivesWe investigate the reporting of obesity on death certificates in three countries (France, Italy, and the United States) with different levels of prevalence, and we examine which causes are frequently associated with obesity.MethodsWe use cause-of-death data for all deaths at ages 50–89 in 2010–2011. Since obesity may not be the underlying cause (UC) of death, we compute age- and sex-standardized death rates considering all mentions of obesity (multiple causes or MC). We use cluster analyses to identify patterns of cause-of-death combinations.ResultsObesity is selected as UC in no more than 20% of the deaths with a mention of obesity. Mortality levels, whether measured from the UC or the MC, are weakly related to levels of prevalence. Patterns of cause-of-death combinations are similar across the countries. In addition to strong links with cardiovascular diseases and diabetes, we identify several less familiar associations.ConclusionsConsidering all mentions on the deaths certificates reduces the underestimation of obesity-related mortality based on the UC only. It also enables us to describe the various mortality patterns involving obesity.

Dementia in the Elderly: Health Consequences on Household Members

The growing number of the oldest-old will cause an increase in the number of mentally ill elderly persons in the population, given that no positive evolution of senile dementia is expected in the near future. Living in the household is the best strategy to contain the pace of mental deterioration, to better manage the disease and to maintain as long as possible the vigilance of the demented person. But dementia is one of the most devastating impairments, both for the persons who are affected by it and for their entire family network and friends, and its impact is high on life and well-being for all persons living with the demented elderly and maximum for his/her caregiver. The aim of this work is to evaluate the impact of the presence of an elderly person with dementia on the perceived health of the co-living household members, using data from the Italian health interview survey carried out by the Italian National Institute of Statistics (Istat) in 2005.

Similarity of Perceived Health Between Household Members: The “Mutual Influences” Hypothesis

Demographers and social epidemiologists have widely recognized that determinants of health operate on different levels. Among all of the relational networks, the family deserves a special place as it is the context where lifestyles and health-related behaviors are generally developed and shared. Using data from the Italian Health Interview Survey 2004/2005 for ages 18 and above, this chapter aims to provide an estimation of the magnitude of influence that the household has on self-perceived health, controlling for individual characteristics and the geographical context. We select three outcome variables to investigate perceived health: Physical Component Summary, Mental Component Summary, and poor Self-Rated Health. We develop an index of homogeneity within households and explore to what extent mutual influences of health perception exist within a household, resulting in a high resemblance of health for people living together, independent of or in addition to the effect of household covariates. Eventually, we try to gain a better understanding of the pathways through which these mutual influences are spread between people in the same household.

Fertility Histories and Health in Later Life in Italy

The importance of life course influences on health differentials in later life has been increasingly recognised. Parenthood represents a major domain of most people’s lives with short and long-term implications. Apart from the physiological and psychological effects of pregnancy and childbirth, the health of both women and men may be influenced by stresses, role changes, and changes in allocation of personal and family resources associated with childrearing and by the emotional and social support benefits of parenthood. The associations of fertility history indicators on health have been rarely studied in familialistic countries such as Italy. In a familialistic country with strong family ties, frequent contact between generations may play a significant role in enhancing the role of parenthood against childlessness, especially for the subjective indicators of health. Additionally it should be stressed that familialistic countries are characterised by the unbalanced division of house and care work: women’s multiple roles may affect (positively for the “role enhancing theory” or negatively for the “role strain model”) the perception of their health status. This study aims to understand how fertility quantum and tempo components may have an effect on different health indicators (self-rated health, presence of limitations, ADL, IADL, and depression score) at ages 50 and above, controlling for a set of demographic and socio-economic indicators. We use data from the Italian Survey on Family and Social Relations 2009, and the pooled baseline interviews of the waves 1 and 2 of the Survey of Health, Ageing and Retirement in Europe (SHARE), for Italian respondents for whom information on their fertility history had been collected. We define individual fertility biographies by parity, early and late fertility, and spacing and explore their effect on both gender. These relations are analysed by taking different socio-economic indicators into consideration in order to control for these confounding factors. Conclusions Our results provide additional insight on how fertility histories may influence health in later life. Concentration of fertility in low parities and a reduction of early pregnancies among younger cohorts of women may have a positive effect on health in the future, while men’s health seems not to be significantly influenced by fertility histories variables.