This paper investigates the impact of behavioural risk factors on non-communicable diseases mortality in Milan, focusing on their neighbourhood variation, with the scope to provide context-specific information to guide the development of effective health promotion interventions. Using administrative healthcare data, population attributable fractions were calculated based on information provided by the Global Burden of Disease project to estimate the number and proportion of deaths attributed to smoking, high body mass index, alcohol consumption, physical inactivity, and dietary risk. The findings revealed distinct territorial patterns of risk factors based on sex/gender, as territorial differences along the centre-periphery axis were observed in men but not in women. Smoking emerged as the primary risk factor for avoidable mortality, particularly in men whilst in females metabolic-related risk factors played a larger role. The proposed methodology provided valuable insights into the distribution of risky health behaviours at the neighbourhood level and underscored the need for context-specific interventions. Overall, the study emphasized the intertwined nature of territorial, socioeconomic, and gender dimensions in shaping health outcomes. It called for targeted interventions that address the specific risk profiles and challenges of each neighbourhood, promoting health equity and reducing the burden of non-communicable diseases. By understanding these complex dynamics, policymakers and public health professionals can develop effective strategies to improve population health and reduce health inequalities.
Cite this paper
Consolazio, D. , Benassi, D. and Russo, A. G. (2024). Neighbourhood-Level Differences in Mortality Attributable to Behavioural Risk Factors in the City of Milan, Italy. Open Access Library Journal, 11, e1083. doi: http://dx.doi.org/10.4236/oalib.1111083.
Lopez, A.D., Mathers, C.D., Ezzati, M., Jamison, D.T. and Murray, C.J.L. (2006) Global Burden of Disease and Risk Factors. World Bank, Washington DC.
https://doi.org/10.1596/978-0-8213-6262-4
d’Ovidio, M. (2009) Milano, città duale. In: Ranci, C., Ed., I limiti sociali della crescita: Milano e le città d’Europa, tra competitività e disuguaglianze. Maggioli, Milano, 9-72.
Consolazio, D., Benassi, D., Russo, A.G. and Sarti, S. (2021) Le disuguaglianze socioeconomiche individuali e territoriali nel Diabete Mellito di Tipo 2 nella città di Milano: Uno studio multilivello. Polis, 36, 433-464.
Consolazio, D., Benassi, D. and Russo, A.G. (2023) Ethnic Residential Segregation in the City of Milan at the Interplay between Social Class, Housing and Labour Market. Urban Studies, 60, 1853-1874. https://doi.org/10.1177/00420980221135592
Petsimeris, P. and Rimoldi, S.M.L. (2015) Socioeconomic Divisions of Space in Milan in the Post-Fordist Era. In: Tammaru, T., Marcinczak, S., van Ham, M., et al., Eds., Socio-Economic Segregation in European Capital Cities. East Meets West, Taylor & Francis, London, 186-213.
Braveman, P. and Gottlieb, L. (2014) The Social Determinants of Health: It’s Time to Consider the Causes of the Causes. Public Health Reports, 129, 19-31.
https://doi.org/10.1177/00333549141291S206
Phelan, J.C., Link, B.G. and Tehranifar, P. (2010) Social Conditions as Fundamental Causes of Health Inequalities: Theory, Evidence, and Policy Implications. Journal of Health and Social Behavior, 51, S28-S40. https://doi.org/10.1177/0022146510383498
Frohlich, K.L., Corin, E. and Potvin, L. (2001) A Theoretical Proposal for the Relationship between Context and Disease. Sociology of Health & Illness, 23, 776-797. https://doi.org/10.1111/1467-9566.00275
Macintyre, S., Ellaway, A. and Cummins, S. (2002) Place Effects on Health: How Can We Conceptualise, Operationalise and Measure Them? Social Science & Medicine, 55, 125-139. https://doi.org/10.1016/S0277-9536(01)00214-3
GBD 2013 Risk Factors Collaborators (2015) Global, Regional, and National Comparative Risk Assessment of 79 Behavioural, Environmental and Occupational, and Metabolic Risks or Clusters of Risks in 188 Countries, 1990-2013: A Systematic Analysis for the Global Burden of Disease Study 2013. The Lancet, 386, 2287-2323.
Northridge, M.E. (1995) Public Health Methods—Attributable Risk as a Link between Causality and Public Health Action. American Journal of Public Health, 85, 1202-1204. https://doi.org/10.2105/AJPH.85.9.1202
Rosen, L. (2013) An Intuitive Approach to Understanding the Attributable Fraction of Disease Due to a Risk Factor: The Case of Smoking. International Journal of Environmental Research and Public Health, 10, 2932-2943.
https://doi.org/10.3390/ijerph10072932
Battisti, F., Carreras, G., Grassi, T., Chellini, E. and Gorini, G. (2017) Estimates of Cancer Deaths Attributable to Behavioural Risk Factors in Italy, 2013. Epidemiologia e Prevenzione, 41, 61-67.
Carreras, G., Battisti, F., Borzoni, L., Cortini, B., Lachi, A., Giovannetti, L., Gorini, G., et al. (2019) Deaths from Noncommunicable Diseases Attributable to Behavioral Risk Factors in Italy and Italian Regions, 2016. Epidemiologia e Prevenzione, 43, 338-346.
Yiannakoulias, N. (2009) Using Population Attributable Risk to Understand Geographic Disease Clusters. Health & Place, 15, 1142-1148.
https://doi.org/10.1016/j.healthplace.2009.07.001
Ezzati, M., Vander Hoorn, S., Rodgers, A., Lopez, A.D., Mathers, C.D. and Murray, C.J. (2003) Estimates of Global and Regional Potential Health Gains from Reducing Multiple Major Risk Factors. The Lancet, 362, 271-280.
https://doi.org/10.1016/S0140-6736(03)13968-2
Friel, S., Chopra, M. and Satcher, D. (2007) Unequal Weight: Equity Oriented Policy Responses to the Global Obesity Epidemic. BMJ, 335, 1241-1243.
https://doi.org/10.1136/bmj.39377.622882.47
Alicandro, G., Sebastiani, G., Bertuccio, P., Zengarini, N., Costa, G., La Vecchia, C. and Frova, L. (2018) The Main Causes of Death Contributing to Absolute and Relative Socio-Economic Inequality in Italy. Public Health, 164, 39-48.
https://doi.org/10.1016/j.puhe.2018.07.011
Federico, B., Kunst, A.E., Vannoni, F., Damiani, G. and Costa, G. (2004) Trends in Educational Inequalities in Smoking in Northern, Mid and Southern Italy, 1980-2000. Preventive Medicine, 39, 919-926.
https://doi.org/10.1016/j.ypmed.2004.03.029
Tramacere, I., Gallus, S., Zuccaro, P., Colombo, P., Rossi, S., Boffetta, P. and La Vecchia, C. (2009) Socio-Demographic Variation in Smoking Habits: Italy, 2008. Preventive Medicine, 48, 213-217. https://doi.org/10.1016/j.ypmed.2008.12.014
Mackenbach, J.P., Stirbu, I., Roskam, A.J.R., Schaap, M.M., Menvielle, G., Leinsalu, M. and Kunst, A.E. (2008) Socioeconomic Inequalities in Health in 22 European Countries. New England Journal of Medicine, 358, 2468-2481.
https://doi.org/10.1056/NEJMsa0707519
Oncini, F. and Guetto, R. (2018) Cultural Capital and Gender Differences in Health Behaviours: A Study on Eating, Smoking and Drinking Patterns. Health Sociology Review, 27, 15-30. https://doi.org/10.1080/14461242.2017.1321493
Davis, J.L., Buchanan, K.L., Katz, R.V. and Green, B.L. (2012) Gender Differences in Cancer Screening Beliefs, Behaviors, and Willingness to Participate: Implications for Health Promotion. American Journal of Men’s Health, 6, 211-217.
https://doi.org/10.1177/1557988311425853
Manteuffel, M., Williams, S., Chen, W., Verbrugge, R.R., Pittman, D.G. and Steinkellner, A. (2014) Influence of Patient Sex and Gender on Medication Use, Adherence, and Prescribing Alignment with Guidelines. Journal of Women’s Health, 23, 112-119. https://doi.org/10.1089/jwh.2012.3972
Consolazio, D., Gattoni, M.E. and Russo, A.G. (2022) Exploring Gender Differences in Medication Consumption and Mortality in a Cohort of Hypertensive Patients in Northern Italy. BMC Public Health, 22, Article No. 768.
https://doi.org/10.1186/s12889-022-13052-9
Rao, M., Prasad, S., Adshead, F. and Tissera, H. (2007) The Built Environment and Health. The Lancet, 370, 1111-1113.
https://doi.org/10.1016/S0140-6736(07)61260-4
Caspi, C.E., Sorensen, G., Subramanian, S.V. and Kawachi, I. (2012) The Local Food Environment and Diet: A Systematic Review. Health & Place, 18, 1172-1187.
https://doi.org/10.1016/j.healthplace.2012.05.006
Brondeel, R., Weill, A., Thomas, F. and Chaix, B. (2014) Use of Healthcare Services in the Residence and Workplace Neighbourhood: The Effect of Spatial Accessibility to Healthcare Services. Health & Place, 30, 127-133.
https://doi.org/10.1016/j.healthplace.2014.09.004
Baum, F.E., Ziersch, A.M., Zhang, G. and Osborne, K. (2009) Do Perceived Neighbourhood Cohesion and Safety Contribute to Neighbourhood Differences in Health? Health & Place, 15, 925-934.
https://doi.org/10.1016/j.healthplace.2009.02.013
Pearce, J., Barnett, R. and Moon, G. (2012) Sociospatial Inequalities in Health-Related Behaviours: Pathways Linking Place and Smoking. Progress in Human Geography, 36, 3-24. https://doi.org/10.1177/0309132511402710
Prior, L., Manley, D. and Jones, K. (2018) Stressed Out? An Investigation of Whether Allostatic Load Mediates Associations between Neighbourhood Deprivation and Health. Health & Place, 52, 25-33. https://doi.org/10.1016/j.healthplace.2018.05.003
McEwen, B.S. and Wingfield, J.C. (2003) The Concept of Allostasis in Biology and Biomedicine. Hormones and Behavior, 43, 2-15.
https://doi.org/10.1016/S0018-506X(02)00024-7
Pickett, K.E. and Pearl, M. (2001) Multilevel Analyses of Neighbourhood Socioeconomic Context and Health Outcomes: A Critical Review. Journal of Epidemiology & Community Health, 55, 111-122. https://doi.org/10.1136/jech.55.2.111
Capocaccia, R., Martina, L., Inghelmann, R., Crocetti, E., De Lisi, V., Falcini, F., De Angelis, R., et al. (2009) A Method to Estimate Mortality Trends When Death Certificates Are Imprecisely Coded: An Application to Cervical Cancer in Italy. International Journal of Cancer, 124, 1200-1205. https://doi.org/10.1002/ijc.24033
Minelli, N. and Marchetti, D. (2013) Discrepancies in Death Certificates, Public Health Registries, and Judicial Determinations in Italy. Journal of Forensic Sciences, 58, 705-710. https://doi.org/10.1111/1556-4029.12114