Socioeconomic differentials in premature mortality in Rome: changes from 1990 to 2001

We analysed all 126,511 death certificates of residents of Rome aged 0–74 years registered between 1990–2001. A 4-level census block index based on the 1991 census was used as an indicator of socioeconomic position (SEP). Using routine mortality data, standardised mortality rates (per 100,000 inhabitants) were calculated by SEP and gender for four time periods. Rate ratios were used to compare mortality by gender and age.Overall premature mortality decreased in both genders and in all socioeconomic groups; the change was greater in the highest socio-economic group. In both men and women, inequalities in mortality strengthened during the 1990s and appeared to stabilise at the end of the 20th century. However, for 60–74 year old women the gap continued to widen.Socioeconomic inequalities in health in Rome are still present at the beginning of the 21st century. Strategies to monitor the impact of SEP on mortality over time in different populations should be implemented to direct health policies.Socioeconomic differences in mortality have been found all over Europe and in the US using individual and area-based socioeconomic indicators[1-3]. In several developed countries the gap in mortality between disadvantaged and well-off groups increased during the 1980s and the beginning of the 1990s[2,4-8]. The role of National Health Services (NHSs) and universal health care coverage in contrasting inequalities in health has been repeatedly advocated [9,10]. However, data on these disparities in Southern Europe, e.g. in Italy, in the second half of the 90s are rare[1,5,6]. In Rome, increases in mortality inequality have been documented in both genders for the periods 1990–92 and 1993–95[6]. In this study we evaluated the temporal changes of premature mortality (under 75 years of age) across socioeconomic groups in Rome over a period of 12 years, from 1990 to 2001.Rome (2,800,000 inhabitants) is divided into 5736 census blocks with an average of 480 inhabitants in each. The area-