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Open Access Research article

Determinants of health disparities between Italian regions

Luisa Franzini1* and Margherita Giannoni23

Author Affiliations

1 Management, Policy, and Community Health Division, University of Texas School of Public Health, 1200 Pressler Drive, Houston, TX 77030, USA

2 Dipartimento di Economia Finanza e Statistica Universita' degli Studi di Perugia, Via Pascoli 20, 06124, Perugia, Italy

3 MECOP Institute, University of Lugano,Via Giuseppe Buffi 6, CH-6904 Lugano, Switzerland

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BMC Public Health 2010, 10:296  doi:10.1186/1471-2458-10-296

Published: 1 June 2010



Among European countries, Italy is one of the countries where regional health disparities contribute substantially to socioeconomic health disparities. In this paper, we report on regional differences in self-reported poor health and explore possible determinants at the individual and regional levels in Italy.


We use data from the "Indagine Multiscopo sulle Famiglie", a survey of aspects of everyday life in the Italian population, to estimate multilevel logistic regressions that model poor self-reported health as a function of individual and regional socioeconomic factors. Next we use the causal step approach to test if living conditions, healthcare characteristics, social isolation, and health behaviors at the regional level mediate the relationship between regional socioeconomic factors and self-rated health.


We find that residents living in regions with more poverty, more unemployment, and more income inequality are more likely to report poor health and that poor living conditions and private share of healthcare expenditures at the regional level mediate socioeconomic disparities in self-rated health among Italian regions.


The implications are that regional contexts matter and that regional policies in Italy have the potential to reduce health disparities by implementing interventions aimed at improving living conditions and access to quality healthcare.