Socioeconomic inequality in health is a long-standing and challenging public health problem (Gray 1982; Sim and Mackie 2006; Mackenbach et al. 2008).
In Europe, socioeconomic inequality in mortality has decreased due to a general overall reduction in mortality. However, there is growing evidence that relative inequality has widened due to a steeper decline among the higher social classes (Mackenbach et al. 2016). This clearly indicates that countries’ response has been inadequate, and much is still to be done to ensure that the whole population adopt healthy behaviors and receive early diagnosis and effective treatment.
In Italy, clear evidence of inequality in mortality emerged from the follow-up of subjects enrolled in the Health Interview Survey, and from a series of metropolitan population cohort studies, set up in cities located in the north and in the centre of the country (Caranci et al. 2018; Sebastiani et al. 2019). However, these studies are not representative of the whole country and the limited number of events did not allow to precisely quantify inequality in cause-specific mortality and in subgroups of the population.
Accurate quantification of the differences in health outcomes among strata of the population is definitely the first step in identifying the most vulnerable individuals that could benefit from public interventions.
Against this backdrop, in 2016, at the National Institute of Statistics (ISTAT) we conceived a cohort of all Italian residents registered in the 2011 Population and Housing Census who have been followed-up for mortality over the subsequent years.