Exploring mortality patterns across territorial areas in Italy

Mortality differentials across rural-urban gradients have long been of interest due to their implications for public health policies. Traditionally, rural areas were believed to have lower mortality thanks to healthier lifestyles and environmental factors. Recent trends suggest a narrowing gap, raising questions about the factors driving these disparities. The differences in mortality rates between territories depend on the different geographical characteristics, and this underscores the need of an analysis at a more detailed territorial level. This study aims to investigate mortality disparities and patterns across central and peripheral gradients and territorial areas in Italy, using the National Strategy for Inner Areas (SNAI) classification. We seek to understand how mortality rates vary between Inner and Central settings, focusing on individuals aged 60 and older. Our analysis includes standardized mortality rates and life expectancy at age 60, examined through spatial analysis techniques, such as Moran's Index and Local Indicators of Spatial Association (LISA). Additionally, we analyse mortality by major causes of death to identify the most significant contributors to the disparities. The findings reveal considerable heterogeneity in mortality rates, with a notable U-shaped pattern indicating higher survival in Ultra-peripheral areas. While overall improvements in mortality levels are observed in recent years, these are less pronounced in the South. The reduction in mortality from circulatory system diseases and cancers contributes significantly to the improvements in both Poles and Inner Areas. However, higher mortality from respiratory and nervous system diseases is more prevalent in Inner Areas, especially in Ultra-peripheral municipalities. By outlining mortality differentials and patterns in Italy, this study provides valuable insights for informing targeted health policies aimed at reducing disparities and improving overall public health outcomes for the older population