IDEAS home Printed from https://ideas.repec.org/a/eee/soceps/v82y2022ipas0038012122000258.html
   My bibliography  Save this article

Socio-economic inequality, interregional mobility and mortality among cancer patients: A mediation analysis approach

Author

Listed:
  • Rubino, Claudio
  • Di Maria, Chiara
  • Abbruzzo, Antonino
  • Ferrante, Mauro

Abstract

This paper investigates the effect of socio-economic status on interregional mobility and mortality among cancer patients. The cohort under analysis comprises patients residing in Sicily (Italy), who were diagnosed with lung and colon cancer between 2010 and 2011. The data was collated from the hospital discharge records of the Sicilian Region and the Regional register of the causes of death, by considering all those patients for whom information relating to socio-economic status was available. First, graphical models were applied to highlight the multivariate structure of association among socio-economic status, interregional mobility and 3-year mortality. Secondly, mediation analysis quantified the direct and indirect effect of socio-economic status relating to mortality. The results revealed that socio-economic status is associated directly and indirectly with mortality due to lung cancer, mediated by interregional mobility. On the other hand, the association of socio-economic status with mortality from colon cancer is only indirect, and also mediated by interregional mobility. The authors of this research hold that the extent of patient mobility and its relation to mortality call for a reconsideration of health policy.

Suggested Citation

  • Rubino, Claudio & Di Maria, Chiara & Abbruzzo, Antonino & Ferrante, Mauro, 2022. "Socio-economic inequality, interregional mobility and mortality among cancer patients: A mediation analysis approach," Socio-Economic Planning Sciences, Elsevier, vol. 82(PA).
  • Handle: RePEc:eee:soceps:v:82:y:2022:i:pa:s0038012122000258
    DOI: 10.1016/j.seps.2022.101247
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0038012122000258
    Download Restriction: Full text for ScienceDirect subscribers only

    File URL: https://libkey.io/10.1016/j.seps.2022.101247?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Antonio Abatemarco & Massimo Aria & Sergio Beraldo & Francesca Stroffolini, 2020. "Measuring Disparities in Access to Health Care: A Proposal Based on an Ex-ante Perspective," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 150(2), pages 549-568, July.
    2. Kurt R. Brekke & Hugh Gravelle & Luigi Siciliani & Odd Rune Straume, 2014. "Patient Choice, Mobility and Competition Among Health Care Providers," Developments in Health Economics and Public Policy, in: Rosella Levaggi & Marcello Montefiori (ed.), Health Care Provision and Patient Mobility, edition 127, pages 1-26, Springer.
    3. Silvia Balia & Rinaldo Brau & Emanuela Marrocu, 2018. "Interregional patient mobility in a decentralized healthcare system," Regional Studies, Taylor & Francis Journals, vol. 52(3), pages 388-402, March.
    4. Denteneer, Dee & Verbeek, Albert, 1985. "A fast algorithm for iterative proportional fitting in log-linear models," Computational Statistics & Data Analysis, Elsevier, vol. 3(1), pages 251-264, May.
    5. Zack Cooper & Stephen Gibbons & Simon Jones & Alistair McGuire, 2011. "Does Hospital Competition Save Lives? Evidence From The English NHS Patient Choice Reforms," Economic Journal, Royal Economic Society, vol. 121(554), pages 228-260, August.
    6. Berta, Paolo & Guerriero, Carla & Levaggi, Rosella, 2021. "Hospitals’ strategic behaviours and patient mobility: Evidence from Italy," Socio-Economic Planning Sciences, Elsevier, vol. 77(C).
    7. Daniel P. Kessler & Mark B. McClellan, 2000. "Is Hospital Competition Socially Wasteful?," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 115(2), pages 577-615.
    8. F. Moscone & E. Tosetti & G. Vittadini, 2012. "Social interaction in patients’ hospital choice: evidence from Italy," Journal of the Royal Statistical Society Series A, Royal Statistical Society, vol. 175(2), pages 453-472, April.
    9. Rosella Levaggi & Roberto Zanola, 2004. "Patients' migration across regions: the case of Italy," Applied Economics, Taylor & Francis Journals, vol. 36(16), pages 1751-1757.
    10. Shen, Yu-Chu, 2003. "The effect of financial pressure on the quality of care in hospitals," Journal of Health Economics, Elsevier, vol. 22(2), pages 243-269, March.
    11. Fattore, Giovanni & Petrarca, Giuseppina & Torbica, Aleksandra, 2014. "Traveling for care: Inter-regional mobility for aortic valve substitution in Italy," Health Policy, Elsevier, vol. 117(1), pages 90-97.
    12. Silvia Balia & Rinaldo Brau & Emanuela Marrocu, 2014. "What Drives Patient Mobility Across Italian Regions? Evidence from Hospital Discharge Data," Developments in Health Economics and Public Policy, in: Rosella Levaggi & Marcello Montefiori (ed.), Health Care Provision and Patient Mobility, edition 127, pages 133-154, Springer.
    13. Meleddu, Marta & Pulina, Manuela & Scuderi, Raffaele, 2020. "Public and private healthcare services: What drives the choice?," Socio-Economic Planning Sciences, Elsevier, vol. 70(C).
    14. Howard David H, 2006. "Quality and Consumer Choice in Healthcare: Evidence from Kidney Transplantation," The B.E. Journal of Economic Analysis & Policy, De Gruyter, vol. 5(1), pages 1-22, January.
    15. Vanessa Didelez, 2019. "Defining causal mediation with a longitudinal mediator and a survival outcome," Lifetime Data Analysis: An International Journal Devoted to Statistical Methods and Applications for Time-to-Event Data, Springer, vol. 25(4), pages 593-610, October.
    16. David Cantarero, 2006. "Health care and patients’ migration across Spanish regions," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 7(2), pages 114-116, June.
    17. Tingley, Dustin & Yamamoto, Teppei & Hirose, Kentaro & Keele, Luke & Imai, Kosuke, 2014. "mediation: R Package for Causal Mediation Analysis," Journal of Statistical Software, Foundation for Open Access Statistics, vol. 59(i05).
    18. Adolph, Christopher & Greer, Scott L. & Massard da Fonseca, Elize, 2012. "Allocation of authority in European health policy," Social Science & Medicine, Elsevier, vol. 75(9), pages 1595-1603.
    19. Balia, Silvia & Brau, Rinaldo & Moro, Daniela, 2020. "Choice of hospital and long-distances: Evidence from Italy," Regional Science and Urban Economics, Elsevier, vol. 81(C).
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Dmitry A. Subbotovsky & Viktor A. Kalashnikov & Alexander E. Drozd & Artur R. Nagapetyan, 2023. "The Impact of the Supply of Oncologists on Mortality from Neoplasms in the Regions of Russia," Journal of Applied Economic Research, Graduate School of Economics and Management, Ural Federal University, vol. 22(4), pages 892-931.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Lippi Bruni, Matteo & Ugolini, Cristina & Verzulli, Rossella, 2021. "Should I wait or should I go? Travelling versus waiting for better healthcare," Regional Science and Urban Economics, Elsevier, vol. 89(C).
    2. Berta, Paolo & Guerriero, Carla & Levaggi, Rosella, 2021. "Hospitals’ strategic behaviours and patient mobility: Evidence from Italy," Socio-Economic Planning Sciences, Elsevier, vol. 77(C).
    3. Giovanni Guarducci & Gabriele Messina & Simona Carbone & Andrea Urbani & Nicola Nante, 2022. "Inter-Regional Patients’ Migration for Hospital Orthopedic Intensive Rehabilitation: The Italian Experience," IJERPH, MDPI, vol. 19(21), pages 1-11, October.
    4. Gravelle, Hugh & Santos, Rita & Siciliani, Luigi, 2014. "Does a hospital's quality depend on the quality of other hospitals? A spatial econometrics approach," Regional Science and Urban Economics, Elsevier, vol. 49(C), pages 203-216.
    5. Piia Pekola & Ismo Linnosmaa & Hennamari Mikkola, 2017. "Competition and quality in a physiotherapy market with fixed prices," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 18(1), pages 97-117, January.
    6. Giuseppe Moscelli & Hugh Gravelle & Luigi Siciliani, 2016. "Market structure, patient choice and hospital quality for elective patients," Working Papers 139cherp, Centre for Health Economics, University of York.
    7. Paolo Berta & Gianmaria Martini & Daniele Spinelli & Giorgio Vittadini, 2022. "The beaten paths effect on patient inter‐regional mobility: An application to the Italian NHS," Papers in Regional Science, Wiley Blackwell, vol. 101(4), pages 945-977, August.
    8. Giuseppe Moscelli & Hugh Gravelle & Luigi Siciliani, 2018. "Effects of Market Structure and Patient Choice on Hospital Quality for Planned Patients," School of Economics Discussion Papers 1118, School of Economics, University of Surrey.
    9. Claudio Pinto, 2017. "Perceived quality and formation of inter-regional networks of health care migration," Advances in Management and Applied Economics, SCIENPRESS Ltd, vol. 7(3), pages 1-5.
    10. Hugh Gravelle & Giuseppe Moscelli & Rita Santos & Luigi Siciliani, 2014. "Patient choice and the effects of hospital market structure on mortality for AMI, hip fracture and stroke patients," Working Papers 106cherp, Centre for Health Economics, University of York.
    11. Siciliani, Luigi & Straume, Odd Rune, 2019. "Competition and equity in health care markets," Journal of Health Economics, Elsevier, vol. 64(C), pages 1-14.
    12. Giuseppe Moscelli & Hugh Gravelle & Luigi Siciliani, 2021. "Hospital competition and quality for non‐emergency patients in the English NHS," RAND Journal of Economics, RAND Corporation, vol. 52(2), pages 382-414, June.
    13. Paolo Berta & Carla Guerriero & Rosella Levaggi, 2018. "The dark side of fiscal federalism:evidence from hospital care in Italy," Working papers 72, Società Italiana di Economia Pubblica.
    14. Brekke, Kurt R. & Canta, Chiara & Siciliani, Luigi & Straume, Odd Rune, 2021. "Hospital competition in a national health service: Evidence from a patient choice reform," Journal of Health Economics, Elsevier, vol. 79(C).
    15. Philippe Choné & Lionel Wilner, 2022. "Financial Incentives and Competitive Pressure: The Case of the Hospital Industry," Journal of the European Economic Association, European Economic Association, vol. 20(2), pages 626-666.
    16. Martin Gaynor & Rodrigo Moreno-Serra & Carol Propper, 2013. "Death by Market Power: Reform, Competition, and Patient Outcomes in the National Health Service," American Economic Journal: Economic Policy, American Economic Association, vol. 5(4), pages 134-166, November.
    17. Martin Gaynor & Carol Propper & Stephan Seiler, 2012. "Free to Choose? Reform and Demand Response in the English National Health Service," The Centre for Market and Public Organisation 12/297, The Centre for Market and Public Organisation, University of Bristol, UK.
    18. Zack Cooper & Stephen Gibbons & Simon Jones & Alistair McGuire, 2011. "Does Hospital Competition Save Lives? Evidence From The English NHS Patient Choice Reforms," Economic Journal, Royal Economic Society, vol. 121(554), pages 228-260, August.
    19. Gravelle, Hugh & Liu, Dan & Propper, Carol & Santos, Rita, 2019. "Spatial competition and quality: Evidence from the English family doctor market," Journal of Health Economics, Elsevier, vol. 68(C).
    20. Hugh Gravelle & Rita Santos & Luigi Siciliani, 2013. "Does a hospitals quality depend on the quality of other hospitals? A spatial econometrics approach to investigating hospital quality competition," Working Papers 082cherp, Centre for Health Economics, University of York.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:soceps:v:82:y:2022:i:pa:s0038012122000258. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/locate/seps .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.