标题： 意大利2002-2019年按年龄和性别划分的死亡率地理不平等：对Lee-Carter模型空间扩展的见解 显示英文标题

标题： Geographical inequalities in mortality by age and gender in Italy, 2002-2019: insights from a spatial extension of the Lee-Carter model

摘要： 意大利报告了发达国家中一些最低的死亡率水平。 最近的证据表明，即使在低死亡率国家，改善可能正在放缓，地区不平等现象正在扩大。 本研究通过分析2002年至2019年间意大利107个省男性和女性按年龄组的死亡率数据，为这一争论提供了新的实证证据。 我们扩展了广泛使用的Lee Carter模型，以包括空间变化的年龄特定效应，并进一步对其进行规范以捕捉空间年龄时间相互作用。 该模型在贝叶斯框架下进行估计，使用inlabru包，该包基于INLA（集成嵌套拉普拉斯近似）用于非线性模型，并促进了平滑先验的使用。 这种方法在省和年份之间借用力量，减轻小区域死亡人数的随机波动。 结果证明了这种细致方法的价值，突显了尽管全国总体改善，但死亡率的不均衡地理分布仍然存在。 死亡率劣势集中在中部南部和西北部部分地区，而中部北部和东北部相对较好。 自2010年以来，这些地理差异有所扩大，表现出明显的年龄和性别特定模式，男性在较年轻的成年人群中更为明显，女性在较年长的成年人群中更为明显。 未来的工作可能涉及将分析细化到按死亡原因或社会经济地位的死亡率，以制定更有针对性的公共卫生政策，解决意大利各省之间的死亡率差异。 显示英文摘要

摘要： Italy reports some of the lowest levels of mortality in the developed world. Recent evidence, however, suggests that even in low mortality countries improvements may be slowing and regional inequalities widening. This study contributes new empirical evidence to the debate by analysing mortality data by single year of age for males and females across 107 provinces in Italy from 2002 to 2019. We extend the widely used Lee Carter model to include spatially varying age specific effects, and further specify it to capture space age time interactions. The model is estimated in a Bayesian framework using the inlabru package, which builds on INLA (Integrated Nested Laplace Approximation) for non linear models and facilitates the use of smoothing priors. This approach borrows strength across provinces and years, mitigating random fluctuations in small area death counts. Results demonstrate the value of such a granular approach, highlighting the existence of an uneven geography of mortality despite overall national improvements. Mortality disadvantage is concentrated in parts of the Centre South and North West, while the Centre North and North East fare relatively better. These geographical differences have widened since 2010, with clear age and gender specific patterns, being more pronounced at younger adult ages for men and at older adult ages for women. Future work may involve refining the analysis to mortality by cause of death or socioeconomic status, informing more targeted public health policies to address mortality disparities across Italy's provinces.