Geographical Inequalities in Mortality by Age and Gender in Italy, 2002-2019: Insights from a Spatial Extension of the Lee-Carter Model.

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.