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A worldwide selection of models that are used to measure health service performance were appraised. The internationally recognised Health System Performance Assessment tool was chosen for testing in a local health authority in the Marche, Italy. Local, regional, national and international comparisons were also used. A complementary means of measuring health inequality involving the Concentration Index enabled a holistic evaluation of the local health environment. While the approach addressed a comprehensive range of issues, limitations with data availability were found to present genuine constraints that require future action. Nevertheless, valuable lessons were learned for policy makers, with the relationship between socioeconomic inequalities and systematic variations in health indicators highlighted. The Health System Performance Assessment tool presents the opportunity for strategic alignment in performance measurement.

Results In the unpaired analyses, an inverse educational gradient in CVD risk was observed, particularly in women. This association was not replicated in the intrapair analyses of female MZ twins, but it persisted among female DZSS twins. For men, the pattern was less clear. Conclusions The attenuation of association in the intrapair analyses suggest that shared familial factors account for part of the observed association between education and CVD. The fact that it was primarily attenuated in MZ twins may point to genetic factors as an important source of confounding. However, since education was associated with CVD in the intrapair analysis of DZSS twins, there was still some evidence of effect of education. Finally, these Danish data suggest that the social inequality in CVD is larger for women than for men. Introduction Changes in meteorological parameters have been associated with stroke occurrence. The incidence of primary intracerebral haemorrhages (PICH) seems to increase in days with cold/ mild outdoor temperature. In Portugal, neurologists forward the hypothesis that the incidence of PICH increases in rainy days and not particularly low temperatures. This study aims to study the association between occurrence of PICH and weather parameters. Methods Data from ACINrpc-project, involving 78 patients suffering a first-ever-in-the-lifetime PICH over a 2-year period in the city of Porto was used. Information on daily weather parameters was obtained from the National Meteorological Office. A Poisson model was used to estimate the association between weather parameters and PICH incidence. Using a conditional logistic regression model, a case-crossover design was then used to estimate the risk of PICH following specific exposures associated with PICH incidence: low diurnal temperature range (DTR) and rainy days. For each subject, the case period was matched with 4 control periods, the same weekday in the previous 4 weeks. Results PICH incidence increases by 11.8% (95% CI 3.8 to 20.4%) for 18C drop in DTR and 3.1% (95% CI 1.1 to 5.1%) for a 1 mm/m 2 in precipitation. Following a day with a DTR<48C the OR is 2.9 (95% CI 1.4 to 5.8), increasing to 8.8 (95% CI 1.7 to 44.8) after a 48 h exposure. Following days with low DTR and rain, the OR is 3.2 (95% CI 1.3 to 8.1) and 9.5 (95% CI 1.1 to 88.9) for a precipitation>10 mm/m 2 and 40 mm/m 2 , respectively. Conclusion Precipitation by itself is not associated with PICH incidence, nevertheless has a synergistic effect in low DTR days. P1-466 EFFECTS OF OUTDOOR TEMPERATURE AND RAIN ON THE RISK OF HEMORRHAGIC STROKE

Background Social determinants of health (SDOH) have increasingly entered health policy conversations as a growing body of researches, reveal the direct relationship between social determinants and health outcome. In fact, the recent literature is moving from the traditional model that focus on how health affects economic status, to a new view that economic status affects health. Objectives To investigate the principal conceptual frameworks for action on social determinants of health. Another aim is to contribute on the ongoing discourse on feasible measures which could be used to alert regions to inequalities in the distribution of health. Methodology, Italian data are used as a demonstration. Quadrant charts illustrate associations between how much regions spend on health and how effectively health system functions. The relevant inequality measures are used to rank health inequalities. Main results Frameworks have been presented to help communities, health professionals and others begin to better understand and address a variety of factors that affects health. Quadrant analysis technique shows the extent to which spending more on health, translates into better health outcomes, higher quality of care and improve access to care across the Italian regions, whilst also recognition the importance of major risk factors. Conclusions The social inequalities in health and what this means for how we understand and reduce them, as not to date been compressively examined empirically. There is an urgent need to expand our knowledge with comparable data on health determinants and more refined health outcomes. Furthermore, there is a need for feasible inequality measures in the health information systems. The measures used in this study, provide a step to inform and guide the uptake of equity-sensitive policies.