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Joudi A, Sargeran K, Hessari H. To appreciate the influence of contributed determinants on dental care utilization in the context of socio-economic inequalities. Int J Equity Health 2024; 23:141. [PMID: 39020386 PMCID: PMC11253340 DOI: 10.1186/s12939-024-02220-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 06/25/2024] [Indexed: 07/19/2024] Open
Abstract
BACKGROUND To appreciate dental care utilization in the context of socio-economic inequalities, it is imperative to identify sources of inequalities and evaluate the extent to which dental care utilization is still related to socio-economic status. This study aimed to quantify the influence of contributed determinants on dental care utilization in the context of socio-economic inequalities amongst adults residing in Tehran metropolis. METHODS In this cross-sectional community-based study, a stratified random sample of 1,510 subjects aged over 18 years was investigated by the zero-inflated Poisson analysis to measure the effect of determinants on utilization of dental care, and concentration index as well as the decomposition approach to identify the contributions of deterministic variables to the socio-economic inequality. Data was obtained by employing a phone interview survey. Individuals who were not willing or able to answer the questions in the telephone interview due to hearing or neurological problems did not participate in the interview. Dental care utilization was measured using the number of dental appointments. RESULTS Gender (male), oral health-related behaviors (such as brushing and dental flossing), experience of toothache, and concern about dental appearance were associated with an increased likelihood of utilizing dental care. Individuals who belonged to advanced age groups and lived alone significantly underutilized dental care. The concentration index equaling 0.05 (SE = 0.05) corroborates a pro-rich inequality. Decomposition analysis demonstrated the impact of oral health-related behaviors (i.e. dental brushing and use of dental flossing), concern about dental appearance, toothache, gender (male), insurance coverage of dental care, and smoking habit on the poor-rich gap in the dental care utilization. CONCLUSIONS The influence of socio-economic inequalities on dental care utilization is discernable along the entire spectrum of socio-economic status. Individuals with lower socio-economic status experience more underutilization of dental care. Community subgroups, particularly the more deprived bracket, require consideration from key stakeholders, including policymakers and health professionals for the enhancement of dental care utilization as revealed by underlying determinants.
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Affiliation(s)
- Aydin Joudi
- Departments of Community Oral Health, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
- Research Center for Caries Prevention, Dentistry Research Institute. Department of Community Oral Health, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Katayoun Sargeran
- Departments of Community Oral Health, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
- Research Center for Caries Prevention, Dentistry Research Institute. Department of Community Oral Health, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Hessari
- Departments of Community Oral Health, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran.
- Research Center for Caries Prevention, Dentistry Research Institute. Department of Community Oral Health, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran.
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Ul Husnain MI, Hajizadeh M, Ahmad H, Khanam R. The Hidden Toll of Psychological Distress in Australian Adults and Its Impact on Health-Related Quality of Life Measured as Health State Utilities. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2024; 22:583-598. [PMID: 38530626 PMCID: PMC11178635 DOI: 10.1007/s40258-024-00879-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Psychological distress (PD) is a major health problem that affects all aspects of health-related quality of life including physical, mental and social health, leading to a substantial human and economic burden. Studies have revealed a concerning rise in the prevalence of PD and various mental health conditions among Australians, particularly in female individuals. There is a scarcity of studies that estimate health state utilities (HSUs), which reflect the overall health-related quality of life in individuals with PD. No such studies have been conducted in Australia thus far. OBJECTIVE We aimed to evaluate the age-specific, sex-specific and PD category-specific HSUs (disutilities) in Australian adults with PD to inform healthcare decision making in the management of PD. METHODS Data on age, sex, SF-36/SF6D responses, Kessler psychological distress (K10) scale scores and other characteristics of N = 15,139 participants (n = 8149 female individuals) aged >15 years were derived from the latest wave (21) of the nationally representative Household, Income and Labor Dynamics in Australia survey. Participants were grouped into the severity categories of no (K10 score: 10-19), mild (K10: 20-24), moderate (K10: 25-29) and severe PD (K10: 30-50). Both crude and adjusted HSUs were calculated from participants' SF-36 profiles, considering potential confounders such as smoking, marital status, remoteness, education and income levels. The calculations were based on the SF-6D algorithm and aligned with Australian population norms. Additionally, the HSUs were stratified by age, sex and PD categories. Disutilities of PD, representing the mean difference between HSUs of people with PD and those without, were also calculated for each group. RESULTS The average age of individuals was 46.130 years (46% male), and 31% experienced PD in the last 4 weeks. Overall, individuals with PD had significantly lower mean HSUs than those likely to be no PD, 0.637 (95% confidence interval [CI] 0.636, 0.640) vs 0.776 (95% CI 0.775, 0.777) i.e. disutility: -0.139 [95% CI -0.139, -0.138]). Mean disutilities of -0.108 (95% CI -0.110, -0.104), -0.140 (95% CI -0.142, -0.138), and -0.188 (95% CI -0.190, -0.187) were observed for mild PD, moderate PD and severe PD, respectively. Disutilities of PD also differed by age and sex groups. For instance, female individuals had up to 0.049 points lower mean HSUs than male individuals across the three classifications of PD. There was a clear decline in health-related quality of life with increasing age, demonstrated by lower mean HSUs in older population age groups, that ranged from 0.818 (95% CI 0.817, 0.818) for the 15-24 years age group with no PD to 0.496 (95% CI 0.491, 0.500) for the 65+ years age group with severe PD). Across all ages and genders, respondents were more likely to report issues in certain dimensions, notably vitality, and these responses did not uniformly align with ageing. CONCLUSIONS The burden of PD in Australia is substantial, with a significant impact on female individuals and older individuals. Implementing age-specific and sex-specific healthcare interventions to address PD among Australian adults may greatly alleviate this burden. The PD state-specific HSUs calculated in our study can serve as valuable inputs for future health economic evaluations of PD in Australia and similar populations.
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Affiliation(s)
| | | | | | - Rasheda Khanam
- University of Southern Queensland, Toowomba, QLD, Australia
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Hou B, Wu Y, Huang Y. Physical exercise and mental health among older adults: the mediating role of social competence. Front Public Health 2024; 12:1385166. [PMID: 38962779 PMCID: PMC11219581 DOI: 10.3389/fpubh.2024.1385166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 06/10/2024] [Indexed: 07/05/2024] Open
Abstract
Background Healthy aging is crucial to the quality of life of older adults, of which mental health is an essential part. Physical exercise strongly affects their mental health and can alleviate psychological problems to a certain extent. Nevertheless, the correlation between physical exercise and the mental health of older adults individuals, as well as the underlying mechanism by which physical exercise impacts mental health, remains rather ambiguous. Methods We utilized multiple linear regression models to investigate the relationship between physical activity and mental health in 3,240 persons aged 60 and up. The propensity score matching (PSM) method was used to assess the robustness of the regression results. In addition, sequential recursive models were employed to investigate the mediating role of social competence in the link between physical activity and mental health. Results and discussion We discovered a strong favorable association between physical exercise and mental health, which was mediated by social competence. Furthermore, the effect of physical exercise on mental health differed across older persons from various socioeconomic backgrounds. Conclusion Older adults should strengthen their understanding of the role of physical exercise. Sports organizations that serve older adults by providing resources and services to help them maintain physical fitness and by hosting sports activities and competitions according to their needs should be established.
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Affiliation(s)
- Bin Hou
- School of Cultural Tourism and Public Administration, Fujian Normal University, Fuzhou, China
| | - Yuxin Wu
- School of Management, Yang-En University, Quanzhou, China
| | - Yuqi Huang
- School of Cultural Tourism and Public Administration, Fujian Normal University, Fuzhou, China
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Bahadori F, Abolfathi Momtaz Y, Mohammadi Shahboulaghi F, Zandieh Z. Information and Communication Technology Adoption Strategies Among Iranian Older Adults: A Qualitative Evaluation. Gerontol Geriatr Med 2024; 10:23337214241246315. [PMID: 38633750 PMCID: PMC11022677 DOI: 10.1177/23337214241246315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/22/2024] [Accepted: 03/09/2024] [Indexed: 04/19/2024] Open
Abstract
In today's world, it is unavoidable for older adults to use technology, which causes some challenges for them. In this qualitative study, we used grounded theory to evaluate information and communication technology (ICT) adoption strategies among Iranian older adults. The participants included 18 older adults, five experts, and five family members of older adults. The data collection method included conducting semi-structured interviews, taking field notes, and observation. The data were analyzed using the Corbin and Strauss approach. Three main themes were extracted as follows: support from others, effort for learning, and smart choice. The subthemes of support from others included creativity in educating older adults; having access to an educational supporter; and receiving informational, emotional, and financial support. The subthemes of effort for learning included utilizing aids, adaptive measures, shortcut techniques, and self-learning. The subthemes of smart choice included physical characteristics, technical features, price sensitivity, and availability of an active sales representative. Accordingly, it is essential to teach older adults to increase their ICT adoption rate and continued use of technology. In this respect, developing a standard ICT manual for older adults can be beneficial.
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Affiliation(s)
- Farzaneh Bahadori
- University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | | | | | - Zhale Zandieh
- University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Soleimanvandiazar N, Mohaqeqi Kamal SH, Basakha M, Karim S, Ahmadi S, Ghaedamini Harouni G, Sajjadi H, Setareh Forouzan A. Decomposition of Healthcare Utilization Inequality in Iran: The Prominent Role of Health Literacy and Neighborhood Characteristics. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2024; 61:469580241229622. [PMID: 38339828 PMCID: PMC10859068 DOI: 10.1177/00469580241229622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 12/27/2023] [Accepted: 01/11/2024] [Indexed: 02/12/2024]
Abstract
Unequal utilization in healthcare can potentially affect the right to health. Access to healthcare services and achieving positive health outcomes and health equity are essential principles in promoting human rights. This study aims to assess and analyze socioeconomic-related inequalities in outpatient health services utilization (OHSU) among various socio-demographic subgroups to inform policies that foster health equity. Data were collected through a cross-sectional survey of 1200 households in Tehran, Iran. Inequality in OHSU among the socio-demographic subgroups was calculated by concentration, Wagstaff, and Erigers indices. Decomposition was used to identify the factors contributing to inequality in OHSU. Marginal effect and elasticity were used to calculate the relative absolute shares of socio-demographic variables in the inequality. The rate of OHSU was 63.61% (CI: 60-66.80) which concentrated among households with better socioeconomic status. Based on the results, living in an affluent neighborhood (Relative share (RS): 85.48) and having a disabled member in the household (RS: 6.58) were the most important factors in the concentration of OHSU in favor of the privileged groups. In contrast, very low levels of health knowledge (RS: -83.79) and having basic insurance coverage (RS: -3.92) concentrated OHSU in favor of the lower socioeconomic households. The study was conducted based on survey data, and this may lead to some limitations. Given that this study was a cross-sectional study, we were unable to establish causal relationships between explanatory variables and outpatient health service utilization and its relevant predictors. Households with disabled member(s), as well as a member(s) with chronic diseases, may experience severe inequalities in access to healthcare services. Policies that facilitate access to health services for these households can play a significant role in improving health equity.
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Affiliation(s)
| | | | - Mehdi Basakha
- University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | | | - Sina Ahmadi
- Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Homeira Sajjadi
- University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Mouseli A, Sharafi M, Mastaneh Z, Shiri MS. Contrasting socioeconomic inequality with noncommunicable diseases: Insights from a population-based survey using the concentration index in Kong cohort study. Health Sci Rep 2023; 6:e1682. [PMID: 37936619 PMCID: PMC10625898 DOI: 10.1002/hsr2.1682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 10/19/2023] [Indexed: 11/09/2023] Open
Abstract
Background Noncommunicable diseases (NCDs) are the major causes of mortality across the globe, which impose a substantial burden on health care systems, particularly in low- and middle-income countries. The present study aimed to determine socioeconomic inequality in the prevalence of NCDs using the concentration index (CI). Methods This cross-sectional study was conducted on the baseline data of the Bandar Kong cohort. The principal component analysis was used to determine people's socioeconomic status (SES). The CI and Lorenz Curve were used for the assessment of socioeconomic inequality. Multivariate logistic regression was used to assess the relationship between SES and the prevalence of NCDs. A p Value less than 0.05 is considered significant. Results Frequency and prevalence of diabetes was 653 (16.22%), hypertension 848 (21.06%), chronic lung diseases 161 (4%), epilepsy 70 (1.74%), mental disorders 191 (4.74%), stillbirth 299 (13.94%), thyroid disorders 391 (9.71%) and depression 146 (3.63%). CI for the prevalence of diabetes was [-0.107, %95 CI: -0.146 to -0.068], hypertension [-0.122, %95 CI: -0.155 to -0.088], chronic lung disease [-0.116, %95 CI: -0.202 to -0.03], psychiatric disorders [-0.230, %95 CI: -0.304 to -0.155], depression [-0.132, %95 CI: -0.220 to-0.043] and stillbirth [-0.162, %95 CI: -0.220 to -0.105]. The Gini index was negative for all these diseases, indicating that these are significantly concentrated in people of poor SES. Conclusions The findings suggest that selected NCDs were concentrated among the poor and the low-income. Particular attention may be necessary to address the problem of NCDs among these groups.
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Affiliation(s)
- Ali Mouseli
- Social Determinants in Health Promotion Research Center, Hormozgan Health InstituteHormozgan University of Medical SciencesBandar AbbasIran
- Department of Health Services Management, School of HealthHormozgan University of Medical SciencesBandar AbbasIran
| | - Mehdi Sharafi
- Social Determinants in Health Promotion Research Center, Hormozgan Health InstituteHormozgan University of Medical SciencesBandar AbbasIran
| | - Zahra Mastaneh
- Department of Health Information Management and Technology, School of Allied Medical SciencesHormozgan University of Medical SciencesBandar AbbasIran
| | - Maryam Shiravani Shiri
- Department of Health Services Management, School of HealthHormozgan University of Medical SciencesBandar AbbasIran
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Islam MI, Salam SS, Kabir E, Khanam R. Identifying Social Determinants and Measuring Socioeconomic Inequalities in the Use of Four Different Mental Health Services by Australian Adolescents Aged 13-17 Years: Results from a Nationwide Study. Healthcare (Basel) 2023; 11:2537. [PMID: 37761734 PMCID: PMC10531418 DOI: 10.3390/healthcare11182537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/04/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
AIM In this study, we aimed to identify the determinants of four different forms of mental health service usage (general health services, school counselling, telephone, and online services), and the number of mental health services accessed (single and multiple) by Australian adolescents aged 13-17 years. We also measured socioeconomic inequality in mental health services' usage following the concentration index approach within the same sample. SUBJECT AND METHODS The data came from the nationwide cross-sectional survey, Young Minds Matter (YMM): the second Australian Child and Adolescent Survey of Mental Health and Wellbeing. Random effect models were used to identify the factors associated with four different mental health services and the number of services accessed. Further, the Erreygers' corrected concentration indices for binary variables were used to quantify the socioeconomic inequality in each mental health service. The four services were the general health service (GP, specialist, psychiatrist, psychologist, hospital including emergency), school services, telephone counselling and online services. RESULTS Overall, 31.9% of the total analytical sample (n = 2268) aged 13-17 years old visited at least one service, with 21.9% accessing a single service and 10% accessing multiple services. The highest percentage of adolescents used online services (20.1%), followed by general mental health services (18.3%), while school services (2.4%) were the least used service. Age, gender, family type and family cohesion statistically significantly increased the use of general health and multiple mental health service usage (p < 0.05). Area of residence was also found to be a significant factor for online service use. The concentration indices (CIs) were -0.073 (p < 0.001) and -0.032 (p < 0.001) for health and telephone services, respectively, which implies pro-rich socio-economic inequality. CONCLUSION Adolescents from low-income families frequently used general mental health services and telephone services compared to those who belonged to high-income families. The study concluded that if we want to increase adolescents' usage of mental health services, we need to tailor our approaches to their socioeconomic backgrounds. In addition, from a policy standpoint, a multi-sectoral strategy is needed to address the factors related to mental health services to reduce inequity in service utilisation.
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Affiliation(s)
- Md Irteja Islam
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia
- Centre for Health Research and School of Business, Faculty of Business, Education, Law and Arts, University of Southern Queensland, Toowoomba, QLD 4350, Australia;
- School of Mathematics, Physics and Computing, Faculty of Health, Engineering and Sciences, University of Southern Queensland, Toowoomba, QLD 4350, Australia;
| | | | - Enamul Kabir
- School of Mathematics, Physics and Computing, Faculty of Health, Engineering and Sciences, University of Southern Queensland, Toowoomba, QLD 4350, Australia;
| | - Rasheda Khanam
- Centre for Health Research and School of Business, Faculty of Business, Education, Law and Arts, University of Southern Queensland, Toowoomba, QLD 4350, Australia;
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Kumar P, Srivastava S, Chaudhary P, Muhammad T. Factors contributing to socio-economic inequality in utilization of caesarean section delivery among women in Indonesia: Evidence from Demographic and Health Survey. PLoS One 2023; 18:e0291485. [PMID: 37703256 PMCID: PMC10499255 DOI: 10.1371/journal.pone.0291485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 08/24/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Most of the existing literature in developing countries focused on either the rising trend of CS or its determinants. There is a paucity of population-based studies on existing socioeconomic inequalities in availing CS services by women in Indonesia. This study aimed to assess the factors associated with caesarian section (CS) delivery and explore the various factors contributing to inequalities in CS delivery rates in Indonesia. METHODS The study utilized nationally representative cross-sectional data from the Indonesia Demographic and Health Survey (IDHS), 2017. We conducted multivariable logistic regression to find the factors associated with CS delivery. Concentration index and Wagstaff's decomposition analysis were used to examine the socioeconomic inequalities in CS delivery among women and associated factors. RESULTS About 17% of women in Indonesia delivered babies through CS. A concentration index of 0.31 in CS delivery rate showed a higher CS delivery rate among women belonging to rich households. About 44.7% of socioeconomic status inequality in CS delivery was explained by educational status among women who went for CS delivery. Women's place of residence explained 30.1% of socioeconomic inequality, and women's age at first birth explained about 11.9% and reporting ANC visits explained 8.4% of the observed inequality. Highest socioeconomic inequality was witnessed in central Sulawesi (0.529), followed by Maluku (0.488) and West Kalimantan (0.457), whereas the lowest was recorded in Yogyakarta (0.021) followed by north Sulawesi (0.047) and east Kalimantan (0.171). Education (44.7%) followed by rural-urban place of residence (30.1%) and age of first birth (11.9%) contributed most to explain the gap in CS delivery among rich and poor women. CONCLUSION The study highlighted the higher CS delivery rates among women from higher socioeconomic groups and thus, it is important to frame policies after identifying the population subgroups with potential underuse or overuse of CS method of delivery.
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Affiliation(s)
- Pradeep Kumar
- International Institute for Population Sciences, Mumbai, Maharashtra, India
| | - Shobhit Srivastava
- International Institute for Population Sciences, Mumbai, Maharashtra, India
| | | | - T. Muhammad
- International Institute for Population Sciences, Mumbai, Maharashtra, India
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Hasan MM. Sex difference and socioeconomic inequality of underweight, overweight and obesity among adult population in Bangladesh. Nutr Health 2023:2601060231163365. [PMID: 36938646 DOI: 10.1177/02601060231163365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Background: Due to rapid socioeconomic development and epidemiological transition, socioeconomic inequality of underweight, overweight, and obesity are becoming a public health concern in Bangladesh. There is a need for country-specific evidence of nutrition inequalities in Bangladesh. Aim: The aim of the study was to measure socioeconomic inequality and decomposition analysis along with the sex differences in underweight, overweight, and obesity among the adult population. Methods: A secondary data analysis was performed in the Bangladesh Demographic and Health Survey (BDHS) 2017-18, a cross-sectional survey used a multi-stage cluster sampling technique. Sociodemographic variables including age, sex, education, socioeconomic status, marital status, and anthropometric data of height and weight were considered for analysis. Body mass index was used for defining underweight, overweight, and obesity. Concentration index (CI) and decomposition analysis were performed for underweight, overweight, and obesity. Results: The proportion of underweight was 15.0%, overweight (23.0%), and obese (5.0%). Underweight was higher in males, whereas overweight and obesity were higher in females. The CI of underweight was -0.121 (p < 0.001), indicating socioeconomic inequality concentrated on lowering socioeconomic status; living in rural areas contributed 14.2% to this inequality. The CI of overweight and obesity was 0.213 (p < 0.001) and 0.142 (p < 0.001), respectively, indicating that inequalities of overweight and obesity concentrated in higher socioeconomic status; urban residency contributed 14.1% and 18.0% to socioeconomic inequality of overweight and obesity. Conclusion: Underweight remains a significant problem for poor people in rural areas, but overweight and obesity were highly prevalent in the higher socioeconomic status of urban areas. Education level and young age group significantly contribute to the socioeconomic inequality of malnutrition. A more detailed epidemiological study is required to understand the causes of socioeconomic disparities of nutritional status in Bangladesh.
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Affiliation(s)
- Md Mehedi Hasan
- Department of Business Administration, North Western University, Khulna, Bangladesh
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High School Students' Depression Literacy about Interventions and Prevention: A Survey in Tehran. DEPRESSION RESEARCH AND TREATMENT 2023; 2023:8540614. [PMID: 36911096 PMCID: PMC10005867 DOI: 10.1155/2023/8540614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 12/11/2022] [Accepted: 01/24/2023] [Indexed: 03/06/2023]
Abstract
Background Given the high prevalence of depressive disorders in the present world and the lack of adequate awareness about prevention and appropriate interventions, increasing mental health literacy is vital for promoting mental health to reduce depression and its consequences. Methods In this descriptive cross-sectional study, participants were recruited among the second high school students in the 2018-2019 academic year. The sample size was 2038, and samples were selected by multistage cluster sampling from different areas of Tehran. Demographic variables like age, gender, level of education, and parents' characteristics and mental health literacy questions in treatment and prevention areas were evaluated. Results Analyses showed that of high school students, 83% considered getting help from psychiatrists and 80% considered learning stress management as the best preventive measures, while as the best treatment measures, 79.5% considered counseling the best place to refer for visiting a professional and 45% selected general counseling centers. Conclusion The study results showed that high school students have a positive attitude toward preventing and treating depressive disorders, getting help from specialists, and useful measures for depressed people. But they did not know enough about preventive measures, including learning effective coping skills, reading self-help books, and continuing to take psychiatric medications. Planning and providing the necessary training are important, especially for high school students.
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Azizabadi Z, Aminisani N, Emamian MH. Socioeconomic inequality in depression and anxiety and its determinants in Iranian older adults. BMC Psychiatry 2022; 22:761. [PMID: 36471352 PMCID: PMC9721087 DOI: 10.1186/s12888-022-04433-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 11/28/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Older adults with lower socioeconomic status are more vulnerable to stressful life events and at increased risk of common mental health disorders like anxiety and depression. This study investigates the socioeconomic inequality in depressive symptoms and anxiety. METHODS The data were from 7462 participants of the Neyshabur longitudinal study of ageing registered during 2016-2018. The outcome variables were anxiety and depressive symptoms. Anxiety was defined by the "Hospital Anxiety and Depression scale Questionnaire", and depressive symptoms was defined and measured by the "short-term form of the Epidemiological Center Questionnaire." The socioeconomic status was defined using principal component analysis of home assets. The Concentration Index (C) was used to measure socioeconomic inequality in anxiety and depressive symptoms. Concentration index was decomposed to its determinants to determine the role of the independent variables on inequality. RESULTS The prevalence of depressive symptoms and anxiety was 12.2% (95% CI: 11.4, 12.9) and 7.0% (95% CI: 6.4, 7.5), respectively. Moreover, the C for anxiety was -0.195 (95% CI: -0.254, -0.136) and for depressive symptoms was -0.206 (95% CI: -0.252, -0.159), which indicate a considerable inequality in favor of high socioeconomic group for anxiety and depressive symptoms. Decomposition of the concentration Index showed that education, unemployment and male sex were the most important positive contributors to the observed inequality in anxiety and depressive symptoms, while age and number of grandchildren were main negative contributors of this inequality. CONCLUSION Low socioeconomic groups were more affected by anxiety and depressive symptoms. Any intervention for alleviation of inequality in anxiety and depression should be focus on education and employment of people, especially in younger elderly.
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Affiliation(s)
- Zahra Azizabadi
- grid.444858.10000 0004 0384 8816Student Research Committee, School of Public Health, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Nayyereh Aminisani
- grid.502998.f0000 0004 0550 3395Healthy Ageing Research Centre, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Mohammad Hassan Emamian
- Ophthalmic Epidemiology Research Center, Shahroud University of Medical Sciences, Shahroud, Iran.
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Farzadfar F, Zalvand R, Karami B, Yoosefi M, Takian A, Tajvar M. Prevalence and Determinants of Severe Mental Disorders in Iran: Evidence from the National Survey of STEPs- 2016. ARCHIVES OF IRANIAN MEDICINE 2022; 25:460-472. [DOI: 10.34172/aim.2022.76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/01/2022] [Indexed: 11/06/2022]
Abstract
Background: The determinants and correlates of severe mental disorders are less understood compared to the common mental disorders, both in the world and in Iran. In this study, we aimed to identify a wide range of determinants of severe stress, severe anger, and severe sadness among Iranian population. Methods: This study is part of a large nationwide cross-sectional survey entitled STEPs conducted using a comprehensive questionnaire to determine the prevalence of main preventable risk factors of non-communicable diseases (NCDs) in Iran by age and sex groups in 2016. In total, 30541 people aged 18+participated in this study. Univariate and multivariate logistic regression analyses were used to examine the associations between the dependent variable, which is severe mental disorders, and independent variables including socio-economic factors, lifestyle and selected NCDs. Results: The prevalence of severe stress, severe anger and sever sadness in the Iranian society was 33%, 35%, and 25%, respectively. Of the investigated socio-economic factors, being men, older, never married and living in rural areas were associated with significantly lower experience of severe mental disorders compared to other groups. For education, income and wealth index, there was no linear and clear pattern. Among lifestyle factors, being nonsmoker, having low physical activities, and higher intake of fruits and vegetables were found to be preventive of severe mental disorders. Additionally, having NCDs including hypertension, high cholesterol, diabetes and heart attacks were also significantly correlated with severe mental disorders. Conclusion: determining factors associated with severe mental disorders in this study would help in raising people’s awareness on avoiding harmful factors, and taking healthier lifestyle such as quitting smoke, and consuming enough vegetables and fruits. Screening high risk people in terms of mental health could contribute to the reduction of mental disorders in the Iranian community.
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Affiliation(s)
- Farshad Farzadfar
- Non–Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Rostam Zalvand
- Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Badrye Karami
- Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Moein Yoosefi
- Non–Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Takian
- Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Department of Global Health and Public Policy, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Health Equity Research Center (HERC), Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Tajvar
- Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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13
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León-Giraldo S, Casas G, Cuervo-Sanchez JS, González-Uribe C, Bernal O, Moreno-Serra R, Suhrcke M. Health in Conflict Zones: Analyzing Inequalities in Mental Health in Colombian Conflict-Affected Territories. Int J Public Health 2021; 66:595311. [PMID: 34744562 PMCID: PMC8565266 DOI: 10.3389/ijph.2021.595311] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 04/27/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: Colombia’s civil conflict and persistent socio-economic disparities have contributed to mental health inequalities in conflict-affected territories. We explore the magnitude of mental health inequalities, contributing socio-economic factors, and sociodemographic characteristics that explain these differences. Methods: The study draws on data collected in 2018, using the household survey Conflicto, Paz y Salud (CONPAS) applied to 1,309 households in Meta, Colombia. Logistic regression and decomposition analysis were used to analyze the risk of mental health disorders, measured with the Self-Reporting Questionnaire -20 (SRQ-20). Results: Individuals with lower socio-economic status are at a higher risk for mental health disorders. Forced displacement accounts for 31% of the measured mental health inequalities. Disparities in employment, education level, disability and conflict incidence between municipalities are other contributing factors. Women and people with disabilities are respectively 2.3 and 1.2 times more prone to present a mental health disorder. Conclusion: It is necessary to tackle the identified risk factors and sociodemographic circumstances that contribute to mental health inequalities in conflict-affected territories, as these hinder adequate/equitable access to mental health services.
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Affiliation(s)
- Sebastián León-Giraldo
- Interdisciplinary Centre of Development Studies, Universidad de Los Andes, Bogotá, Colombia.,Alberto Lleras Camargo School of Government, Universidad de Los Andes, Bogotá, Colombia
| | - Germán Casas
- School of Medicine, Universidad de Los Andes, Bogotá, Colombia.,Fundación Santa Fe de Bogotá University Hospital, Bogotá, Colombia
| | | | | | - Oscar Bernal
- Alberto Lleras Camargo School of Government, Universidad de Los Andes, Bogotá, Colombia
| | | | - Marc Suhrcke
- Centre for Health Economics, University of York, York, United Kingdom.,Luxembourg, Institute of Socio-Economic Research (LISER), Luxembourg
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14
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Islam MI, Ormsby GM, Kabir E, Khanam R. Estimating income-related and area-based inequalities in mental health among nationally representative adolescents in Australia: The concentration index approach. PLoS One 2021; 16:e0257573. [PMID: 34547040 PMCID: PMC8455142 DOI: 10.1371/journal.pone.0257573] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 09/06/2021] [Indexed: 11/30/2022] Open
Abstract
Despite the awareness of the importance of mental health problems among adolescents in developed countries like Australia, inequality has not been widely researched. This study, is therefore, aimed to measure and compare household income-related and area-based socioeconomic inequalities in mental health problems (bullying victimization, mental disorders-single and multiple, self-harm and suicidality-ideation, plan and attempt) among Australian adolescents aged 12-17 years. Young Minds Matter (YMM)-the 2nd national cross-sectional mental health and well-being survey involving Australian children and adolescents conducted in 2013-14, was used in this study to select data for adolescents aged 12-17 years (n = 2521). Outcome variables included: bullying, mental disorders, self-harm, and suicidal ideation, plan and attempt. The Erreygers's corrected concentration index (CI) approach was used to measure the socioeconomic inequalities in mental health problems using two separate rank variables-equivalised household income quintiles and area-based Index of Relative Socioeconomic Advantage and Disadvantage (IRSAD) quintiles. The prevalence of mental health problems in the previous 12-months among these study participants were: bullying victimization (31.1%, 95% CI: 29%-33%), mental disorder (22.9%, 95% CI: 21%-24%), self-harm (9.1%, 95% CI: 8%-10%), suicidal ideation (8.5%, 95% CI: 7%-10%), suicidal plan (5.9%, 95% CI: 5%-7%) and suicidal attempt (2.8%, 95% CI: 2%-3%). The concentration indices (CIs) were statistically significant for bullying victimization (CI = -0.049, p = 0.020), multiple mental disorders (CI = -0.088, p = <0.001), suicidal ideation (CI = -0.023, p = 0.047) and suicidal attempt (CI = -0.021, p = 0.002), implying pro-poor socioeconomic inequalities based on equivalized household income quintiles. Similar findings revealed when adolescents mental health inequalities calculated on the basis of area based IRSAD (Index of Relative Socio-economic Advantage and Disadvantage) quintiles. Overall, adolescents from economically worse-off families experienced more mental health-related problems compared to those from economically better-off families. This has implications for prevention strategies and government policy in order to promote mental health and provide equitable healthcare facility.
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Affiliation(s)
- Md Irteja Islam
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
- Centre for Health Research and School of Business, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Gail M. Ormsby
- Professional Studies, School of Education, Faculty of Business, Education and Law, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Enamul Kabir
- School of Sciences, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Rasheda Khanam
- Centre for Health Research and School of Business, University of Southern Queensland, Toowoomba, Queensland, Australia
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15
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Zarei E, Pakzad R, Yekta A, Amini M, Sardari S, Khabazkhoob M. Economic Inequality in Visual Impairment: A Study in Deprived Rural Population of Iran. J Curr Ophthalmol 2021; 33:165-170. [PMID: 34409227 PMCID: PMC8365585 DOI: 10.4103/2452-2325.288936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/04/2021] [Accepted: 01/05/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose: To determine economic inequality in visual impairment (VI) and its determinants in the rural population of Iran. Methods: In this population-based, cross-sectional study, 3850 individuals, aged 3–93 years were selected from the north and southwest regions of Iran using multi-staged stratified cluster random sampling. The outcome was VI, measured in 20 feet. Economic status was constructed using principal component analysis on home assets. The concentration index (C) was used to determine inequality, and the gap between low and high economic groups was decomposed to explained and unexplained portions using the Oaxaca–Blinder decomposition method. Results: Of the 3850 individuals that were invited, 3314 participated in the study. The data of 3095 participants were finally analyzed. The C was −0.248 (95% confidence interval [CI]: −0.347 - −0.148), indicating a pro-poor inequality (concentration of VI in low economic group). The prevalence (95% CI) of VI was 1.72% (0.92–2.52) in the high economic group and 10.66% (8.84–12.48) in the low economic group with a gap of 8.94% (6.95–10.93) between the two groups. The explained and unexplained portions comprised 67.22% and 32.77% of the gap, respectively. Among the study variables, age (13.98%) and economic status (80.70%) were significant determinants of inequality in the explained portion. The variables of education (coefficient: −4.41; P < 0.001), age (coefficient: 14.09; P < 0.001), living place (coefficient: 6.96; P: 0.006), and economic status (coefficient: −7.37; P < 0.001) had significant effects on inequality in the unexplained portion. Conclusions: The result showed that VI had a higher concentration in the low economic group, and the major contributor of this inequality was economic status. Therefore, policymakers should formulate appropriate interventions to improve the economic status and alleviate economic inequality.
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Affiliation(s)
- Ehsan Zarei
- School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Pakzad
- Department of Epidemiology, Faculty of Health, Ilam University of Medical sciences, Ilam, Iran
| | - Abbasali Yekta
- Refractive Errors Research Center, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Masoomeh Amini
- School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sara Sardari
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
| | - Mehdi Khabazkhoob
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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16
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Gutierrez JP, Agudelo-Botero M, Garcia-Saiso S, Zepeda-Tena C, Davila-Cervantes CA, Gonzalez-Robledo MC, Fullman N, Razo C, Hernández-Prado B, Martínez G, Barquera S, Lozano R. Advances and challenges on the path toward the SDGs: subnational inequalities in Mexico, 1990-2017. BMJ Glob Health 2021; 5:bmjgh-2020-002382. [PMID: 33122296 PMCID: PMC7597504 DOI: 10.1136/bmjgh-2020-002382] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/07/2020] [Accepted: 05/28/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The sustainable development goals (SDGs) have generated momentum for global health, aligning efforts from governments and international organisations toward a set of goals that are expected to reflect improvements in life conditions across the globe. Mexico has huge social inequalities that can affect access to quality care and health outcomes. The objective of this study is to analyse inequalities among Mexico's 32 states on the health-related SDG indicators (HRSDGIs) from 1990 to 2017. METHODS These analyses rely on the estimation of HRSDGIs as part of the Global Burden of Disease study 2017. We estimated the concentration index for 40+3 HRSDGI stratified by Socio-demographic Index and marginalisation index, and then for indicators where inequalities were identified, we ran decomposition analyses using structural variables such as gross domestic product per capita, poverty and health expenditure. FINDINGS Mexico has made progress on most HRSDGIs, but current trends in improvement do not appear to fast enough to meet 2030 targets. Out of 43 HRSDGIs, we identified evidence of inequality between Mexico's states for 30 indicators; of those, 23 HRSDGIs were unequal distributed affecting states with lower development and seven affecting states with higher development. The decomposition analysis indicates that social determinants of health are major drivers of HRSDGI inequalities in Mexico. INTERPRETATION Modifying current trends for HRSDGIs will require subnational-level and national-level policy action, of which should be informed by the latest available data and monitoring on the health-related SDGs. The SDGs' overarching objective of leaving no-one behind should be prioritised not only for individuals but also for communities and other subnational levels.
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Affiliation(s)
- Juan Pablo Gutierrez
- Center for Policy, Population & Health Research, Universidad Nacional Autónoma de México, Coyoacan, Mexico
| | - Marcela Agudelo-Botero
- Center for Policy, Population & Health Research, Universidad Nacional Autónoma de México, Coyoacan, Mexico
| | - Sebastian Garcia-Saiso
- Center for Policy, Population & Health Research, Universidad Nacional Autónoma de México, Coyoacan, Mexico
| | - Carolina Zepeda-Tena
- Center for Policy, Population & Health Research, Universidad Nacional Autónoma de México, Coyoacan, Mexico
| | | | | | - Nancy Fullman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Christian Razo
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | | | - Gabriel Martínez
- Departamento Académico de Economía, ITAM, Alvaro Obregon, Mexico
| | | | - Rafael Lozano
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
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17
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Sharafi M, Bahramali E, Farjam M, Rezaeian S, Afrashteh S, Amiri Z. Socioeconomic inequality in noncommunicable diseases: Results from a baseline Persian cohort study. Med J Islam Repub Iran 2021; 35:78. [PMID: 34291002 PMCID: PMC8285560 DOI: 10.47176/mjiri.35.78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Indexed: 11/25/2022] Open
Abstract
Background: Contrary to health indices advancement during recent years, health inequalities are still a global challenge. This study aimed to determine socioeconomic factors for noncommunicable diseases using concentration indices (CI).
Methods: This cross-sectional study was conducted on the baseline data from a cohort study in Fasa (southern Iran). Principle component analysis was used to measure asset index. Moreover, socioeconomic inequalities were calculated by CI. Analysis was done at 95% confidence level using STATA software.
Results: A total of 7990 individuals were included in the study. The highest negative CIs were significantly found for epilepsy (-0.334), paramnesia (-0.255), and learning disabilities (-0.063), respectively, and the lowest were significantly found for chronic headaches (-0.046), recurrent headaches (-0.03), infertility (-0.028) and hypertension (-0.057). This index was positive for breast cancer (0.298). Furthermore, it was not Significant for diabetes, thyroid disorders, depression, and chronic lung diseases.
Conclusion: The findings showed a significant inequality in the most of the noncommunicable diseases in the region, which are more concentrated among the poorest population. Policymakers in the health system and city planners should consider these results to decrease the burden of noncommunicable diseases in the society by identifying vulnerable subcategories.
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Affiliation(s)
- Mehdi Sharafi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ehsan Bahramali
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Mojtaba Farjam
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Shahab Rezaeian
- Infectious Diseases Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.,Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sima Afrashteh
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Amiri
- Hormozgan University of Medical Sciences, Hormozgan, Iran
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18
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Ghiasvand H, Mohamadi E, Olyaeemanesh A, Kiani MM, Armoon B, Takian A. Health equity in Iran: A systematic review. Med J Islam Repub Iran 2021; 35:51. [PMID: 34268239 PMCID: PMC8271272 DOI: 10.47176/mjiri.35.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Indexed: 12/02/2022] Open
Abstract
Background: Health inequities are among debatable and challenging aspects of health systems. Achieving equity through social determinants of health approach has been mentioned in most upstream national plans and acts in Iran. This paper reports the findings of a systematic review of the current synthesized evidence on health equity in Iran.
Methods: This is a narrative systematic review. The relevant concepts and terminology in health equity was found through MeSH. We retrieved the relevant studies from PubMed/MedLine, Social Sciences Database, and Google Scholar in English, plus the Jihad University Database (SID), and Google Scholar in Farsi databases from 1979 until the end of January 2018. The retrieved evidence has been assessed primarily based on PICOS criteria and then Ottawa-Newcastle Scale, and CASP for qualitative studies. We used PRISMA flow diagram and a narrative approach for synthesizing the evidence.
Results: We retrieved 172 455 studies. Following the primary and quality appraisal process, 114 studies were entered in the final phase of the analysis. The main part (approximately 95%) of the final phase included cross-sectional studies that had been analyzed through current descriptive inequality analysis indicators, analytical regression, or decomposition-based approaches. The studies were categorized within 3 main groups: health outcomes (40.3%), health utilization (32%), and health expenditures (27%).
Conclusion: As a part of understanding the current situation of health equity in the policymakers’ need to refer the retrieved evidence in this study, they need more inputs specially regarding the social determinants of health approach. It seems that health equity research plan in Iran needs to be redirected in new paths that give appropriate weights to biological, gene-based, environmental and contextbased, economic, social, and political aspects of health as well. We advocate addressing the aspects of Social Determinant of Health (SDH) in analyzing health inequalities.
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Affiliation(s)
- Hesam Ghiasvand
- Health Economics Group, Medical School, Institute of Health Researches, South Cloister Building, University of Exeter, United Kingdom
| | - Efat Mohamadi
- Health Equity Research Center (HERC), Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Olyaeemanesh
- National Institute of Health Research, Tehran University of Medical Sciences (TUMS), Tehran, Iran.,Department of Management and Health Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mehdi Kiani
- Health Equity Research Center (HERC), Tehran University of Medical Sciences, Tehran, Iran.,Department of Global Health & Public Policy, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahram Armoon
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Amirhossein Takian
- Health Equity Research Center (HERC), Tehran University of Medical Sciences, Tehran, Iran.,Department of Management and Health Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.,Department of Global Health & Public Policy, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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19
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Mehri A, Baigi V, Rahimi D, Nedjat S. Childhood socioeconomic status and adulthood mental health: results from the survey on employees of Tehran University of Medical Sciences. J Public Health (Oxf) 2021; 44:10-17. [PMID: 33611588 DOI: 10.1093/pubmed/fdab004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 11/20/2020] [Accepted: 12/30/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Socioeconomic status, especially during childhood, is known as one of the key factors affecting health. This study's objective was to investigate the association between childhood socioeconomic and mental health status in adulthood. METHODS This cross-sectional study was conducted on 2062 employees of Tehran University of Medical Sciences. Depression, stress and anxiety were measured using the validated DASS-42 questionnaire. A self-rated question was used to assess childhood socioeconomic status. Other variables including age, sex, marital status, and also wealth index, were measured. Linear regression models were used to analyze the data. RESULTS 24.6% of men and 33.8% of women had degrees of depression (mild, moderate, severe or very severe). 32.9% of men and 29.4% of women had mild, moderate, severe or very severe anxiety. 36.3% of men and 45.2% of women also exhibited mild, moderate, severe or very severe stress. Results showed after adjusting for the current socioeconomic status, childhood socioeconomic status has a relationship with the mental health of individuals. CONCLUSION People with a suboptimal childhood socioeconomic status seem to be a high-risk group for depression, stress and anxiety in adulthood. Strategies need to put into practice to improve the mental health of these people.
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Affiliation(s)
- Ahmad Mehri
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Vali Baigi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Danial Rahimi
- Department of Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Saharnaz Nedjat
- Department of Epidemiology and Biostatistics, School of Public Health, Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
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20
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Renna F, Kosteas VD, Dinkar K. Inequality in health insurance coverage before and after the Affordable Care Act. HEALTH ECONOMICS 2021; 30:384-402. [PMID: 33253479 DOI: 10.1002/hec.4195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/20/2020] [Accepted: 10/22/2020] [Indexed: 06/12/2023]
Abstract
This study examines how the Affordable Care Act (ACA) affected income related inequality in health insurance coverage in the United States. Analyzing data from the American Community Survey (ACS) from 2010 through 2018, we apply difference-in-differences, and triple-differences estimation to the Recentered Influence Function OLS estimation. We find that the ACA reduced inequality in health insurance coverage in the United States. Most of this reduction was a result of the Medicaid expansion. Additional decomposition analysis shows there was little change in inequality of coverage through an employer plan, and a decrease in inequality for coverage through direct purchase of health insurance. These results indicate that the insurance exchanges also contributed to declining inequality in health insurance coverage.
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Affiliation(s)
- Francesco Renna
- Department of Economics, Cleveland State University, Cleveland, Ohio, USA
| | - Vasilios D Kosteas
- Department of Economics, Cleveland State University, Cleveland, Ohio, USA
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21
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León-Giraldo S, Casas G, Cuervo-Sánchez JS, González-Uribe C, Olmos A, Kreif N, Suhrcke M, Bernal O, Moreno-Serra R. A light of hope? Inequalities in mental health before and after the peace agreement in Colombia: a decomposition analysis. Int J Equity Health 2021; 20:39. [PMID: 33468165 PMCID: PMC7816354 DOI: 10.1186/s12939-021-01381-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 01/06/2021] [Indexed: 11/21/2022] Open
Abstract
Background The present study seeks to evaluate the change in mental health inequalities in the department of Meta after the signing of Colombia’s Peace Agreement in 2016 with the FARC guerrilla group. Using a validated survey instrument composed of 20 questions (‘SRQ-20’), we measure changes in mental health inequalities from 2014, before the signing of the agreement, to 2018, after the signing. We then decompose the changes in inequalities to establish which socioeconomic factors explain differences in mental health inequalities over time. Methods Our study uses information from the Conflicto, Salud y Paz (CONPAS) survey conducted in the department of Meta, Colombia, in 1309 households in 2018, with retrospective information for 2014. To measure inequalities, we calculate the concentration indices for both years. Through the Oaxaca change decomposition method, we disaggregate changes in mental health inequalities into its underlying factors. This method allows us to explain the relationship between changes in mental health inequalities and changes in inequalities in several sociodemographic factors. It also identifies the extent to which these factors help explain the changes in mental health inequalities. Results Mental health inequalities in Meta were reduced almost by half from 2014 to 2018. In 2018, the population at the lower and middle socioeconomic levels had fewer chances of experiencing mental health disorders in comparison to 2014. The reduction in mental health differences is mostly attributed to reductions in the influence of certain sociodemographic variables, such as residence in rural zones and conflict-affected territories, working in the informal sector, or experiencing internal displacement. However, even though mental health inequalities have diminished, overall mental health outcomes have worsened in these years. Conclusions The reduction in the contribution of conflict-related variables for explaining mental health inequalities could mean that the negative consequences of conflict on mental health have started to diminish in the short run after the peace agreement. Nevertheless, conflict and the presence of other socioeconomic inequalities still contribute to persistent adverse mental health outcomes in the overall population. Thus, public policy should be oriented towards improving mental health care services in these territories, given the post-accord context.
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Affiliation(s)
- Sebastián León-Giraldo
- Alberto Lleras Camargo School of Government, Universidad de los Andes, Bogotá, Colombia.
| | - Germán Casas
- School of Medicine, Universidad de los Andes, Bogotá, Colombia
| | | | | | - Antonio Olmos
- Alberto Lleras Camargo School of Government, Universidad de los Andes, Bogotá, Colombia
| | - Noemi Kreif
- Centre for Health Economics, University of York, York, UK
| | - Marc Suhrcke
- Centre for Health Economics, University of York, York, UK
| | - Oscar Bernal
- Alberto Lleras Camargo School of Government, Universidad de los Andes, Bogotá, Colombia
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22
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Najafi F, Pasdar Y, Karami Matin B, Rezaei S, Kazemi Karyani A, Soltani S, Soofi M, Rezaeian S, Zangeneh A, Moradinazar M, Hamzeh B, Jorjoran Shushtari Z, sajjadipour M, Eslami S, khosrojerdi M, Shabestari S, Mehrparvar AH, Kashi Z, Nejatizadeh A, Naghipour M, Sadeghi Boogar S, Fakhari A, Cheraghian B, Heidari H, Molavi P, Hajizadeh M, Salimi Y. Decomposing socioeconomic inequality in poor mental health among Iranian adult population: results from the PERSIAN cohort study. BMC Psychiatry 2020; 20:229. [PMID: 32404081 PMCID: PMC7218818 DOI: 10.1186/s12888-020-02596-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 04/12/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Socioeconomic inequality in mental health in Iran is poorly understood. This study aimed to assess socioeconomic inequality in poor mental health among Iranian adults. METHODS The study used the baseline data of PERSIAN cohort study including 131,813 participants from 17 geographically distinct areas of Iran. The Erreygers Concentration index (E) was used to quantify the socioeconomic inequalities in poor mental health. Moreover, we decomposed the E to identify factors contributing to the observed socioeconomic inequality in poor mental health in Iran. RESULTS The estimated E for poor mental health was - 0.012 (95% CI: - 0.0144, - 0.0089), indicating slightly higher concentration of mental health problem among socioeconomically disadvantaged adults in Iran. Socioeconomic inequality in poor mental health was mainly explained by gender (19.93%) and age (12.70%). Region, SES itself, and physical activity were other important factors that contributed to the concentration of poor mental health among adults with low socioeconomic status. CONCLUSION There exists nearly equitable distribution in poor mental health among Iranian adults, but with important variations by gender, SES, and geography. These results suggested that interventional programs in Iran should focus on should focus more on socioeconomically disadvantaged people as a whole, with particular attention to the needs of women and those living in more socially disadvantaged regions.
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Affiliation(s)
- Farid Najafi
- grid.412112.50000 0001 2012 5829Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Yahya Pasdar
- grid.412112.50000 0001 2012 5829Nutritional Sciences Department, School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Behzad Karami Matin
- grid.412112.50000 0001 2012 5829Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Satar Rezaei
- grid.412112.50000 0001 2012 5829Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ali Kazemi Karyani
- grid.412112.50000 0001 2012 5829Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shahin Soltani
- grid.412112.50000 0001 2012 5829Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Moslem Soofi
- grid.412112.50000 0001 2012 5829Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shahab Rezaeian
- grid.412112.50000 0001 2012 5829Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Alireza Zangeneh
- grid.412112.50000 0001 2012 5829Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mehdi Moradinazar
- grid.412112.50000 0001 2012 5829Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Behrooz Hamzeh
- grid.412112.50000 0001 2012 5829Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Zahra Jorjoran Shushtari
- grid.472458.80000 0004 0612 774XSocial Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mansour sajjadipour
- grid.411705.60000 0001 0166 0922South Tehran Health Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeid Eslami
- grid.411583.a0000 0001 2198 6209Pharmaceutical Research Center, Pharmaceutical Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam khosrojerdi
- grid.412328.e0000 0004 0610 7204Cellular and molecular research center, school of medicine, Sabzevar university of medical sciences, Sabzevar, Iran
| | - Sahar Shabestari
- grid.488433.00000 0004 0612 8339Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Amir Houshang Mehrparvar
- grid.412505.70000 0004 0612 5912Industrial Diseases Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Zahra Kashi
- grid.411623.30000 0001 2227 0923Diabetes Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Azim Nejatizadeh
- grid.412237.10000 0004 0385 452XMolecular Medicine Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Mohammadreza Naghipour
- grid.411874.f0000 0004 0571 1549Gastrointestinal and liver disease research center, Guilan University of medical sciences, Rasht, Iran
| | - Shahrokh Sadeghi Boogar
- grid.412571.40000 0000 8819 4698Gastroenterohepatology Research Center, Shiraz university of medical sciences, Shiraz, Iran
| | - Ali Fakhari
- grid.412888.f0000 0001 2174 8913Research Center of psychiatry and behavioral sciences, Tabriz University of Medical sciences, Tabriz, Iran
| | - Bahman Cheraghian
- grid.411230.50000 0000 9296 6873Department of Biostatistics and Epidemiology, school of public health, Ahvaz jundishapur university of medical sciences, Ahvaz, Iran
| | - Haydeh Heidari
- grid.440801.90000 0004 0384 8883Modeling in Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Parviz Molavi
- grid.411426.40000 0004 0611 7226Digestive Disease Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Mohammad Hajizadeh
- grid.55602.340000 0004 1936 8200School of Health Administration, Faculty of Health, Dalhousie University, Halifax, Canada
| | - Yahya Salimi
- Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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JieAnNaMu, Xu X, You H, Gu H, Gu J, Li X, Cui N, Kou Y. Inequalities in health-related quality of life and the contribution from socioeconomic status: evidence from Tibet, China. BMC Public Health 2020; 20:630. [PMID: 32375713 PMCID: PMC7203898 DOI: 10.1186/s12889-020-08790-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 04/27/2020] [Indexed: 12/29/2022] Open
Abstract
Background This study aimed to understand the association between socioeconomic status (SES) and Health Related Quality of Life (HRQoL) and the contribution of SES to health inequality among Tibetans of agricultural and pastoral areas (APA) in Tibet, China. Methods The data were from Health Survey of Tibetans in APA conducted in 2014. A total of 816 respondents were enrolled for the analysis Multiple linear regression was employed to examine the relationship between SES and HRQoL. Concentration index (CI) was used to measure the degree of health inequality and a Wagstaff-type CI decomposition method was applied to measure the contribution of SES to inequality. Results SES had significant association with HRQoL among the Tibetans in APA. The high SES group was more likely to have a higher Eq-5d index (0.77 vs. 0.67, P < 0.001) and VAS (72.94 vs. 62.41, P < 0.001) than the low SES group. The Concentration index of the Eq-5d index and VAS for total sample was 0.022 and 0.026 respectively, indicating a slight pro-rich inequality among this population. The decomposition analyses showed the SES is the main contributor to health inequality and contributed 45.50 and 41.39% to inequality for the Eq-5d index and VAS, respectively. Conclusion The results showed SES is positively associated with HRQoL among Tibetans in APA. There was a slight pro-rich inequality in the health of the participants and most health inequality was attributable to SES. This study is helpful in gaining an insight into the HRQoL, health inequality and the relationship between SES and health inequality among Tibetans of APA in China.
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Affiliation(s)
- JieAnNaMu
- Center for Health Policy and Management Studies, Nanjing University, Nanjing, China
| | - Xinpeng Xu
- Center for Health Policy and Management Studies, Nanjing University, Nanjing, China
| | - Hua You
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, China.
| | - Hai Gu
- Center for Health Policy and Management Studies, Nanjing University, Nanjing, China.
| | - Jinghong Gu
- Nanjing Foreign Language School, Nanjing, China
| | - Xiaolu Li
- Department of Otolaryngology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Nan Cui
- Center for Health Policy and Management Studies, Nanjing University, Nanjing, China
| | - Yun Kou
- Center for Health Policy and Management Studies, Nanjing University, Nanjing, China
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Wang J, Zhu H, Liu H, Wu K, Zhang X, Zhao M, Yin H, Qi X, Hao Y, Li Y, Liang L, Jiao M, Xu J, Liu B, Wu Q, Shan L. Can the reform of integrating health insurance reduce inequity in catastrophic health expenditure? Evidence from China. Int J Equity Health 2020; 19:49. [PMID: 32245473 PMCID: PMC7126184 DOI: 10.1186/s12939-020-1145-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 02/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND China's fragmentation of social health insurance schemes has become a key obstacle that hampers equal access to health care and financial protection. This study aims to explores if the policy intervention Urban and Rural Residents Basic Medical Insurance (URRBMI) scheme, which integrates Urban Resident Basic Medical Insurance (URBMI) and New Rural Cooperative Medical Scheme (NCMS), can curb the persistent inequity of catastrophic health expenditure (CHE) and further analyses the determinants causing inequity. METHODS Data were derived from the Fifth National Health Service Survey (NHSS). A total of 11,104 households covered by URRBMI and 20,590 households covered by URBMI or NCMS were selected to analyze CHE and the impoverishment rate from medical expenses. Moreover, the decomposition method based on a probit model was employed to analyse factors contributing CHE inequity. RESULTS The overall incidence of CHE under integrated insurance scheme was 15.53%, about 1.10% higher than the non-integrated scheme; however, the intensity of CHE and impoverishment among the poorest was improved. Although CHE was still concentrated among the poor under URRBMI (CI = -0.53), it showed 28.38% lower in the degree of inequity. For URRBMI households, due to the promotion of integration reform to the utilization of rural residents' better health services, the factor of residence (24.41%) turns out to be a major factor in increasing inequity, the factor of households with hospitalized members (- 84.53%) played a positive role in reducing inequity and factors related to social economic status also contributed significantly in increasing inequity. CONCLUSION The progress made in the integrated URRBMI on CHE equity deserves recognition, even though it did not reduce the overall CHE or the impoverishment rate effectively. Therefore, for enhanced equity, more targeted solutions should be considered, such as promoting more precise insurance intervention for the most vulnerable population and including costly diseases suitable for outpatient treatment into benefit packages. Additionally, comprehensive strategies such as favourable targeted benefit packages or job creation are required for the disadvantaged.
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Affiliation(s)
- Jiahui Wang
- Department of Social Medicine, Health Management College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang Province, China
| | - Hong Zhu
- Department of Social Medicine, Health Management College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang Province, China
| | - Huan Liu
- Department of Social Medicine, Health Management College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang Province, China
| | - Ke Wu
- Tong Zhou District's Volunteer Services Guidance Center of Beijing Municipality, Beijing, China
| | - Xin Zhang
- Department of Social Medicine, Health Management College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang Province, China
| | - Miaomiao Zhao
- Department of Health Management, School of Public Health, Nantong University, Nantong, Jiangsu Province, China
| | - Hang Yin
- Department of Social Medicine, Health Management College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang Province, China
| | - Xinye Qi
- Department of Social Medicine, Health Management College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang Province, China
| | - Yanhua Hao
- Department of Social Medicine, Health Management College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang Province, China
| | - Ye Li
- Department of Social Medicine, Health Management College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang Province, China
| | - Libo Liang
- Department of Social Medicine, Health Management College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang Province, China
| | - Mingli Jiao
- Department of Social Medicine, Health Management College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang Province, China
| | - Jiao Xu
- Department of Social Medicine, Health Management College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang Province, China
| | - Baohua Liu
- Department of Social Medicine, Health Management College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang Province, China
| | - Qunhong Wu
- Department of Social Medicine, Health Management College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang Province, China.
| | - Linghan Shan
- Department of Social Medicine, Health Management College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang Province, China.
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Explaining Income-Related Inequalities in Dietary Knowledge: Evidence from the China Health and Nutrition Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17020532. [PMID: 31952113 PMCID: PMC7013705 DOI: 10.3390/ijerph17020532] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 01/04/2020] [Accepted: 01/09/2020] [Indexed: 11/16/2022]
Abstract
Lack of adequate dietary knowledge may result in poor health conditions. This study aims to measure income-related inequality in dietary knowledge, and to explain the sources of the inequality. Data were from the China Health and Nutrition Survey (CHNS) conducted in 2015. A summary of the dietary knowledge score and dietary guideline awareness was used to measure the dietary knowledge of respondents. The concentration index was employed as a measure of socioeconomic inequality and was decomposed into its determining factors. The study found that the proportion of respondents who correctly answered questions on dietary knowledge was significantly low for some questions. Compared to rural residents, urban residents had a higher proportion of correctly answered dietary knowledge questions. In addition, there are pro-rich inequalities in dietary knowledge. This observed inequality is determined not only by individual factors but also high-level area factors. Our study recommends that future dietary education programs could take different strategies for individuals with different educational levels and focus more on disadvantaged people. It would be beneficial to consider local dietary habits in developing education materials.
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Hashmi R, Alam K, Gow J. Socioeconomic inequalities in mental health in Australia: Explaining life shock exposure. Health Policy 2019; 124:97-105. [PMID: 31718854 DOI: 10.1016/j.healthpol.2019.10.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 10/24/2019] [Accepted: 10/26/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Recent research suggests that there exists a strong link between life shocks and mental health. However, research on the distributional aspects of these shocks on mental health status is limited. In the health inequality literature no Australian studies have examined this relationship. OBJECTIVE This study examines the distributional impact of life shocks (negative life events and financial hardships) on mental health inequality among different socioeconomic groups in a longitudinal setting in Australia. METHODS This study analysed the data of 13,496 individuals from the Household, Income and Labour Dynamics in Australia (HILDA) survey, waves 12-17 (2012-2017). Using concentration index and Blinder-Oaxaca approaches, the study decomposed socioeconomic inequalities in mental health and changes in inequalities in mental health over the study period. The study used frailty indices to capture the severity of life shocks experienced by an individual. RESULTS The results suggest that exposure to just one life shock will result in a greater risk of mental disorder in the most disadvantaged socioeconomic groups. The results also indicate that 24.7%-40.5% of pro-rich socioeconomic mental health inequality are due to life shocks. Financial hardship shocks contributes to 21.6%-35.4% of inequality compared with 2.3%-5.4% inequality generated by negative life event shocks across waves. CONCLUSIONS Lower SES groups experience more life shocks than higher SES groups and in turn generate higher socioeconomic mental health inequality. Policies aimed at reducing socioeconomic inequality in mental health should account for these shocks when designing interventions.
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Affiliation(s)
- Rubayyat Hashmi
- School of Commerce, Faculty of Business, Education, Law & Arts and Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, Queensland, 4350, Australia.
| | - Khorshed Alam
- School of Commerce, Faculty of Business, Education, Law & Arts and Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, Queensland, 4350, Australia.
| | - Jeff Gow
- School of Commerce, Faculty of Business, Education, Law & Arts and Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, Queensland, 4350, Australia; School of Accounting, Economics and Finance, University of KwaZulu-Natal, Durban, 4000, South Africa.
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Almasi-Hashiani A, Abbasi M, Tavakol M, Baigi V, Mohammadi M, Nazari J, Morasae EK, Shadi Y, Taheri M. Decomposing Socioeconomic Inequality in Health Literacy in Iran: A Concentration Index Approach. Int J Prev Med 2019; 10:184. [PMID: 32133102 PMCID: PMC6826687 DOI: 10.4103/ijpvm.ijpvm_565_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 06/02/2019] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Health literacy is a major factor for health promotion and well-being. In spite of several researches on health literacy, information on the subject of the status of health literacy in Asian countries such as Iran is inadequate. Therefore, this study aimed to assess the inequality of health literacy in an Iranian population and its influencing factors. METHODS In this cross-sectional study, 736 families were selected by cluster random sampling. A validated questionnaire was used to measure the health literacy of participants. Socioeconomic status (SES) was calculated by asset-based approach, and principal component analysis (PCA) was performed to estimate the families' SES. Concentration index and curve were used to measure SES inequality in health literacy, and after that decomposed into its determinants. The data were analyzed by Stata software. RESULTS The mean age of the participants was 34.81 years (standard deviation = 5.98 years). The value of concentration index for health literacy equals 0.2292 (95% confidence interval = 0.168-0.283), and this value indicates that there is inequality in distribution of health literacy in Iran and the inequality disfavors the poor. CONCLUSIONS The results of this study revealed that there is inequality in distribution of health literacy in Iran, and people of higher economic status in Iran enjoy from better health literacy levels.
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Affiliation(s)
- Amir Almasi-Hashiani
- Department of Epidemiology, School of Health, Arak University of Medical Sciences, Arak, Iran
| | - Mahmoud Abbasi
- Medical Ethics and Law Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Tavakol
- Sociology Department, School of Social Sciences, University of Tehran, Tehran, Iran
| | - Vali Baigi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehri Mohammadi
- School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Javad Nazari
- School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Esmaeil Khedmati Morasae
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care North West Coast (NIHR CLAHRC NWC), Institute of Psychology, Health, and Society, Department of Health Services Research, University of Liverpool, UK
| | - Yahya Shadi
- Zanjan University of Medical Sciences, Zanjan, Iran
| | - Majid Taheri
- Medical Ethics and Law Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Spatial Modeling of Depression and Its Related Factors Using a Spatial Generalized Linear Mixed Model in Mashhad, Iran: A Cross-Sectional Study. ACTA ACUST UNITED AC 2019. [DOI: 10.5812/semj.87532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Gorabi AM, Heshmat R, Farid M, Motamed-Gorji N, Motlagh ME, Zavareh NHT, Djalalinia S, Sheidaei A, Asayesh H, Madadi Z, Qorbani M, Kelishadi R. Economic Inequality in Life Satisfaction and Self-perceived Health in Iranian Children and Adolescents: The CASPIAN IV Study. Int J Prev Med 2019; 10:70. [PMID: 31198505 PMCID: PMC6547786 DOI: 10.4103/ijpvm.ijpvm_508_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 11/18/2017] [Indexed: 11/15/2022] Open
Abstract
Background: The purpose of this study was to assess socioeconomic status (SES) inequality in life satisfaction (LS) and good self-perceived health (SPH) in Iranian children and adolescents. Methods: This nationwide study was conducted as part of a fourth national school-based surveillance program performed on 14880 students aged 6–18 years who were living in urban and rural areas of 30 provinces of Iran between 2011 and 2012. Using principle component analysis, the SES of participants was constructed as single variable. SES inequality in LS and good SPH across the SES quintiles was assessed using the concentration index (C) and slope index of inequality (SII). The determinants of this inequality are investigated by the Oaxaca Blinder decomposition method. Results: Frequency of LS along with the SES quintiles shifted significantly from 73.28% (95% CI: 71.49, 75.08) in the lowest quintile to 86.57% (95% CI:85.20, 87.93) in the highest SES quintile. Frequency of favorable SPH linearly increased from lowest SES quintile (76.18% (95% CI: 74.45, 77.92)) to highest SES quintile (83.39% (95% CI: 81.89, 84.89)). C index for LS and good SPH was negative, which suggests inequality was in favor of high SES group. SII for LS and SPH was 15.73 (95% CI: 12.10, 19.35) and 8.21 (95% CI: 5.46, 10.96)]. Living area and passive smoking were the most contributed factors in SES inequality of LS. Also passive smoking and physical activity were the most contributed factors in SES inequality of SPH. Conclusions: SES inequality in LS and good SPH was in favor of high SES group. These findings are useful for health policies, better programming and future complementary analyses.
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Affiliation(s)
- Armita Mahdavi Gorabi
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Heshmat
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Malihe Farid
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Nazgol Motamed-Gorji
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Neda Hani-Tabaei Zavareh
- Department of Public Health, Master Candidate in Public Health, Massachusetts College of Pharmacy and Health Sciences, Boston, USA
| | - Shirin Djalalinia
- Development of Research and Technology Center, Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
| | - Ali Sheidaei
- Department of Epidemiology and Biostatistics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Asayesh
- Department of Medical Emergencies, Qom University of Medical Sciences, Qom, Iran
| | - Zahra Madadi
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Qorbani
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.,Department of Epidemiology, Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Roya Kelishadi
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Diseases, Isfahan University of Medical Sciences, Isfahan, Iran
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A Decomposition Analysis of Inequality in Malnutrition among Under-Five Children in Iran: Findings from Multiple Indicator Demographic and Health Survey, 2010. IRANIAN JOURNAL OF PUBLIC HEALTH 2019; 48:748-757. [PMID: 31110986 PMCID: PMC6500533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/30/2022]
Abstract
BACKGROUND Nutritional status at the early stages of children's lives is essential for growth and development not only in infancy but also in adult life. This study aimed to measure the inequality in malnutrition among under-five children in Iran and explore the impact of socioeconomic factors on this inequality using a regression-based decomposition approach. METHODS Data were extracted from Iran's Multiple-Indicator Demographic and Health Survey 2010. The concentration index of stunting, underweight, and wasting were applied in order to measure the magnitude of socioeconomic inequality in child malnutrition. Moreover, the concentration indices were decomposed to understand the contribution of socioeconomic variables in childhood malnutrition inequality. RESULTS The obtained concentration indices of stunting, underweight, and wasting were respectively -0.177, -0.092, and -0.031. Socioeconomic inequality in stunting and underweight was statistically significant, however this socioeconomic gradient was not observed in wasting. More than 50% of the inequality in stunting and about 63% of the inequality in underweight were influenced by socioeconomic status. Furthermore, maternal education was associated with 19% and 22% of inequality in stunting and underweight respectively. CONCLUSION The average reduction of malnutrition indices at the national level hides the burden of malnutrition among children in poor families. If government and policymakers seek to solve this problem, they have to take direct and targeted actions to eliminate the existing inequalities in the socioeconomic determinants associated with malnutrition.
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Witthayapipopsakul W, Cetthakrikul N, Suphanchaimat R, Noree T, Sawaengdee K. Equity of health workforce distribution in Thailand: an implication of concentration index. Risk Manag Healthc Policy 2019; 12:13-22. [PMID: 30787643 PMCID: PMC6368115 DOI: 10.2147/rmhp.s181174] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Geographical maldistribution has been a critical concern of health workforce planning in Thailand for years. This study aimed to assess the equity of health workforce distribution in public hospitals affiliated to the Office of Permanent Secretary (OPS) of the Ministry of Public Health (MOPH) through the application of “concentration index” (CI). Methods A cross sectional quantitative design was employed. The dataset comprised 1) health workforce data from the OPS, MOPH in 2016, 2) regional and provincial-level economic data from the National Economic and Social Development Board in 2015, and 3) population data from the Ministry of Interior in 2015. Descriptive statistics, Spearman’s rank correlation, and CI analysis were performed. Results Thailand had 2.04 health professionals working in public facilities per 1,000 population. Spearman’s correlation found positive relationship in all health professionals. Yet, statistical significance was not found in most health professionals but doctors (P<0.001). Positive correlation was observed in all health cadres at regional and provincial hospitals (rs=0.348, P=0.002). In the CI analysis, the distribution of health professionals across provincial income was relatively equitable in all cadres. Significant CIs were found in doctor density (CI =0.055, P=0.001), all professionals density at district hospitals (CI =–0.049, P=0.012), and all professionals density at provincial and regional hospitals (CI =0.078, P=0.003). Conclusion The positive CIs implied that the distribution of all health professionals, especially doctors, at provincial and regional hospitals slightly favored the richer provinces. In contrast, the distribution at district hospitals was slightly more concentrated in less well-off provinces. From a macro-view, the distribution of all health professionals in Thailand was relatively equitable across provincial economic status. This might be due to the extensive health infrastructure development and rural retention policies over the past four decades.
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Affiliation(s)
- Woranan Witthayapipopsakul
- Health Financing Node, International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand, ;
| | - Nisachol Cetthakrikul
- Health Promotion Policy Research Centre, International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Rapeepong Suphanchaimat
- Non-Thai population research unit, International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand.,Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Thinakorn Noree
- Human Resources for Health Development Office, International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Krisada Sawaengdee
- Human Resources for Health Development Office, International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand
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Measurement components of socioeconomic status in health-related studies in Iran. BMC Res Notes 2019; 12:70. [PMID: 30704521 PMCID: PMC6357485 DOI: 10.1186/s13104-019-4101-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 01/19/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The socioeconomic status (SES) is as a symbol of social determinants of health which has a dominant influence on population health. The purpose of this study was collecting, weighing, and determining the most relevant SES measurement items in Iran. RESULTS The SES health studies conducted in Iran was searched from 2007 to 2017. First, the SES items were categorized. Then, each item was weighed based on its reliability and generalizability. Finally, the necessity of items was determined, weighed, and ranked. This is the two-round Delphi technique. After weighing 57 SES items, 37 items were selected with ≥ 1 weight and classified in 7 categories. According to the Delphi evaluation, 15 items were identified ≥ 3.5 for measuring SES of Iranian households: household size, head of household education, head of household job, household monthly income, type of school that children attend, house ownership, local value of residence, number of rooms in the house, house area, personal computer/laptop, smart cell phone, 3D TV, dishwasher, microwave, and car ownership. The SES items for the present society are categorized in 7 domains. The items collected in this study have the most comprehension of all studies related to income, life facilities, and assets.
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Harouni GG, Mahdavi MRV, Naghdi S, Armoon B, Fazaeli AA, Ghiasvand H, Noroozi M, Ahounbar E. Decomposing disparity in adult individual's mental health in Tehran among lower and higher economic groups; an Oaxaca- Blinder analysis on urban HEART Survey- round 2. Afr Health Sci 2018; 18:1018-1026. [PMID: 30766568 PMCID: PMC6354884 DOI: 10.4314/ahs.v18i4.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Mental health is one of the main aspects of social well-being. Tehran -capital of Iran- is metropolitan, where the mental health status of citizens is not prioritized effectively. OBJECTIVES The purpose of this study was identifying contributors of mental health inequality between lower and higher economic groups in Tehran through Oaxaca- Blinder method. METHODS The study was conducted by the data of Tehran's Urban Heart Survey- Round 2 (2012). Through a three- stage stratified and clustered sampling method, 34,700 were selected as samples. The mental health status was measured by the General Health Questionnaire 28- items (GHQ- 28) and the quantity of the inequality in mental health was measured by corrected concentration index. The Fairlie's decomposition approach was performed in STATA 14. RESULTS The corrected concentration index were: -0.0967 and -0.1004 by Erreyger's and Wagstaff 's approaches. Being of the Iranian origin, disability conditions, employment status and smoking were identified as the main contributors of inequality in mental health among lower and higher economic groups. CONCLUSION Thus, re-organizing strategies and plans on promoting the socio- economic status of non-Iranian residents, improving employment opportunities, developing well-designed environment for disabled individuals and supporting plans to reduce smoking is recommended to the urban policy makers.
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Affiliation(s)
| | - Mohammad Reza Vaez Mahdavi
- Department of Physiology, School of Medicine, Shahed University, Tehran, Iran
- Health Equity Research Center, Shahed University, Tehran, Iran
| | - Seyran Naghdi
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Bahram Armoon
- Assistant Professor of Health Education and Promotion, School of Nursing and Midwifery, Saveh University of Medical Sciences, Saveh, Iran
- Assistant Professor of Health Education and Promotion, Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Ali Akbar Fazaeli
- Social Determinants of Health Research Center, Department of Health Management and Economic, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Hesam Ghiasvand
- Social Determinants of Health Research Center, University of Social Welfare & Rehabilitation Sciences, Tehran, Iran
| | - Mehdi Noroozi
- Social Determinants of Health Research Center, University of Social Welfare & Rehabilitation Sciences, Tehran, Iran
| | - Elaheh Ahounbar
- Substance Use and Dependence Research Center, University of Social Welfare& Rehabilitation Sciences, Tehran, Iran
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Rarani MA, Shadi Y, Rashedi V, Morasae EK. What has Iran achieved in under-five mortality in terms of equity and efficiency in the past decades? Public Health 2018; 166:128-139. [PMID: 30481724 DOI: 10.1016/j.puhe.2018.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 09/26/2018] [Accepted: 10/03/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Iran has made remarkable progress in reducing child mortality over the past few decades. However, this promising profile is mainly average driven, and inequalities are not counted in judgments about the progress. In the present study, we used an achievement index approach to combine average and inequalities to provide a better picture of Iran's achievement in under-five mortality over the last two decades. STUDY DESIGN The study had a cross-sectional design. METHODS Data gathered in the two recent national demographic health surveys (DHSs) in 2000 and 2010 were used to conduct the analyses. Accordingly, 45,646 live births covered by DHS 2000 and 10,604 live births covered by DHS 2010 were investigated. An achievement index was constructed by incorporating some extensions to the concentration index, namely by incorporation of the average into the index. RESULTS The standard concentration index showed that under-five mortality was unequally distributed, hurting the poor, across all provinces and Iran overall in 2000 (concentration index = -0.1311 [standard error {SE} = 0.0139]) and 2010 (-0.1367 [SE = 0.0381]). The achievement index revealed that Iran has had achievements in under-five mortality (relative change in the mean has decreased from 29.5% to 25.8%), but the achievement was mostly due to reductions in the average mortality and not in its unequal distribution. The same result applied to a considerable number of provinces, and only a few have made achievements in both inequality and average. CONCLUSIONS Considering the lack of progress in the reduction of inequalities in under-five mortality over the past decades, equity-oriented policies should be of prime importance for Iran's healthcare system.
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Affiliation(s)
- M A Rarani
- Health Management and Economics Research Centre, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Y Shadi
- School of Public Health, Zanjan University of Medical Sciences and Health Services, Zanjan, Iran
| | - V Rashedi
- School of Behavioural Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran; Iranian Research Centre on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - E K Morasae
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care, North West Coast (NIHR CLAHRC NWC), Institute of Psychology, Health and Society, Health Services Research Department, University of Liverpool, UK.
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Ranjbar Ezzatabadi M, Khosravi A, Bahrami MA, Rafiei S. Socio-economic inequalities in health services utilization: a cross-sectional study. Int J Health Care Qual Assur 2018; 31:69-75. [PMID: 29504844 DOI: 10.1108/ijhcqa-04-2017-0059] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose Developing country workers mainly face important challenges when examining equality in health services utilization among the population and identifying influential factors. The purpose of this paper us to: understand health service use among households with different socio-economic status in Isfahan province; and to investigate probable inequality determinants in service utilization. Design/methodology/approach Almost 1,040 households living in Isfahan province participated in this cross-sectional study in 2013. Data were collected by a questionnaire with three sections: demographic characteristics; socio-economic status; and health services utilization. The concentration index was applied to measure inequality. Analysts used STATA 11. Findings Economic status, educational level, insurance coverage and household gender were the most influential factors on health services utilization. Those with a high socio-economic level were more likely to demand and use such services; although self-medication patterns showed an opposite trend. Practical implications Female-headed families face with more difficulties in access to basic human needs including health. Supportive policies are needed to meet their demands. Originality/value The authors used principle component analysis to assess households' economic situation, which reduced the variables into a single index.
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Affiliation(s)
- Mohammad Ranjbar Ezzatabadi
- Health Policy Research Center, Shahid Sadoughi University of Medical Sciences and Health Services , Yazd, Iran
| | - Ameneh Khosravi
- School of Health, Shahid Sadoughi University of Medical Sciences and Health Services , Yazd, Iran
| | | | - Sima Rafiei
- Faculty of Health, Qazvin University of Medical Sciences , Qazvin, Iran
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Amroussia N, Gustafsson PE, Mosquera PA. Explaining mental health inequalities in Northern Sweden: a decomposition analysis. Glob Health Action 2018; 10:1305814. [PMID: 28562191 PMCID: PMC5496092 DOI: 10.1080/16549716.2017.1305814] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background: There has been a substantial increase of income inequalities in Sweden over the last 20 years, which also could be reflected in health inequalities, including mental health inequalities. Despite the growing body of literature focusing on health inequalities in Sweden, income-related inequalities in mental health have received little attention. Particularly scarce are research from Northern Sweden and examinations of the social determinants of health inequalities. Objectives: The present study seeks to provide evidence regarding inequalities in mental health in Northern Sweden. The specific aims were to (1) quantify the income-related inequality in mental health in Northern Sweden, and (2) determine the contribution of social determinants to the inequality. Methods: The study population comprised 25,646 participants of the 2014 Health on Equal Terms survey in the four northernmost counties of Sweden, aged 16 to 84 years old. Income-related inequalities in mental health were quantified by the concentration index and further decomposed by applying Wagstaff-type decomposition analysis. Results: The overall concentration index of mental health in Northern Sweden was −0.15 (95% CI: −0.17 to −0.13), indicating income inequalities in mental health disfavoring the less affluent population. The decomposition analysis results revealed that socio-economic conditions, including employment status (31%), income (22.6%), and cash margin (14%), made the largest contribution to the pro-rich inequalities in mental health. The second-largest contribution came from demographic factors, mainly age (11.3%) and gender (6%). Psychosocial factors were of smaller importance, with perceived discrimination (8%) and emotional support (3.4%) making moderate contributions to the health inequalities. Conclusions: The present study demonstrates substantial income-related mental health inequalities in Northern Sweden, and provides insights into their underpinnings. These findings suggest that addressing the root causes is essential for promoting mental health equity in this region.
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Affiliation(s)
- Nada Amroussia
- a Epidemiology and Global Health, Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden
| | - Per E Gustafsson
- a Epidemiology and Global Health, Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden
| | - Paola A Mosquera
- a Epidemiology and Global Health, Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden
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Mansouri A, Emamian MH, Zeraati H, Hashemi H, Fotouhi A. Economic Inequality in Presenting Vision in Shahroud, Iran: Two Decomposition Methods. Int J Health Policy Manag 2018; 7:59-69. [PMID: 29325403 PMCID: PMC5745868 DOI: 10.15171/ijhpm.2017.48] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 04/12/2017] [Indexed: 11/18/2022] Open
Abstract
Background: Visual acuity, like many other health-related problems, does not have an equal distribution in terms of socio-economic factors. We conducted this study to estimate and decompose economic inequality in presenting visual acuity using two methods and to compare their results in a population aged 40-64 years in Shahroud, Iran.
Methods: The data of 5188 participants in the first phase of the Shahroud Cohort Eye Study, performed in 2009, were used for this study. Our outcome variable was presenting vision acuity (PVA) that was measured using LogMAR (logarithm of the minimum angle of resolution). The living standard variable used for estimation of inequality was the economic status and was constructed by principal component analysis on home assets. Inequality indices were concentration index and the gap between low and high economic groups. We decomposed these indices by the concentration index and BlinderOaxaca decomposition approaches respectively and compared the results.
Results: The concentration index of PVA was -0.245 (95% CI: -0.278, -0.212). The PVA gap between groups with a high and low economic status was 0.0705 and was in favor of the high economic group. Education, economic status, and age were the most important contributors of inequality in both concentration index and Blinder-Oaxaca decomposition. Percent contribution of these three factors in the concentration index and Blinder-Oaxaca decomposition was 41.1% vs. 43.4%, 25.4% vs. 19.1% and 15.2% vs. 16.2%, respectively. Other factors including gender, marital status, employment status and diabetes had minor contributions.
Conclusion: This study showed that individuals with poorer visual acuity were more concentrated among people with a lower economic status. The main contributors of this inequality were similar in concentration index and Blinder-Oaxaca decomposition. So, it can be concluded that setting appropriate interventions to promote the literacy and income level in people with low economic status, formulating policies to address economic problems in the elderly, and paying more attention to their vision problems can help to alleviate economic inequality in visual acuity.
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Affiliation(s)
- Asieh Mansouri
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hassan Emamian
- Ophthalmic Epidemiology Research Center, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Hojjat Zeraati
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Hasan Hashemi
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | - Akbar Fotouhi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Adesanya A. O, Rojas BM, Darboe A, Beogo I. Socioeconomic differential in self-assessment of health and happiness in 5 African countries: Finding from World Value Survey. PLoS One 2017; 12:e0188281. [PMID: 29176854 PMCID: PMC5703504 DOI: 10.1371/journal.pone.0188281] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 11/03/2017] [Indexed: 11/18/2022] Open
Abstract
Objective Factors that contribute to wealth related inequalities in self-rated health (SRH) and happiness remains unclear most especially in sub-Saharan countries (SSA). This study aims to explore and compare socioeconomic differentials in SRH and happiness in five SSA countries. Methods Using the 2010/2014 World Values Survey (WVS), we obtained a sample of 9,869 participants of age 16 and above from five SSA countries (Nigeria, Ghana, South Africa, Rwanda and Zimbabwe). Socioeconomic inequalities were quantified using the concentration index. The contribution of each predictor to concentration index’s magnitude was obtained by means of regression based decomposition analysis. Results Poor SRH ranges from approximately 9% in Nigeria to 20% in Zimbabwe, whereas unhappiness was lower in Rwanda (9.5%) and higher in South Africa (23.3%). Concentration index was negative for both outcomes in all countries, which implies that poor SRH and unhappiness are excessively concentrated among the poorest socioeconomic strata. Although magnitudes differ across countries, however, the major contributor to wealth-related inequality in poor SRH is satisfaction with financial situation whereas for unhappiness the major contributors are level of income and satisfaction with financial situation. Conclusions This study underscores an association between wealth related inequalities and poor SRH and unhappiness in the context of SSA. Improving equity in health, as suggested by the commission of social determinants of health may be useful in fighting against the unfair distribution of resources. Thus, knowledge about the self-rating of health and happiness can serve as proxy estimates for understanding the distribution of health care access and economic resources needed for well-being in resident countries.
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Affiliation(s)
| | - Bomar Mendez Rojas
- International Health Program, National Yang Ming University, Taipei, Taiwan
| | - Amadou Darboe
- Ministry of Health and Social Welfare, Banjul, The Gambia
- School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- * E-mail:
| | - Idrissa Beogo
- École Nationale de Santé Publique, Ouagadougou, Burkina Faso
- Université Laval, rue de l'Université, Québec (Québec), Canada
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Adesanya OA, Darboe A, Mendez Rojas B, Abiodun DE, Beogo I. Factors contributing to regional inequalities in acute respiratory infections symptoms among under-five children in Nigeria: a decomposition analysis. Int J Equity Health 2017; 16:140. [PMID: 28784132 PMCID: PMC5545834 DOI: 10.1186/s12939-017-0626-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 07/12/2017] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Acute respiratory infections (ARI) are major causes of morbidity and mortality in many low-income countries. Although factors associated with ARI symptoms in children under 5 years of age have been identified; however, variation in their prevalence resulting from regional-specific proximate determinants has received little attention. Therefore, we aim to investigate the specific regional determinants of overall and wealth-related inequality in children having ARI in Nigeria over a decade. METHODS We analyzed trends in development of ARI symptoms among children under 5 years of age in Nigeria using nationally representative cross sectional surveys carried out in 2003, 2008 and 2013. Overall- and household wealth index based- inequality in the distribution of prevalence of ARI symptoms were estimated by region using Gini index and Concentration Index, respectively. Multivariate logistic regressions for complex survey and decomposition analysis for both indexes were used to calculate percentual contribution. RESULTS We found a decreasing trend in development of ARI symptoms over the decade between regions. Children in South Western region had reduced likelihood of developing the symptoms. Concentration index (CI) for the prevalence of ARI symptoms over the years and across regions had negative values (all p < 0.05). Gini index (GI) varies from 0.21 in North East to 0.62 in South Western region. Furthermore, the mapping showed that the extent at which both inequalities contribute to ARI symptoms prevalence in each region is different. The four major sources of wealth-related inequalities were poor households, no maternal education, biomass cooking, and rural area. The major contributors to overall inequalities were having a child aged 6 to 23 months, having no maternal education, having no vaccination card, and having a high birth order/short birth interval. CONCLUSIONS Although ARI prevalence decreased over the decade, it has remained unequally distributed between regions and over the time. The sources of those inequalities are context sensitive. Thus, in future health promotion initiatives, it is imperative to account for regional variations in the distribution of ARI.
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Affiliation(s)
- Oluwafunmilade A. Adesanya
- International College of Medicine, Institute of Public Health, International Health Program, National Yang Ming University, Taipei, Taiwan, Republic of China
| | | | - Bomar Mendez Rojas
- International College of Medicine, Institute of Public Health, International Health Program, National Yang Ming University, Taipei, Taiwan, Republic of China
- Centro de Investigaciones e Intervenciones en Salud, León, Nicaragua
| | - Deji Emmanuel Abiodun
- Business School, Department of Management, University of South Wales, Pontypridd, UK
| | - Idrissa Beogo
- École Nationale de Santé Publique, Ouagadougou, Burkina Faso
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Kunna R, San Sebastian M, Stewart Williams J. Measurement and decomposition of socioeconomic inequality in single and multimorbidity in older adults in China and Ghana: results from the WHO study on global AGEing and adult health (SAGE). Int J Equity Health 2017; 16:79. [PMID: 28506233 PMCID: PMC5433064 DOI: 10.1186/s12939-017-0578-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 05/08/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Globally people are living longer and enduring non-communicable diseases (NCDs) many of which co-occur as multimorbidity. Demographic and socioeconomic factors are determinants of inequalities and inequities in health. There is a need for country-specific evidence of NCD inequalities in developing countries where populations are ageing rapidly amid economic and social change. The study measures and decomposes socioeconomic inequality in single and multiple NCD morbidity in adults aged 50 and over in China and Ghana. METHODS The data source is the World Health Organization Study on Global AGEing and Adult Health (SAGE) Wave 1 (2007-2010). Nationally representative cross-sectional data collected from adults in China (n = 11,814) and Ghana (n = 4,050) are analysed. Country populations are ranked by a socioeconomic index based on ownership of household assets. The study uses a decomposed concentration index (CI) of single and multiple NCD morbidity (multimorbidity) covering arthritis, diabetes, angina, stroke, asthma, depression, chronic lung disease and hypertension. The CI quantifies the extent of overall inequality on each morbidity measure. The decomposition utilises a regression-based approach to examine individual contributions of demographic and socioeconomic factors, or determinants, to the overall inequality. RESULTS In China, the prevalence of single and multiple NCD morbidity was 64.7% and 53.4%, compared with 65.9% and 55.5% respectively in Ghana. Inequalities were significant and more highly concentrated among the poor in China (single morbidity CI = -0.0365: 95% CI = -0.0689,-0.0040; multimorbidity CI = -0.0801: 95% CI = -0.1233,-0.0368;). In Ghana inequalities were significant and more highly concentrated among the rich (single morbidity CI = 0.1182; 95% CI = 0.0697, 0.1668; multimorbidity CI = 0.1453: 95% CI = 0.0794, 0.2083). In China, rural residence contributed most to inequality in single morbidity (36.4%) and the wealth quintiles contributed most to inequality in multimorbidity (39.0%). In Ghana, the wealth quintiles contributed 24.5% to inequality in single morbidity and body mass index contributed 16.2% to the inequality in multimorbidity. CONCLUSIONS The country comparison reflects different stages of economic development and social change in China and Ghana. More studies of this type are needed to inform policy-makers about the patterning of socioeconomic inequalities in health, particularly in developing countries undergoing rapid epidemiological and demographic transitions.
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Affiliation(s)
- Rasha Kunna
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, SE-901 87 Umeå, Sweden
| | - Miguel San Sebastian
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, SE-901 87 Umeå, Sweden
| | - Jennifer Stewart Williams
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, SE-901 87 Umeå, Sweden
- Research Centre for Generational Health and Ageing Faculty of Health, University of Newcastle, New Lambton Heights, NSW 2305 Australia
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Amini Rarani M, Rashidian A, Khosravi A, Arab M, Abbasian E, Khedmati Morasae E. Changes in Socio-Economic Inequality in Neonatal Mortality in Iran Between 1995-2000 and 2005-2010: An Oaxaca Decomposition Analysis. Int J Health Policy Manag 2017; 6:219-218. [PMID: 28812805 PMCID: PMC5384984 DOI: 10.15171/ijhpm.2016.127] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 09/17/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Exploring changes in health inequality and its determinants over time is of policy interest. Accordingly, this study aimed to decompose inequality in neonatal mortality into its contributing factors and then explore changes from 1995-2000 to 2005-2010 in Iran. METHODS Required data were drawn from two Iran's demographic and health survey (DHS) conducted in 2000 and 2010. Normalized concentration index (CI) was used to measure the magnitude of inequality in neonatal mortality. The contribution of various determinants to inequality was estimated by decomposing concentration indices in 1995-2000 and 2005-2010. Finally, changes in inequality were investigated using Oaxaca-type decomposition technique. RESULTS Pro-rich inequality in neonatal mortality was declined by 16%, ie, the normalized CI dropped from -0.1490 in 1995-2000 to -0.1254 in 2005-2010. The largest contribution to inequality was attributable to mother's education (32%) and household's economic status (49%) in 1995-2000 and 2005-2010, respectively. Changes in mother's educational level (121%), use of skilled birth attendants (79%), mother's age at the delivery time (25-34 years old) (54%) and using modern contraceptive (29%) were mainly accountable for the decrease in inequality in neonatal mortality. CONCLUSION Policy actions on improving households' economic status and maternal education, especially in rural areas, may have led to the reduction in neonatal mortality inequality in Iran.
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Affiliation(s)
- Mostafa Amini Rarani
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Arash Rashidian
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ardeshir Khosravi
- Deputy of Public Health, Ministry of Health and Medical Education, Tehran, Iran
| | - Mohammad Arab
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Esmaeil Khedmati Morasae
- Department of Public Health, Qom University of Medical Sciences, Qom, Iran
- Centre for System Studies (CSS), Hull University Business School (HUBS), Hull York Medical School (HYMS), University of Hull, Hull, UK
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AHMADI DOULABI M, SAJEDI F, VAMEGHI R, MAZAHERI MA, AKBARZADEH BAGHBAN A. Socioeconomic Status Index to Interpret Inequalities in Child Development. IRANIAN JOURNAL OF CHILD NEUROLOGY 2017; 11:13-25. [PMID: 28698723 PMCID: PMC5493825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE There have been contradictory findings on the relationship between Socioeconomic Status (SES) and child development although SES is associated with child development outcomes. The present study intended to define the relationship between SES and child development in Tehran kindergartens, Iran. MATERIALS & METHODS This cross-sectional survey studied 1036 children aged 36-60 month, in different kindergartens in Tehran City, Iran, in 2014-2015. The principal factor analysis (PFA) model was employed to construct SES indices. The constructed SES variable was employed as an independent variable in logistic regression model to evaluate its role in developmental delay as a dependent variable. RESULTS The relationship between SES and developmental delay was significant at P=0.003. SES proved to have a significant (P<0.05) impact on developmental delay, both as an independent variable and after controlling risk factors. CONCLUSION There should be more emphasis on developmental monitoring and appropriate intervention programs for children to give them higher chance of having a more productive life.
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Affiliation(s)
- Mahbobeh AHMADI DOULABI
- PhD Candidate of Pediatric, Neurorehabilitation Research Center, University of Social Welfare & Rehabilitation Sciences, Tehran, Iran
| | - Firoozeh SAJEDI
- Pediatric Department, Pediatric Neurorehabilitation Research Center, University of Social Welfare & Rehabilitation Sciences, Tehran, Iran
| | - Roshanak VAMEGHI
- Pediatric Department, Pediatric Neurorehabilitation Research Center, University of Social Welfare & Rehabilitation Sciences, Tehran, Iran
| | | | - Alireza AKBARZADEH BAGHBAN
- PhD in Biostatistics, Proteomics Research Center, Department of Basic Sciences,School of Rehabilitation Sciences,Shahid Beheshti University of Medical Sciences,Tehran, Iran
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Christiani Y, Tavener M, Byles JE. Contextualizing urban living as a determinant of women's health in Jakarta, Indonesia. Women Health 2016; 57:1204-1220. [PMID: 27880091 DOI: 10.1080/03630242.2016.1263271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Big cities can offer great opportunities for women to have a better life. At the same time, however, the physical and social environment in cities can negatively affect their health. We conducted focus groups with 24 women (aged 18-72 years) living in Jakarta, Indonesia from October to November 2014. Our aim was to elicit women's experiences of living in Jakarta, including their health and accessing health care. The most frequent health problems reported by women in this study were hypertension and arthritis. Women often gave priority to their family, particularly their children, over themselves and their own health. Discussants also thought that the city's physical and social conditions could affect their health, and that women were more prone to feel stress than men. The results of this study highlight the importance of addressing social determinants of health across the life course, including gender, to improve women's health status. Moreover, multi-sectoral collaboration at the municipal and national level is needed for urban planning to create better living conditions for women in the cities.
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Affiliation(s)
- Yodi Christiani
- a Priority Research Centre for Gender, Health and Ageing, Hunter Medical Research Institute , University of Newcastle , New Lambton Heights , New South Wales , Australia
| | - Meredith Tavener
- a Priority Research Centre for Gender, Health and Ageing, Hunter Medical Research Institute , University of Newcastle , New Lambton Heights , New South Wales , Australia
| | - Julie E Byles
- a Priority Research Centre for Gender, Health and Ageing, Hunter Medical Research Institute , University of Newcastle , New Lambton Heights , New South Wales , Australia
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Gustafsson PE, Sebastián MS, Mosquera PA. Meddling with middle modalities: a decomposition approach to mental health inequalities between intersectional gender and economic middle groups in northern Sweden. Glob Health Action 2016; 9:32819. [PMID: 27887668 PMCID: PMC5124119 DOI: 10.3402/gha.v9.32819] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 10/27/2016] [Accepted: 10/31/2016] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Intersectionality has received increased interest within population health research in recent years, as a concept and framework to understand entangled dimensions of health inequalities, such as gender and socioeconomic inequalities in health. However, little attention has been paid to the intersectional middle groups, referring to those occupying positions of mixed advantage and disadvantage. OBJECTIVE This article aimed to 1) examine mental health inequalities between intersectional groups reflecting structural positions of gender and economic affluence and 2) decompose any observed health inequalities, among middle groups, into contributions from experiences and conditions representing processes of privilege and oppression. DESIGN Participants (N=25,585) came from the cross-sectional 'Health on Equal Terms' survey covering 16- to 84-year-olds in the four northernmost counties of Sweden. Six intersectional positions were constructed from gender (woman vs. men) and tertiles (low vs. medium vs. high) of disposable income. Mental health was measured through the General Health Questionnaire-12. Explanatory variables covered areas of material conditions, job relations, violence, domestic burden, and healthcare contacts. Analysis of variance (Aim 1) and Blinder-Oaxaca decomposition analysis (Aim 2) were used. RESULTS Significant mental health inequalities were found between dominant (high-income women and middle-income men) and subordinate (middle-income women and low-income men) middle groups. The health inequalities between adjacent middle groups were mostly explained by violence (mid-income women vs. men comparison); material conditions (mid- vs. low-income men comparison); and material needs, job relations, and unmet medical needs (high- vs. mid-income women comparison). CONCLUSIONS The study suggests complex processes whereby dominant middle groups in the intersectional space of economic affluence and gender can leverage strategic resources to gain mental health advantage relative to subordinate middle groups.
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Affiliation(s)
- Per E Gustafsson
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden;
| | - Miguel San Sebastián
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Paola A Mosquera
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Bohra T, Benmarhnia T, McKinnon B, Kaufman JS. Decomposing Educational Inequalities in Child Mortality: A Temporal Trend Analysis of Access to Water and Sanitation in Peru. Am J Trop Med Hyg 2016; 96:57-64. [PMID: 27821698 DOI: 10.4269/ajtmh.15-0745] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 09/23/2016] [Indexed: 11/07/2022] Open
Abstract
Previous studies of inequality in health and mortality have largely focused on income-based inequality. Maternal education plays an important role in determining access to water and sanitation, and inequalities in child mortality arising due to differential access, especially in low- and middle-income countries such as Peru. This article aims to explain education-related inequalities in child mortality in Peru using a regression-based decomposition of the concentration index of child mortality. The analysis combines a concentration index created along a cumulative distribution of the Demographic and Health Surveys sample ranked according to maternal education, and decomposition measures the contribution of water and sanitation to educational inequalities in child mortality. We observed a large education-related inequality in child mortality and access to water and sanitation. There is a need for programs and policies in child health to focus on ensuring equity and to consider the educational stratification of the population to target the most disadvantaged segments of the population.
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Affiliation(s)
- Tasneem Bohra
- Master of Public Health, School of Public Health, Ecole des Hautes Études en Santé Publique (EHESP), Rennes, France
| | - Tarik Benmarhnia
- Institute for Health and Social Policy, McGill University, Montreal, Canada.
| | - Britt McKinnon
- Institute for Health and Social Policy, McGill University, Montreal, Canada
| | - Jay S Kaufman
- Institute for Health and Social Policy, McGill University, Montreal, Canada.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
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Kim SW, Skordis-Worrall J, Haghparast-Bidgoli H, Pulkki-Brännström AM. Socio-economic inequity in HIV testing in Malawi. Glob Health Action 2016; 9:31730. [PMID: 27790970 PMCID: PMC5084389 DOI: 10.3402/gha.v9.31730] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 09/29/2016] [Accepted: 09/29/2016] [Indexed: 12/05/2022] Open
Abstract
Background Human immunodeficiency virus (HIV) is a significant contributor to Malawi's burden of disease. Despite a number of studies describing socio-economic differences in HIV prevalence, there is a paucity of evidence on socio-economic inequity in HIV testing in Malawi. Objective To assess horizontal inequity (HI) in HIV testing in Malawi. Design Data from the Demographic and Health Surveys (DHSs) 2004 and 2010 in Malawi are used for the analysis. The sample size for DHS 2004 was 14,571 (women =11,362 and men=3,209), and for DHS 2010 it was 29,830 (women=22,716 and men=7,114). The concentration index is used to quantify the amount of socio-economic-related inequality in HIV testing. The inequality is a primary method in this study. Corrected need, a further adjustment of the standard decomposition index, was calculated. Standard HI was compared with corrected need-adjusted inequity. Variables used to measure health need include symptoms of sexually transmitted infections. Non-need variables include wealth, education, literacy and marital status. Results Between 2004 and 2010, the proportion of the population ever tested for HIV increased from 15 to 75% among women and from 16 to 54% among men. The need for HIV testing among men was concentrated among the relatively wealthy in 2004, but the need was more equitably distributed in 2010. Standard HI was 0.152 in 2004 and 0.008 in 2010 among women, and 0.186 in 2004 and 0.04 in 2010 among men. Rural–urban inequity also fell in this period, but HIV testing remained pro-rich among rural men (HI 0.041). The main social contributors to inequity in HIV testing were wealth in 2004 and education in 2010. Conclusions Inequity in HIV testing in Malawi decreased between 2004 and 2010. This may be due to the increased support to HIV testing by global donors over this period.
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Affiliation(s)
- Sung Wook Kim
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom.,UCL Institute for Global Health, UCL, London, United Kingdom;
| | | | | | - Anni-Maria Pulkki-Brännström
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Heshmat R, Qorbani M, Ghoreshi B, Djalalinia S, Tabatabaie OR, Safiri S, Noroozi M, Motlagh ME, Ahadi Z, Asayesh H, Kelishadi R. Association of socioeconomic status with psychiatric problems and violent behaviours in a nationally representative sample of Iranian children and adolescents: the CASPIAN-IV study. BMJ Open 2016; 6:e011615. [PMID: 27531729 PMCID: PMC5013516 DOI: 10.1136/bmjopen-2016-011615] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 06/07/2016] [Accepted: 07/12/2016] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES The aim of the present study was to evaluate the association between socioeconomic status (SES) and psychiatric problems and violent behaviours in a nationally representative sample of Iranian children and adolescents, based on nationwide surveillance programme data, 2011-2012. METHODS Overall, 14 880 students, aged 6-18 years, were selected using a multistage cluster sampling method from rural and urban areas of 30 provinces in Iran. SES was estimated based on a main summarised component, extracted from principle component analysis of family assets and parents' jobs and education. For statistical analysis, SES was classified as 'low', 'middle' and 'high'. The WHO-Global School Based Student Health Survey (WHO-GSHS) questionnaire was used to assess psychiatric problems and violent behaviours. RESULTS In total, 13 486 students (participation rate 90.6%) completed the study: 50.8% were boys and 75.6% were urban residents, with a mean age of 12.47±3.36 years. In the multivariate model, the ORs of depression, anxiety, feeling worthless, anger, insomnia, confusion and physical fights were lower in students with high SES compared with those with low SES (p<0.05) but physical fights was lower in the high SES group than in the low SES group (p<0.05). No significant relationship was documented between SES and other variables, including getting worried, history of bullying and being victimised. CONCLUSIONS Children and adolescents with low SES were at higher risk for psychiatric problems and violent behaviours. Mental health policies and public interventional strategies should be considered at the public level, notably for low SES families.
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Affiliation(s)
- Ramin Heshmat
- Chronic Diseases Research Centre, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Qorbani
- Dietary Supplements and Probiotics Research Centre, Alborz University of Medical Sciences, Karaj, Iran Endocrinology and Metabolism Research Centre, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Shirin Djalalinia
- Development of Research and Technology Centre, Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
| | - Omid Reza Tabatabaie
- Chronic Diseases Research Centre, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeid Safiri
- Managerial Epidemiology Research Center, Department of Public Health, School of Nursing and Midwifery, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Mehdi Noroozi
- Substance Abuse and Dependence Research Centre, University of Social, Welfare and Rehabilitation Sciences, Tehran, Iran
| | | | - Zeinab Ahadi
- Chronic Diseases Research Centre, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Asayesh
- Department of Medical Emergencies, Qom University of Medical Sciences, Qom, Iran
| | - Roya Kelishadi
- Department of Paediatrics, Child Growth and Development Research Centre, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
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48
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Baigi V, Nedjat S, Fotouhi A, Janani L, Mohammad K. Subjective social status in association with various health and socioeconomic indicators in Tehran. J Public Health (Oxf) 2016. [DOI: 10.1007/s10389-016-0749-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Heckley G, Gerdtham UG, Kjellsson G. A general method for decomposing the causes of socioeconomic inequality in health. JOURNAL OF HEALTH ECONOMICS 2016; 48:89-106. [PMID: 27137844 DOI: 10.1016/j.jhealeco.2016.03.006] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 03/13/2016] [Accepted: 03/28/2016] [Indexed: 06/05/2023]
Abstract
We introduce a general decomposition method applicable to all forms of bivariate rank dependent indices of socioeconomic inequality in health, including the concentration index. The technique is based on recentered influence function regression and requires only the application of OLS to a transformed variable with similar interpretation. Our method requires few identifying assumptions to yield valid estimates in most common empirical applications, unlike current methods favoured in the literature. Using the Swedish Twin Registry and a within twin pair fixed effects identification strategy, our new method finds no evidence of a causal effect of education on income-related health inequality.
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Affiliation(s)
- Gawain Heckley
- Health Economics & Management, Institute of Economic Research, Lund University, Box 117, 22100, Sweden; Health Economics Unit, Department of Clinical Sciences, Medicon Village, Lund University, Lund, Sweden.
| | - Ulf-G Gerdtham
- Health Economics & Management, Institute of Economic Research, Lund University, Box 117, 22100, Sweden; Health Economics Unit, Department of Clinical Sciences, Medicon Village, Lund University, Lund, Sweden; Department of Economics, Lund University, Lund, Sweden
| | - Gustav Kjellsson
- Department of Economics, University of Gothenburg, Gothenburg, Sweden; Centre of Health Economics at Gothenburg University (CHEGU), Gothenburg, Sweden
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50
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Bahramian H, Mohebbi SZ, Khami MR, Asadi-Lari M, Shamshiri AR, Hessari H. Psychosocial determinants of dental service utilization among adults: Results from a population-based survey (Urban HEART-2) in Tehran, Iran. Eur J Dent 2016; 9:542-550. [PMID: 26929694 PMCID: PMC4745237 DOI: 10.4103/1305-7456.172622] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To evaluate the association between dental service utilization and mental health in an adult population in the context of the socioeconomic status of the participants. SUBJECTS AND METHODS Multi-stage cluster random sampling was performed in Tehran, Iran, in 2011. Data were collected on dental service utilization, barriers of dental visit, self-perceived oral health, mental health, age, gender, education, and wealth status. The complex sample analysis method in SPSS and the survey data analysis menu in STATA were employed for statistical evaluation. RESULTS Of 20,320 participants, 25-36% suffered from disorders in at least one of the domains of somatization, anxiety, social dysfunction, and depression. Only 56% of the participants visited a dentist at least once during the last year. The main barriers to a dental visit were "no perceived need" and "high costs." Females, the richest participants, subjects aged 25-64-year-old, and those with poor self-perceived oral health, mental health disorders, and higher education had more visits. The participants who perceived the need but did not visit a dentist due to some reasons mostly comprised females, those aged 25-44-year-old, those with a poor perceived oral health, disordered people in all domains of mental health, and poorer participants. CONCLUSION Dental service utilization was influenced by socioeconomic factors and the mental health status of the adult population after controlling for multiple confounders. Reducing financial hardship and providing health education on the importance of preventive visits may decrease barriers to regular visits in countries with developing oral health systems.
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Affiliation(s)
- Hoda Bahramian
- Department of Community Oral Health, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Simin Z Mohebbi
- Research Center for Caries Prevention, Dental Research Institute, Department of Community Oral Health, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad R Khami
- Research Center for Caries Prevention, Dental Research Institute, Department of Community Oral Health, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Asadi-Lari
- Department of Epidemiology, Oncopathology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad R Shamshiri
- Department of Community Oral Health, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Hessari
- Research Center for Caries Prevention, Dental Research Institute, Department of Community Oral Health, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
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