Why caesarean is more unequally concentrated among better-off people in Tehran? A concentration index decomposition approach

2018 ◽  
Vol 73 (2) ◽  
pp. 182-187 ◽  
Author(s):  
Reza Omani-Samani ◽  
Amir Almasi-Hashiani ◽  
Saeid Safiri ◽  
Mahroo Rezaeinejad ◽  
Fatemeh Shokri ◽  
...  
Keyword(s):  
Low Income ◽  
Concentration Index ◽  
Socioeconomic Inequality ◽  
Economic Status ◽  
Principal Component ◽  
Socioeconomic Inequalities ◽  
Positive Contribution ◽  
Contributing Factors ◽  
Cross Sectional ◽  
Decomposition Approach

BackgroundIran, as one of the low-income and middle-income countries, has experienced a remarkable increase in the caesarean section (CS) rate during the past three decades. Although several studies have been conducted on the prevalence and risk factors affecting CS, but few studies were done regarding socioeconomic factors influencing the CS rate. The aim of this study was to identify socioeconomic inequalities and its determinants in CS in Tehran, capital of Iran.MethodsA population-based cross-sectional study was conducted on 5170 pregnancies in Tehran, since 2015. Principal component analysis was applied to measure the asset-based economic status. Concentration index was used to measure socioeconomic inequality in CS and then decomposed in to its determinants.ResultsThe concentration index and its 95% CI for CS history was 0.102 (0.091 to 0.112). Decomposition of the concentration index showed that economic status had the largest contribution (49.2%) to socioeconomic inequality in CS. Mother’s education (14.9%), father’s occupation (13.3%) and father’s nationality (9.7%) had the next high positive contribution to measured inequality in CS, respectively.ConclusionsCS is mostly concentrated among women with high economic status. The identified contributing factors should be addressed to decrease the socioeconomic inequalities as possible.

scholarly journals Understanding determinants of unequal distribution of stillbirth in Tehran, Iran: a concentration index decomposition approach

BMJ Open ◽  
2017 ◽  
Vol 7 (5) ◽  
pp. e013644 ◽  
Author(s):  
Amir Almasi-Hashiani ◽  
Mahdi Sepidarkish ◽  
Saeid Safiri ◽  
Esmaeil Khedmati Morasae ◽  
Yahya Shadi ◽  
...  
Keyword(s):  
Concentration Index ◽  
Economic Status ◽  
Principal Component ◽  
Population Based ◽  
Cross Sectional Study ◽  
Related Factors ◽  
Negative Contribution ◽  
Cross Sectional ◽  
Unequal Distribution ◽  
Decomposition Approach

ObjectiveThe present inquiry set to determine the economic inequality in history of stillbirth and understanding determinants of unequal distribution of stillbirth in Tehran, Iran.MethodsA population-based cross-sectional study was conducted on 5170 pregnancies in Tehran, Iran, since 2015. Principal component analysis (PCA) was applied to measure the asset-based economic status. Concentration index was used to measure socioeconomic inequality in stillbirth and then decomposed into its determinants.ResultsThe concentration index and its 95% CI for stillbirth was −0.121 (−0.235 to −0.002). Decomposition of the concentration index showed that mother’s education (50%), mother’s occupation (30%), economic status (26%) and father’s age (12%) had the highest positive contributions to measured inequality in stillbirth history in Tehran. Mother’s age (17%) had the highest negative contribution to inequality.ConclusionsStillbirth is unequally distributed among Iranian women and is mostly concentrated among low economic status people. Mother-related factors had the highest positive and negative contributions to inequality, highlighting specific interventions for mothers to redress inequality.

scholarly journals Socioeconomic inequality in dental care utilization in Iran: a decomposition approach

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Satar Rezaei ◽  
Mohammad Hajizadeh ◽  
Seyed Fahim Irandoost ◽  
Yahya Salimi
Keyword(s):  
Socioeconomic Status ◽  
Dental Care ◽  
Socioeconomic Inequality ◽  
Insurance Coverage ◽  
Socioeconomic Inequalities ◽  
Care Utilization ◽  
Contributing Factors ◽  
Decomposition Approach ◽  
Dental Care Utilization ◽  
Education Status

Abstract Purpose Socioeconomic inequalities in dental care utilization in Iran are rarely documented. This study aimed to provide insight into socioeconomic inequalities in dental care utilization and its main contributing factors among Iranian households. Design/methodology/approach A total of 37,860 households from the 2017 Household Income and Expenditure Survey (HIES) were included in the study. Data on dental care utilization, age, gender and education attainment of the head of household, socioeconomic status of households, health insurance coverage, living areas and provinces were obtained for the survey. The concentration curve and the normalized concentration index (Cn) was used to illustrate and quantify socioeconomic inequalities in dental care utilization among Iranian households. The Cn was decomposed to identify the main determinants of the observed socioeconomic inequality in dental care utilization in Iran. Findings The study indicated that the prevalence of dental care utilization among Iranian’s households was 4.67% (95% confidence interval [CI]: 4.46 to 4.88%). The results suggested a higher concentration of dental care utilization among socioeconomically advantaged households (Cn = 0.2522; 95% CI: 0.2258 to 0.2791) in Iran. Pro-rich inequality in dental care utilization also found in rural (Cn = 0.2659; 95%CI: 0.2221 to 0.3098) and urban (Cn = 0.0.2504; 95% CI: 0.0.2159 to 0.2841) areas. The results revealed socioeconomic status of households, age and education status of head of households and residing provinces as the main contributing factors to the concentration of dental care utilization among the wealthy households. Originality/value This study revealed pro-rich inequalities in dental care utilization among households in Iran and its provinces. Thus, health policymakers should focus on designing effective evidence-based interventions to improve healthcare utilization among household with the older head of households, lower education status, and living in relatively poor provinces to reduce socioeconomic inequality in dental care utilization in Iran.

scholarly journals Exploring socioeconomic inequalities in the use of medicinal herbs among Iranian households: evidence from a national cross-sectional survey

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Satar Rezaei ◽  
Sina Ahmadi ◽  
Amjad Mohamadi-Bolbanabad ◽  
Ahmad Khanijahani
Keyword(s):  
Socioeconomic Status ◽  
Economic Status ◽  
Household Head ◽  
Decomposition Analysis ◽  
Wealth Index ◽  
Socioeconomic Inequalities ◽  
Medicinal Herbs ◽  
Contributing Factors ◽  
Cross Sectional Survey ◽  
Cross Sectional

Abstract Background Association between socioeconomic status and medicinal herbs (MH) are rarely documented in Iran. Our goal was to measure and decompose socioeconomic inequalities in MH use among Iranian households. Methods The data used in this cross-sectional study were extracted from the 2018 Household Income and Expenditure Survey (HIES) (N = 38,859). Data on MH use, age, gender, and education status of the head of household; a constructed wealth index of household (as a proxy for household’s socioeconomic status); and place of residence (urban or rural) were obtained from the survey. Publicly available province-level data on Human Development Index (HDI) were obtained from the Institute for Management Research at Radbound University. We used the concentration curve and the normalized concentration index (Cn) to measure the magnitude of socioeconomic inequalities in MH among Iranian households. The Cn was decomposed to identify the main determinants of socioeconomic inequalities in MH in Iran. Results The overall prevalence of MH use among Iranian households was 4.7% (95% confidence interval [CI]: 4.5 to 4.9%) in the last month before data collection. The Cn for MH use for the whole of samples was 0.1519; 95% CI = 0.1254 to 0.1784; suggesting a higher concentration of MH use among the households with high socioeconomic level. The decomposition analysis indicated that the main contributing factors to the concentration of MH use were the economic status of households, development status of the province, and education level of the household head. Conclusions This study demonstrated that MH use is more concentrated among socioeconomically advantaged households in Iran and its provinces. This finding might contrast with the widespread belief that wealthy and socioeconomically advantaged populations, compared to low SES groups, tend to seek disproportionately more modern medical treatments and medications than MH. Understanding the factors affecting MH use, socioeconomic inequality in use of MH and its determinants provide an opportunity for health policymakers to design effective evidence-based interventions among providers and consumers of MH.

scholarly journals Twelve-year persistence of inequalities in antenatal care utilisation among women in Tanzania: a decomposition analysis of population-based cross-sectional surveys

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e040450
Author(s):  
Deogratius Bintabara ◽  
Namanya Basinda
Keyword(s):  
Antenatal Care ◽  
Concentration Index ◽  
Maternal Education ◽  
Socioeconomic Inequality ◽  
Decomposition Analysis ◽  
Population Based ◽  
Socioeconomic Inequalities ◽  
Reproductive Age ◽  
Women Of Reproductive Age ◽  
Cross Sectional

ObjectiveThis study was undertaken to assess the trend and contributors of socioeconomic inequalities in antenatal care (ANC) utilisation among women of reproductive age in Tanzania from 2004 to 2016.DesignPopulation-based cross-sectional surveys.SettingThis study analysed nationally representative data for women of reproductive age obtained from the 2004–2016 Tanzania Demographic Health Surveys.Primary outcome measureThe outcome variables analysed in this study are: (1) attendance of ANC and (2) accessing adequate antenatal care.Analytical methodsThe concentration curve and the concentration index were used to measure socioeconomic inequality in attending and accessing adequate ANC. The concentration index was decomposed to identify the factors explaining the observed socioeconomic inequality of these two outcomes.ResultsThe concentration index for attending at least four ANC visits increased from 0.169 in 2004 to 0.243 in 2016 (p<0.01). Similarly, for accessing adequate care, the index increased from 0.147 in 2004 to 0.355 in 2016 (p<0.01). This indicates the significant increase in socioeconomic inequalities (favouring wealthier women) for these two outcomes over time. Furthermore, the results show that wealth status was the largest contributor to inequality in both attending at least four visits (71%, 50% and 70%) and accessing adequate ANC (50%, 42% and 51%) in 2004, 2010 and 2016, respectively, in favour of wealthier women (p<0.05). The other contributors to socioeconomic inequalities in ANC utilisation were maternal education and type of residence.ConclusionOver the 12 years of surveys, there was no reduction in socioeconomic inequalities in ANC utilisation in Tanzania. Therefore, the efforts of achieving universal health coverage should focus on reducing wealth-related inequality and improving women’s education from poor households.

scholarly journals Socio-economic inequality in unhealthy snacks consumption among adolescent students in Iran: a concentration index decomposition analysis

2019 ◽  
Vol 22 (12) ◽  
pp. 2179-2188 ◽  
Author(s):  
Vahid Yazdi-Feyzabadi ◽  
Arash Rashidian ◽  
Mostafa Amini Rarani
Keyword(s):  
Concentration Index ◽  
Economic Status ◽  
Economic Inequality ◽  
Decomposition Analysis ◽  
Principal Component ◽  
Cross Sectional Study ◽  
Future Health ◽  
Cross Sectional ◽  
Adolescent Students ◽  
Unhealthy Snacks

AbstractObjective:The present study aimed to assess and decompose the socio-economic inequality in unhealthy snacks consumption among adolescent students in Kerman, Iran.Design:The data were obtained from a cross-sectional study. Principal component analysis was done to measure the socio-economic status (SES) of the adolescents’ families and the normalized concentration index (NCI) was used to measure the inequality in unhealthy snacks consumption among adolescent students of different SES. The contributions of environmental and individual explanatory variables to inequality were assessed by decomposing the concentration index.Setting:Forty secondary schools of Kerman Province in Iran in 2015.Participants:Eighth-grade adolescent students (n 1320).Results:The data of 1242 adolescent students were completed for the current study. Unhealthy snacks consumption was unequally distributed among adolescent students and was concentrated mainly among the high-SES adolescents (NCI = 0·179; 95 % CI 0·056, 0·119). The decomposition showed that higher SES (62 %) and receiving pocket money allowance (31 %), as environmental variables, had the highest positive contributions to the measured inequality in unhealthy snacks consumption. Taste and sensory perception (7 %) as well as cost sensitivity (5 %), as individual variables, followed them in terms of their contribution importance.Conclusions:It is highly suggested that both environmental and individual factors should be addressed at different settings including schools, families and suppliers of unhealthy snacks. These findings can help future health promotion strategies in Iran to tackle the observed inequality in unhealthy snacks consumption.

Effectiveness of mobile produce markets in increasing access and affordability of fruits and vegetables among low-income seniors

2020 ◽  
Vol 23 (17) ◽  
pp. 3226-3235
Author(s):  
Reece Lyerly ◽  
Pasquale Rummo ◽  
Sarah Amin ◽  
Whitney Evans ◽  
Eliza Dexter Cohen ◽  
...  
Keyword(s):  
Rhode Island ◽  
Low Income ◽  
Fruits And Vegetables ◽  
Economic Status ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Assistance Program ◽  
Logistic Regression Models ◽  
Populations At Risk ◽  
Nutrition Assistance

AbstractObjective:Mobile produce markets (MPM) offering Supplemental Nutrition Assistance Program (SNAP) incentive programmes have the potential to provide accessible and affordable fruits and vegetables (FV) to populations at risk of food insecurity. The objective of this study is to characterise the customer base of an MPM and describe their participation at twelve market sites serving low-income seniors.Design:In 2018, customers from an MPM in Rhode Island (RI) participated in a cross-sectional survey (n 330; 68 % response rate), which measured dietary patterns, food security and food shopping behaviours. We compared the shopping habits and market experiences of customers who currently received SNAP benefits with those who did not currently receive SNAP benefits.Setting:An MPM in RI which offers a 50 % discount for FV purchased with SNAP benefits.Participants:This study describes current market customers at twelve market sites serving low-income seniors.Results:Market customers were mostly low-income, female, over the age of 50 years and Hispanic/Latino. Most customers received SNAP benefits, and almost half were food insecure. In addition, three quarters of SNAP customers reported their SNAP benefits last longer since shopping at the markets. Mixed logistic regression models indicated that SNAP customers were more likely to report buying and eating more FV than non-SNAP customers.Conclusions:MPM are critical resources of affordable produce and have been successful in improving access to FV among individuals of low socio-economic status in RI. This case study can inform policy and programme recommendations for MPM and SNAP incentive programmes.

scholarly journals Socioeconomic inequality in intermittent preventive treatment using Sulphadoxine pyrimethamine among pregnant women in Nigeria

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Fatima Mahmud Muhammad ◽  
Reza Majdzadeh ◽  
Saharnaz Nedjat ◽  
Haniye Sadat Sajadi ◽  
Mahboubeh Parsaeian
Keyword(s):  
Pregnant Women ◽  
Concentration Index ◽  
Socioeconomic Inequality ◽  
Intermittent Preventive Treatment ◽  
Wealth Index ◽  
Preventive Treatment ◽  
Educational Status ◽  
P Value ◽  
Contributing Factors ◽  
Sulphadoxine Pyrimethamine

Abstract Background Intermittent preventive treatment using Sulphadoxine pyrimethamine (IPTp-SP) for malaria prevention is recommended for all pregnant women in malaria endemic areas. However, there is limited evidence on the level of socioeconomic inequality in IPTp-SP use among pregnant women in Nigeria. Thus, this study aimed to determine the level of socioeconomic inequality in IPTp-SP use among pregnant women in Nigeria and to decompose it into its contributing factors. Methods A secondary data analysis of Nigerian demographic and health survey of 2018 was conducted. A sample of 21,621 pregnant women aged between 15 and 49 years and had live birth in the previous 2 years before the survey were included in this analysis. The study participants were recruited based on a stratified two-stage cluster sampling method. Socioeconomic inequality was decomposed into its contributing factors by concentration index. Result Totally 63.6% of pregnant women took at least one dose of IPTp-SP prophylaxis. Among IPTp-SP users, 35.1% took one dose, 38.6% took two doses and 26.2% took three doses and more. Based on both concentration index of 0.180 (p-value = < 0.001, 95% CI: 0.176 to 0.183) and Erreyger’s normalization concentration index 0.280 (p-value = < 0.001, 95% CI: 0.251 to 0.309), the IPTp-SP utilization was pro-rich. The largest contributors to the inequality in IPTp-SP uptake were wealth index (47.81%) and educational status (28.66%). Conclusion Our findings showed that IPTp-SP use was pro-rich in Nigeria. Wealth index and educational status were the factors that significantly contributed to the inequality. The disparities could be reduced through free IPTp service expansion by targeting pregnant women from low socioeconomic status.

scholarly journals Inequalities in Cognitive Impairment Among Older Adults in China and the Associated Social Determinants: A Decomposition Approach

2020 ◽  
Author(s):  
Qingwen Deng ◽  
Wenbin Liu
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Emotional Support ◽  
Financial Support ◽  
Concentration Index ◽  
Economic Status ◽  
Living Arrangement ◽  
Education Level ◽  
Socioeconomic Inequalities ◽  
Chinese Older Adults

Abstract BackgroundDespite there is growing evidence focusing on health inequalities in China, socioeconomic inequalities in cognitive impairment among older adults have received little attention. This study aims to measure socioeconomic inequalities in cognitive impairment among Chinese older adults, and determine the contributing social factors to the inequalities.MethodsA cross-sectional analysis was performed using data from the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS), a total of 10556 older adults aged 65 and over were included in the study. The prevalence of cognitive impairment was measured by using the Chinese version of the Mini-Mental State Examination. The socioeconomic inequalities in cognitive impairment were illustrated and quantified by the concentration curve and normalized concentration index. Multivariate logistic regression was conducted to identify the associated factors of cognitive impairment. And decomposition analysis was further applied to decompose the contribution of each determinant to the observed inequalities in cognitive impairment.ResultsThe study indicated that the prevalence of cognitive impairment among Chinese older adults was 18.95%. The overall concentration index for cognitive impairment was − 0.046, which suggested a higher concentration of cognitive impairment among socioeconomically disadvantaged older adults. The results showed the prevalence of cognitive impairment was associated with sex, age, marital status, education level, occupation, economic status, emotional support, financial support, living arrangement, and participation in informal activities. Decomposition results further revealed the contributions of the determinants to the inequalities in cognitive impairment. Specifically, age (131.61%), marital status (85.68%), emotional support (84.85%), education level (39.73%), occupation (21.24%), sex (17.25%), financial support (− 4.19%), economic status (1.02%), living arrangement (0.88%), and informal activities (0.30%) have varying degrees of contributions to the inequality in cognitive impairment.ConclusionThis study sheds light on the pro-rich inequality in cognitive impairment among older adults in China. It suggests that policymakers should pay more attention to older adults who are female, old-old, widowed, illiterate, economically disadvantaged, have no social support, and are less socially involved. Also, more targeted interventions should be undertaken to improve the socioeconomic conditions of these vulnerable individuals and their ability to cope with the risk of cognitive impairment.

Trends in Socioeconomic Inequalities in the Use of Antenatal Care Services by Women Aged 15 to 49 Years in Vietnam

2019 ◽  
Vol 31 (5) ◽  
pp. 413-421 ◽  
Author(s):  
Vu Duy Kien ◽  
Tej Ram Jat ◽  
Tran Van Phu ◽  
Le Manh Cuong ◽  
Vu Thi Mai Anh ◽  
...  
Keyword(s):  
Antenatal Care ◽  
Socioeconomic Inequality ◽  
Economic Status ◽  
Socioeconomic Inequalities ◽  
Limited Information ◽  
Care Services ◽  
Multiple Indicator Cluster Survey ◽  
Multiple Indicator ◽  
The Common ◽  
Concentration Indices

Despite considerable variations in the use of antenatal care (ANC) services in Vietnam, limited information is available on socioeconomic inequalities concerning the use of ANC services. This study aimed to assess the trends and changes in socioeconomic inequalities in the use of ANC services by women aged 15 to 49 years in Vietnam from 2006 to 2014. We used data from the Multiple Indicator Cluster Survey conducted in 2006, 2011, and 2014. The percentage of women who received ANC services increased significantly from 26.5% in 2006 to 42.7% in 2011 and reached 56.6% in 2014. We found a decreasing trend in the concentration indices of the use of ANC services from 0.36 in 2006 to 0.19 in 2014. The common factors significantly associated with the higher percentage of the use of ANC services in 2006, 2011, and 2014 were women belonging to the Kinh and Hoa ethnic groups and belonging to wealthier groups. Our study showed a reduction in socioeconomic inequality in the use of ANC services between 2004 and 2014. However, significant inequalities still exist in the use of ANC services based on women’s education, ethnicity, and economic status.

scholarly journals Disparities in baseline neurocognitive testing for student concussion management in Massachusetts high schools

2020 ◽  
Vol 6 (1) ◽  
pp. e000752
Author(s):  
Julia Campbell ◽  
Jonathan Howland ◽  
Courtney Hess ◽  
Kerrie Nelson ◽  
Robert A Stern ◽  
...  
Keyword(s):  
High Schools ◽  
Low Income ◽  
Economic Status ◽  
Secondary Analysis ◽  
Neurocognitive Testing ◽  
Student Body ◽  
Cross Sectional ◽  
Concussion Management ◽  
Health Related ◽  
Baseline Testing

PurposeThere is evidence of socioeconomic disparities with respect to the implementation of student-sports concussion laws nationally. The purpose of this study was to examine school sociodemographic characteristics associated with the provision of computerised baseline neurocognitive testing (BNT) in Massachusetts (MA) high schools, and to assess whether the scope of testing is associated with the economic status of student populations in MA.MethodsA cross-sectional secondary analysis of surveys conducted with MA athletic directors (n=270) was employed to investigate school characteristics associated with the provision of BNT. Correlation and regression analyses were used to assess whether the scope of testing is associated with the economic status of student populations in MA.ResultsThe scope of BNT was independently associated with the economic disadvantage rate (EDR) of the student population (β=−0.02, p=0.01); whether or not the school employs an athletic trainer (AT) (β=0.43, p=0.03); and school size (β=−0.54, p=0.03). In a multivariable regression model, EDR was significantly associated with the scope of baseline testing, while controlling for AT and size (β=−0.01, p=0.03, adj-R2=0.1135).ConclusionAmong public high schools in MA, disparities in the provision of BNT for students are associated with the economic characteristics of the student body. Schools that have a greater proportion of low-income students are less likely to provide comprehensive BNT. The clinical implications of not receiving BNT prior to concussion may include diminished quality of postconcussive care, which can have short-term and long-term social, health-related and educational impacts.

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