Skip Navigation
Skip to contents

JPMPH : Journal of Preventive Medicine and Public Health



Page Path
HOME > Search
3 "Decomposition"
Article category
Publication year
Funded articles
Original Articles
Measurement and Decomposition of Socioeconomic Inequality in Metabolic Syndrome: A Cross-sectional Analysis of the RaNCD Cohort Study in the West of Iran
Moslem Soofi, Farid Najafi, Shahin Soltani, Behzad Karamimatin
J Prev Med Public Health. 2023;56(1):50-58.   Published online January 6, 2023
  • 2,656 View
  • 96 Download
  • 2 Web of Science
  • 2 Crossref
AbstractAbstract PDF
Socioeconomic inequality in metabolic syndrome (MetS) remains poorly understood in Iran. The present study examined the extent of the socioeconomic inequalities in MetS and quantified the contribution of its determinants to explain the observed inequality, with a focus on middle-aged adults in Iran.
This cross-sectional study used data from the Ravansar Non-Communicable Disease cohort study. A sample of 9975 middle-aged adults aged 35-65 years was analyzed. MetS was assessed based on the International Diabetes Federation definition. Principal component analysis was used to construct socioeconomic status (SES). The Wagstaff normalized concentration index (CIn) was employed to measure the magnitude of socioeconomic inequalities in MetS. Decomposition analysis was performed to identify and calculate the contribution of the MetS inequality determinants.
The proportion of MetS in the sample was 41.1%. The CIn of having MetS was 0.043 (95% confidence interval, 0.020 to 0.066), indicating that MetS was more concentrated among individuals with high SES. The main contributors to the observed inequality in MetS were SES (72.0%), residence (rural or urban, 46.9%), and physical activity (31.5%).
Our findings indicated a pro-poor inequality in MetS among Iranian middle-aged adults. These results highlight the importance of persuading middle-aged adults to be physically active, particularly those in an urban setting. In addition to targeting physically inactive individuals and those with low levels of education, policy interventions aimed at mitigating socioeconomic inequality in MetS should increase the focus on high-SES individuals and the urban population.


Citations to this article as recorded by  
  • Sleep Quality, Nutrient Intake, and Social Development Index Predict Metabolic Syndrome in the Tlalpan 2020 Cohort: A Machine Learning and Synthetic Data Study
    Guadalupe Gutiérrez-Esparza, Mireya Martinez-Garcia, Tania Ramírez-delReal, Lucero Elizabeth Groves-Miralrio, Manlio F. Marquez, Tomás Pulido, Luis M. Amezcua-Guerra, Enrique Hernández-Lemus
    Nutrients.2024; 16(5): 612.     CrossRef
  • Socioeconomic inequalities in metabolic syndrome and its components in a sample of Iranian Kurdish adults
    Pardis Mohammadzadeh, Farhad Moradpour, Bijan Nouri, Farideh Mostafavi, Farid Najafi, Ghobad Moradi
    Epidemiology and Health.2023; 45: e2023083.     CrossRef
Measuring and decomposing socioeconomic inequality in catastrophic healthcare expenditures in Iran
Satar Rezaei, Mohammad Hajizadeh
J Prev Med Public Health. 2019;52(4):214-223.   Published online June 14, 2019
  • 6,494 View
  • 216 Download
  • 15 Crossref
AbstractAbstract PDF
Equity in financial protection against healthcare expenditures is one the primary functions of health systems worldwide. This study aimed to quantify socioeconomic inequality in facing catastrophic healthcare expenditures (CHE) and to identify the main factors contributing to socioeconomic inequality in CHE in Iran.
A total of 37 860 households were drawn from the Households Income and Expenditure Survey, conducted by the Statistical Center of Iran in 2017. The prevalence of CHE was measured using a cut-off of spending at least 40% of the capacity to pay on healthcare services. The concentration curve and concentration index (C) were used to illustrate and measure the extent of socioeconomic inequality in CHE among Iranian households. The C was decomposed to identify the main factors explaining the observed socioeconomic inequality in CHE in Iran.
The prevalence of CHE among Iranian households in 2017 was 5.26% (95% confidence interval [CI], 5.04 to 5.49). The value of C was -0.17 (95% CI, -0.19 to -0.13), suggesting that CHE was mainly concentrated among socioeconomically disadvantaged households in Iran. The decomposition analysis highlighted the household wealth index as explaining 71.7% of the concentration of CHE among the poor in Iran.
This study revealed that CHE is disproportionately concentrated among poor households in Iran. Health policies to reduce socioeconomic inequality in facing CHE in Iran should focus on socioeconomically disadvantaged households.


Citations to this article as recorded by  
  • Prevalence and Determinants of Catastrophic Healthcare Expenditures in Iran From 2013 to 2019
    Abdoreza mousavi, Farhad lotfi, Samira Alipour, Aliakbar Fazaeli, Mohsen Bayati
    Journal of Preventive Medicine and Public Health.2024; 57(1): 65.     CrossRef
  • Examining the level and distribution of catastrophic health expenditure from 2013 to 2018: A province-level study in China
    Mingsheng Chen, Lizheng Xu, Lei Si, Zhonghua Wang, Stephen Jan
    Economic Modelling.2023; 121: 106233.     CrossRef
  • Equity and extent of financial risk protection indicators during COVID-19 pandemic in rural part of Tamil Nadu, India
    Yuvaraj Krishnamoorthy, Sathish Rajaa, Isha Sinha, Murali Krishnan, Gerald Samuel, Krishna Kanth
    Heliyon.2023; 9(8): e18902.     CrossRef
  • Catastrophic household expenditure associated with out-of-pocket payments for dental healthcare in Spain
    Samuel López-López, Raúl del Pozo-Rubio, Marta Ortega-Ortega, Francisco Escribano-Sotos
    The European Journal of Health Economics.2022; 23(7): 1187.     CrossRef
  • User fee removal for the poor: a qualitative study to explore policies for social health assistance in Iran
    Manal Etemadi, Mohammad Hajizadeh
    BMC Health Services Research.2022;[Epub]     CrossRef
  • A 25-Year Trend of Catastrophic Health Expenditure and Its Inequality in China: Evidence from Longitudinal Data
    Yongjian Xu, Yiting Zhou, Andi Pramono, Yazhuo Liu, Cong Jia
    Risk Management and Healthcare Policy.2022; Volume 15: 969.     CrossRef
  • Decomposition of Socioeconomic Inequality in Cardiovascular Disease Prevalence in the Adult Population: A Cohort-based Cross-sectional Study in Northwest Iran
    Farhad Pourfarzi, Telma Zahirian Moghadam, Hamed Zandian
    Journal of Preventive Medicine and Public Health.2022; 55(3): 297.     CrossRef
  • Financial risk protection from out-of-pocket health spending in low- and middle-income countries: a scoping review of the literature
    Taslima Rahman, Dominic Gasbarro, Khurshid Alam
    Health Research Policy and Systems.2022;[Epub]     CrossRef
  • Incidence of catastrophic healthcare expenditure and its main determinants in Mexican households caring for a person with a mental disorder
    Lina Diaz-Castro, Héctor Cabello-Rangel, Carlos Pineda-Antúnez, Alejandra Pérez de León
    Global Mental Health.2021;[Epub]     CrossRef
  • Unmet dental care need in West of Iran: determinants and inequality
    Amjad Mohamadi-Bolbanabad, Farman Zahir Abdullah, Hossein Safari, Satar Rezaei, Abdorrahim Afkhamzadeh, Shina Amirhosseini, Afshin Shadi, Jamal Mahmoudpour, Bakhtiar Piroozi
    International Journal of Human Rights in Healthcare.2021; 14(5): 426.     CrossRef
  • The impact of out-of pocket payments of households for dental healthcare services on catastrophic healthcare expenditure in Iran
    Abraha Woldemichael, Satar Rezaei, Ali Kazemi Karyani, Mohammad Ebrahimi, Shahin Soltani, Abbas Aghaei
    BMC Public Health.2021;[Epub]     CrossRef
  • Measuring Out-of-pocket Payment, Catastrophic Health Expenditure and the Related Socioeconomic Inequality in Peru: A Comparison Between 2008 and 2017
    Akram Hernández-Vásquez, Carlos Rojas-Roque, Rodrigo Vargas-Fernández, Diego Rosselli
    Journal of Preventive Medicine and Public Health.2020; 53(4): 266.     CrossRef
  • Incidence and Intensity of Catastrophic Health-care Expenditure for Type 2 Diabetes Mellitus Care in Iran: Determinants and Inequality

    Bakhtiar Piroozi, Amjad Mohamadi-Bolbanabad, Ghobad Moradi, Hossein Safari, Shahnaz Ghafoori, Yadolah Zarezade, Farzam Bidarpour, Satar Rezaei
    Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy.2020; Volume 13: 2865.     CrossRef
  • Trend and status of out-of-pocket payments for healthcare in Iran: equity and catastrophic effect
    Satar Rezaei, Abraha Woldemichael, Mohammad Ebrahimi, Sina Ahmadi
    Journal of the Egyptian Public Health Association.2020;[Epub]     CrossRef
  • Catastrophic Out-of-Pocket Health Expenditure Among Rural Households in the Semi-Pastoral Community, Western Ethiopia: A Community-Based Cross-Sectional Study
    Debelo Shikuro, Mezgebu Yitayal, Adane Kebede, Ayal Debie
    ClinicoEconomics and Outcomes Research.2020; Volume 12: 761.     CrossRef
Has Income-related Inequity in Health Care Utilization and Expenditures Been Improved? Evidence From the Korean National Health and Nutrition Examination Survey of 2005 and 2010
Eunkyoung Kim, Soonman Kwon, Ke Xu
J Prev Med Public Health. 2013;46(5):237-248.   Published online September 30, 2013
  • 12,287 View
  • 97 Download
  • 10 Crossref
AbstractAbstract PDF

The purpose of this study is to examine and explain the extent of income-related inequity in health care utilization and expenditures to compare the extent in 2005 and 2010 in Korea.


We employed the concentration indices and the horizontal inequity index proposed by Wagstaff and van Doorslaer based on one- and two-part models. This study was conducted using data from the 2005 and 2010 Korean National Health and Nutrition Examination Survey. We examined health care utilization and expenditures for different types of health care providers, including health centers, physician clinics, hospitals, general hospitals, dental care, and licensed traditional medical practitioners.


The results show the equitable distribution of overall health care utilization with pro-poor tendencies and modest pro-rich inequity in the amount of medical expenditures in 2010. For the decomposition analysis, non-need variables such as income, education, private insurance, and occupational status have contributed considerably to pro-rich inequality in health care over the period between 2005 and 2010.


We found that health care utilization in Korea in 2010 was fairly equitable, but the poor still have some barriers to accessing primary care and continuing to receive medical care.



Citations to this article as recorded by  
  • Increase in Potential Low-value Magnetic Resonance Imaging Utilization Due to Out-of-pocket Payment Reduction Across Income Groups in Korea: An Experimental Vignette Study
    Yukyung Shin, Ji-su Lee, Young Kyung Do
    Journal of Preventive Medicine and Public Health.2022; 55(4): 389.     CrossRef
  • Factors associated with the preventive healthcare service use among older adults in Korea: Focusing on age variation
    Jane Park, Sang Kyoung Kahng
    Asian Social Work and Policy Review.2021; 15(1): 24.     CrossRef
  • Effect of a Mobile Phone–Based Glucose-Monitoring and Feedback System for Type 2 Diabetes Management in Multiple Primary Care Clinic Settings: Cluster Randomized Controlled Trial
    Yeoree Yang, Eun Young Lee, Hun-Sung Kim, Seung-Hwan Lee, Kun-Ho Yoon, Jae-Hyoung Cho
    JMIR mHealth and uHealth.2020; 8(2): e16266.     CrossRef
  • Health Care Utilization Inequality in a Mixed Public-Private Health Care System: An Insight from the National Survey in Iran
    Mohammadreza Zakeri, Kamran Bagheri Lankarani, Zahra Kavosi, Ramin Ravangard
    Health Scope.2019;[Epub]     CrossRef
  • The inequity of inpatient services in rural areas and the New-Type Rural Cooperative Medical System (NRCMS) in China: repeated cross sectional analysis
    Bingbing Pan, Samuel D Towne, Yuxing Chen, ZhaoKang Yuan
    Health Policy and Planning.2017; 32(5): 634.     CrossRef
  • The association between objective income and subjective financial need and depressive symptoms in South Koreans aged 60 and older
    Woorim Kim, Tae Hyun Kim, Tae‐Hoon Lee, Yeong Jun Ju, Eun‐Cheol Park
    Psychogeriatrics.2017; 17(6): 389.     CrossRef
  • The Effect of Occurrence and Reoccurrence of Catastrophic Health Expenditure on Transition to Poverty and Persistence of Poverty in South Korea
    Eunkyoung Kim, Soonman Kwon
    Health Policy and Management.2016; 26(3): 172.     CrossRef
  • Socioeconomic Disparities in Osteoporosis Prevalence: Different Results in the Overall Korean Adult Population and Single-person Households
    Jungmee Kim, Joongyub Lee, Ju-Young Shin, Byung-Joo Park
    Journal of Preventive Medicine and Public Health.2015; 48(2): 84.     CrossRef
  • Horizontal inequities in dental service utilization
    Eunsuk Ahn, Min Young Kim, Hosung Shin
    Journal of Korean Academy of Oral Health.2015; 39(1): 9.     CrossRef
  • Equity in the Utilization of Healthcare Services in India: Evidence From National Sample Survey
    Soumitra Ghosh
    SSRN Electronic Journal.2014;[Epub]     CrossRef

JPMPH : Journal of Preventive Medicine and Public Health