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Original Articles
Prevalence and Determinants of Catastrophic Healthcare Expenditures in Iran From 2013 to 2019
Abdoreza mousavi, Farhad lotfi, Samira Alipour, Aliakbar Fazaeli, Mohsen Bayati
J Prev Med Public Health. 2024;57(1):65-72.   Published online November 25, 2023
DOI: https://doi.org/10.3961/jpmph.23.291
  • 2,141 View
  • 226 Download
  • 1 Web of Science
  • 1 Crossref
AbstractAbstract AbstractSummary PDF
Objectives
Protecting people against financial hardship caused by illness stands as a fundamental obligation within healthcare systems and constitutes a pivotal component in achieving universal health coverage. The objective of this study was to analyze the prevalence and determinants of catastrophic health expenditures (CHE) in Iran, over the period of 2013 to 2019.
Methods
Data were obtained from 7 annual national surveys conducted between 2013 and 2019 on the income and expenditures of Iranian households. The prevalence of CHE was determined using a threshold of 40% of household capacity to pay for healthcare. A binary logistic regression model was used to identify the determinants influencing CHE.
Results
The prevalence of CHE increased from 3.60% in 2013 to 3.95% in 2019. In all the years analyzed, the extent of CHE occurrence among rural populations exceeded that of urban populations. Living in an urban area, having a higher wealth index, possessing health insurance coverage, and having employed family members, an employed household head, and a literate household head are all associated with a reduced likelihood of CHE (p<0.05). Conversely, the use of dental, outpatient, and inpatient care, and the presence of elderly members in the household, are associated with an increased probability of facing CHE (p<0.05).
Conclusions
Throughout the study period, CHE consistently exceeded the 1% threshold designated in the national development plan. Continuous monitoring of CHE and its determinants at both household and health system levels is essential for the implementation of effective strategies aimed at enhancing financial protection.
Summary
Key Message
• The aim of this study was to analyze the prevalence and determinants of catastrophic health expenditures (CHE) in Iran. • Catastrophic health expenditures (CHE) are used for monitoring financial protection within health systems. • The World Health Organization defines CHE as out-of-pocket payments for healthcare that exceed 40% of a household’s capacity to pay. • In Iran, the prevalence of CHE increased from 3.60% in 2013 to 3.95% in 2019. • Continuous monitoring of CHE and its determinants is essential for implementing effective strategies aimed at enhancing financial protection.

Citations

Citations to this article as recorded by  
  • An analysis of financial protection and financing incidence of out-of-pocket health expenditures in Kazakhstan from 2018 to 2021
    Askhat Shaltynov, Yulia Semenova, Madina Abenova, Assel Baibussinova, Ulzhan Jamedinova, Ayan Myssayev
    Scientific Reports.2024;[Epub]     CrossRef
Gender Inequalities in Mental Health During the COVID-19 Pandemic: A Population-based Study in Korea
Minku Kang, Sarah Yu, Seung-Ah Choe, Daseul Moon, Myung Ki, Byung Chul Chun
J Prev Med Public Health. 2023;56(5):413-421.   Published online August 19, 2023
DOI: https://doi.org/10.3961/jpmph.23.170
  • 2,323 View
  • 120 Download
  • 1 Web of Science
  • 1 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Objectives
This study explored the effect of the coronavirus disease 2019 (COVID-19) pandemic on psychosocial stress in prime working-age individuals in Korea, focusing on gender inequalities. We hypothesized that the impact of COVID-19 on mental health would differ by age and gender, with younger women potentially demonstrating heightened vulnerability relative to men.
Methods
The study involved data from the Korea Community Health Survey and included 319 592 adults aged 30 years to 49 years. We employed log-binomial regression analysis, controlling for variables including age, education, employment status, marital status, and the presence of children. The study period included 3 phases: the period prior to the COVID-19 outbreak (pre–COVID-19), the early pandemic, and the period following the introduction of vaccinations (post-vaccination).
Results
The findings indicated that women were at a heightened risk of psychosocial stress during the early pandemic (relative risk [RR], 1.01; 95% confidence interval [CI], 0.98 to 1.05) and post-vaccination period (RR, 1.07; 95% CI, 1.04 to 1.10) compared to men. This pattern was prominent in urban women aged 30-34 years (pre–COVID-19: RR, 1.06; 95% CI, 1.02 to 1.10; early pandemic: RR, 1.16; 95% CI, 1.08 to 1.25; post-vaccination period, RR, 1.22; 95% CI, 1.14 to 1.31).
Conclusions
The COVID-19 pandemic has exerted unequal impacts on psychosocial stress among prime working-age individuals in Korea, with women, particularly those in urban areas, experiencing a heightened risk. The findings highlight the importance of addressing gender-specific needs and implementing appropriate interventions to mitigate the psychosocial consequences of the pandemic.
Summary
Korean summary
코로나19 대유행이 국내 경제활동인구의 정신건강에 미친 젠더화된 영향을 조사하였다. 연구대상자는 2017-2021년 지역사회건강조사 조사대상자 319,592명이다. 연구 결과, 대유행 이후 30-39세 연령대 여성의 스트레스 수준이 남성에 비하여 현저히 증가한 것으로 나타났으며, 사회적 거리두기를 엄격하게 시행하였던 도시 지역에서 이러한 경향이 두드러졌다. 이번 연구 결과는 대유행 대응 노력에서 취약 집단을 지원하기 위한 중재 정책의 필요성을 강조한다
Key Message
We investigate the gendered impact of the COVID-19 pandemic on the mental health of the working-age population in Korea, focusing on ages 30-49, utilizing data from the Korea Community Health Survey (KCHS) from 2017 to 2021 including 319,592 participants. Findings reveal a notable increase in stress levels among women in the 30-39 age group after the pandemic compared to men, accentuating in urban areas with stringent social distancing measures. Our results underscore the necessity for intervention policies to support vulnerable groups in pandemic response efforts.

Citations

Citations to this article as recorded by  
  • Exploring the association between consultation themes and suicidal ideation: a gender-stratified analysis of Hangzhou Mental Health Hotline (2014-2023)
    Deyuan Wu, Yating Wei, Qiuxia Chen, Xiaonv Fu, Haidong Song
    BMC Psychiatry.2024;[Epub]     CrossRef
A Regionalization Model to Increase Equity of Access to Maternal and Neonatal Care Services in Iran
Zahra Mohammadi Daniali, Mohammad Mehdi Sepehri, Farzad Movahedi Sobhani, Mohammad Heidarzadeh
J Prev Med Public Health. 2022;55(1):49-59.   Published online December 28, 2021
DOI: https://doi.org/10.3961/jpmph.21.401
  • 3,808 View
  • 154 Download
  • 3 Web of Science
  • 7 Crossref
AbstractAbstract PDFSupplementary Material
Objectives
Access to maternal and neonatal care services (MNCS) is an important goal of health policy in developing countries. In this study, we proposed a 3-level hierarchical location-allocation model to maximize the coverage of MNCS providers in Iran.
Methods
First, the necessary criteria for designing an MNCS network were explored. Birth data, including gestational age and birth weight, were collected from the data bank of the Iranian Maternal and Neonatal Network national registry based on 3 service levels (I, II, and III). Vehicular travel times between the points of demand and MNCS providers were considered. Alternative MNCS were mapped in some cities to reduce access difficulties.
Results
It was found that 130, 121, and 86 MNCS providers were needed to respond to level I, II, and III demands, respectively, in 373 cities. Service level III was not available in 39 cities within the determined travel time, which led to an increased average travel time of 173 minutes to the nearest MNCS provider.
Conclusions
This study revealed inequalities in the distribution of MNCS providers. Management of the distribution of MNCS providers can be used to enhance spatial access to health services and reduce the risk of neonatal mortality and morbidity. This method may provide a sustainable healthcare solution at the policy and decision-making level for regional, or even universal, healthcare networks.
Summary

Citations

Citations to this article as recorded by  
  • Epidemiology and Clinical Features of COVID-19 among 4,015 Neonates in Iran: Results of the National Study from the Iranian Maternal and Neonatal Network
    David A. Schwartz, Parisa Mohagheghi, Fereshteh Moshfegh, Nazanin Zafaranloo, Narjes Khalili, Mohammad Heidarzadeh, Abbas Habibelahi, Roya Ghafoury, Fatemeh Afrashteh
    American Journal of Perinatology.2024; 41(S 01): e1698.     CrossRef
  • Global burden and inequality of maternal and neonatal disorders: based on data from the 2019 Global Burden of Disease study
    R Peng, Y Tong, M Yang, J Wang, L Yang, J Zhu, Yu Liu, H Wang, Z Shi, Ya Liu
    QJM: An International Journal of Medicine.2024; 117(1): 24.     CrossRef
  • Multi-objective mammography unit location–allocation problem: A case study
    Marcos Vinícius Andrade de Campos, Romário dos Santos Lopes de Assis, Marcone Jamilson Freitas Souza, Eduardo Camargo de Siqueira, Maria Amélia Lopes Silva, Sérgio Ricardo de Souza
    Operations Research for Health Care.2024; 41: 100430.     CrossRef
  • An integrated location–allocation model for reducing disparities and increasing accessibility to public health screening centers
    João Flávio de Freitas Almeida, Lásara Fabrícia Rodrigues, Luiz Ricardo Pinto, Francisco Carlos Cardoso de Campos
    Healthcare Analytics.2024; 6: 100349.     CrossRef
  • Association Between Maternal Co-morbidities and Cesarean Delivery Outcomes: A Retrospective Study
    Sara Farzadi, Fatemeh Hosseinzadeh, Soheil Soltanipour, Samaneh Ghazanfar Tehran, Maryam Kounani, Mahin Tayefeh Ashrafiyeh, Gelareh Biazar
    Modern Care Journal.2024;[Epub]     CrossRef
  • Enhancing geographical access to cardiovascular disease healthcare services in Lagos State, Nigeria
    Oluwaseun Addie, Olalekan John Taiwo
    Open Health.2024;[Epub]     CrossRef
  • An optimization model for equitable accessibility to magnetic resonance imaging technology in developing countries
    João Flávio de Freitas Almeida, Samuel Vieira Conceição, Virgínia Silva Magalhães
    Decision Analytics Journal.2022; 4: 100105.     CrossRef
Special Articles
Measuring the Burden of Disease in Korea, 2008-2018
Yoon-Sun Jung, Young-Eun Kim, Hyesook Park, In-Hwan Oh, Min-Woo Jo, Minsu Ock, Dun-Sol Go, Seok-Jun Yoon
J Prev Med Public Health. 2021;54(5):293-300.   Published online September 30, 2021
DOI: https://doi.org/10.3961/jpmph.21.478
  • 8,682 View
  • 457 Download
  • 26 Web of Science
  • 30 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
The study aims to examine the current status and differences in the burden of disease in Korea during 2008-2018. We calculated the burden of disease for Koreans from 2008 to 2018 using an incidence-based approach. Disability adjusted life years (DALYs) were expressed in units per 100 000 population by adding years of life lost (YLLs) and years lived with disability (YLDs). DALY calculation results were presented by gender, age group, disease, region, and income level. To explore differences in DALYs by region and income level, we used administrative district and insurance premium information from the National Health Insurance Service claims data. The burden of disease among Koreans showed an increasing trend from 2008 to 2018. By 2017, the burden of disease among men was higher than that among women. Diabetes mellitus, low back pain, and chronic lower respiratory disease were ranked high in the burden of disease; the sum of DALY rates for these diseases accounted for 18.4% of the total burden of disease among Koreans in 2018. The top leading causes associated with a high burden of disease differed slightly according to gender, age group, and income level. In this study, we measured the health status of Koreans and differences in the population health level according to gender, age group, region, and income level. This data can be used as an indicator of health equity, and the results derived from this study can be used to guide community-centered (or customized) health promotion policies and projects, and for setting national health policy goals.
Summary
Korean summary
이 논문에서는 장애보정생존년수라는 지표를 활용하여 2008-2018년 한국인의 질병부담 산출결과를 제시하였으며, 성별·연령군별·질환별 질병부담 수준의 차이 뿐만 아니라 지역 및 소득수준의 사회경제적 수준에 따른 질병부담의 격차도 함께 제시하였다.

Citations

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  • Widening disparities in the national prevalence of diabetes mellitus for people with disabilities in South Korea
    I. Hwang, S.Y. Kim, Y.Y. Kim, J.H. Park
    Public Health.2024; 226: 173.     CrossRef
  • Trends in Healthy Life Expectancy (HALE) and Disparities by Income and Region in Korea (2008–2020): Analysis of a Nationwide Claims Database
    Yoon-Sun Jung, Young-Eun Kim, Minsu Ock, Seok-Jun Yoon
    Journal of Korean Medical Science.2024;[Epub]     CrossRef
  • Measuring the Burden of Disease in Korea Using Disability-Adjusted Life Years (2008–2020)
    Yoon-Sun Jung, Young-Eun Kim, Minsu Ock, Seok-Jun Yoon
    Journal of Korean Medical Science.2024;[Epub]     CrossRef
  • Opioid Prescription and Long-term Survival Outcomes in Adults: A Nationwide Cohort Study in Korea
    Tak Kyu Oh, In-Ae Song
    Journal of Korean Medical Science.2024;[Epub]     CrossRef
  • Changes in tuberculosis burden and its associated risk factors in Guizhou Province of China during 2006–2020: an observational study
    Yun Wang, Huijuan Chen, Xiaoqi Zeng, Long Liao, Xiaolong Lu, Aihua Zhang
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  • Burden and Regional Disparities in the Firearm Mortality Profiles in Brazil: A Systematic Analysis of Findings From the Global Burden of Disease 2019
    Paula Protti, Beatriz Remondes Sequeira, Luiza Morais de Oliveira, Francisco Winter dos Santos Figueiredo
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  • Trends of Gaps Between Health-Adjusted Life Expectancy and Life Expectancy at the Regional Level in Korea Using a Group-Based Multi-Trajectory Modeling Approach (2008–2019)
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    Journal of Korean Medical Science.2024;[Epub]     CrossRef
  • Accuracy assessment of patient safety incident (PSI) codes and present-on-admission (POA) indicators: a cross-sectional analysis using the Patient Safety Incidents Inquiry (PSII) in Korea
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    BMC Health Services Research.2024;[Epub]     CrossRef
  • Use of Herbal Decoction and Pharmacopuncture in Individuals with Chronic Disease: findings from a nationally representative panel
    Chan-Young Kwon, Sunghun Yun, Bo-Hyoung Jang, Il-Su Park
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  • Korean National Burden of Disease: The Importance of Diabetes Management
    Chung-Nyun Kim, Yoon-Sun Jung, Young-Eun Kim, Minsu Ock, Seok-Jun Yoon
    Diabetes & Metabolism Journal.2024; 48(4): 518.     CrossRef
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    Junghyun Kwon
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    Yoon-Sun Jung, Seok-Jun Yoon
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  • Relevance Index Regional Variation by Each Disease and Its Essential Medical Field: A Retrospective Data Analysis From 2016-2020 in Korea
    Young-Eun Kim, Jeehee Pyo, Haneul Lee, HyeRan Jeong, Young-Kwon Park, Jeong-Wook Seo, Minsu Ock, Seok-Jun Yoon
    Journal of Korean Medical Science.2023;[Epub]     CrossRef
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    Life Cycle.2023;[Epub]     CrossRef
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    Ji Eun Park, Saerom Kim, Myoung-Hee Kim, Taemi Kim, Seung-Ah Choe, Hye Sook Min
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    Jenny Moon, Yeeun Seo, Hyeok-Hee Lee, Hokyou Lee, Fumie Kaneko, Sojung Shin, Eunji Kim, Kyu Sun Yum, Young Dae Kim, Jang-Hyun Baek, Hyeon Chang Kim
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    Young-Eun Kim, Yoon-Sun Jung, Minsu Ock, Seok-Jun Yoon
    Journal of Preventive Medicine and Public Health.2022; 55(1): 10.     CrossRef
  • A Review of the Types and Characteristics of Healthy Life Expectancy and Methodological Issues
    Young-Eun Kim, Yoon-Sun Jung, Minsu Ock, Seok-Jun Yoon
    Journal of Preventive Medicine and Public Health.2022; 55(1): 1.     CrossRef
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    Tae Eung Kim, Ru-Gyeom Lee, So-Youn Park, In-Hwan Oh
    Journal of Preventive Medicine and Public Health.2022; 55(1): 19.     CrossRef
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    Yoon-Sun Jung, Seok-Jun Yoon
    International Journal of Environmental Research and Public Health.2022; 19(6): 3493.     CrossRef
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    Hyunkyu Kim, Seung Hoon Kim, Sung-In Jang, Eun-Cheol Park
    Journal of Preventive Medicine and Public Health.2022; 55(2): 173.     CrossRef
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    Kyungsik Kim, June Young Choi, Su-jin Kim, Eun Kyung Lee, Young Ki Lee, Jun Sun Ryu, Kyu Eun Lee, Jae Hoon Moon, Young Joo Park, Sun Wook Cho, Sue K. Park
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  • Projection of Cancer Incidence and Mortality From 2020 to 2035 in the Korean Population Aged 20 Years and Older
    Youjin Hong, Sangjun Lee, Sungji Moon, Soseul Sung, Woojin Lim, Kyungsik Kim, Seokyung An, Jeoungbin Choi, Kwang-Pil Ko, Inah Kim, Jung Eun Lee, Sue K. Park
    Journal of Preventive Medicine and Public Health.2022; 55(6): 529.     CrossRef
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The National Health Plan 2030: Its Purpose and Directions of Development
Yumi Oh
J Prev Med Public Health. 2021;54(3):173-181.   Published online May 7, 2021
DOI: https://doi.org/10.3961/jpmph.21.198
  • 4,998 View
  • 161 Download
  • 15 Web of Science
  • 19 Crossref
AbstractAbstract AbstractSummary PDF
The National Health Plan 2030 (HP2030) started to be prepared in 2017 and was completed and announced in December 2020. This study presents an overview of how it was established, the major changes in policies, its purpose, and future directions. This study analyzed the steps taken in the past 4 years to establish HP2030 and reviewed major issues at the international and governmental levels based on an evaluation of HP2020 and its content. HP2030 establishes 6 divisions and 28 topic areas, and it will continue to expand investments in health with a total budget of 2.5 trillion Korean won. It also established goals to enhance health equity for the first time, with the goal of calculating healthy life expectancy in a way that reflects the circumstances of Korea and reducing the gap in income and healthy life expectancy between regions. The establishment of HP2030 is significant in that it constitutes a sustainable long-term plan with sufficient preparation, contains policy measures that everyone participates in and makes together, and works towards improvements in universal health standards and health equity. With the announcement of HP2030, which includes goals and directions of the national health policy for the next 10 years, it will be necessary to further strengthen collaboration with relevant ministries, local governments, and agencies in various fields to concretize support for prevention-centered health management as a national task and to develop a health-friendly environment that considers health in all policy areas.
Summary
Korean summary
본 연구는 지난 17년부터 4년간 준비한 국민건강증진종합계획2030이 발표됨에 따라 수립경과와 주요 변화정책을 분석하고, 수립의 의의를 검토하여 향후 추진방향을 제시하고자 한다. 국민건강증진종합계획2030의 수립은 충분한 준비기간을 통한 지속가능한 중장기 계획의 수립, 모든 사람에 함께 참여하고 만들어가는 정책으로서의 전환, 보편적인 건강수준 향상과 건강형평성 제고를 했다는데 그 의의가 있다 향후 10년간의 국가 건강정책의 목표와 방향을 담은 HP2030 발표를 계기로, 모든 정책 영역에서 건강을 고려하는 건강친화적 환경 구축을 위해 관련 부처와 지자체, 다양한 분야의 주체들과 협력을 강화해야 하겠다.

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COVID-19: Special Article
Mainstreaming of Health Equity in Infectious Disease Control Policy During the COVID-19 Pandemic Era
Hongjo Choi, Seong-Yi Kim, Jung-Woo Kim, Yukyung Park, Myoung-Hee Kim
J Prev Med Public Health. 2021;54(1):1-7.   Published online January 15, 2021
DOI: https://doi.org/10.3961/jpmph.20.593
  • 6,190 View
  • 316 Download
  • 8 Web of Science
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AbstractAbstract AbstractSummary PDF
The Korean government’s strategy to combat coronavirus disease 2019 (COVID-19) has focused on non-pharmaceutical interventions, such as social distancing and wearing masks, along with testing, tracing, and treatment; overall, its performance has been relatively good compared to that of many other countries heavily affected by COVID-19. However, little attention has been paid to health equity in measures to control the COVID-19 pandemic. The study aimed to examine the unequal impacts of COVID-19 across socioeconomic groups and to suggest potential solutions to tackle these inequalities. The pathways linking social determinants and health could be entry points to tackle the unequal consequences of this public health emergency. It is crucial for infectious disease policy to consider social determinants of health including poor housing, precarious working conditions, disrupted healthcare services, and suspension of social services. Moreover, the high levels of uncertainty and complexity inherent in this public health emergency, as well as the health and socioeconomic inequalities caused by the pandemic, underscore the need for good governance other than top-down measures by the government. We emphasize that a people-centered perspective is a key approach during the pandemic era. Mutual trust between the state and civil society, strong accountability of the government, and civic participation are essential components of cooperative disaster governance.
Summary
Korean summary
"이 연구는 코로나19 대유행이 건강불평등에 미치는 영향을 검토하고, 불평등 완화 방안을 제시하고자 한다. 건강의 사회적 결정요인은 코로나19와 건강불평등을 이해하기 위한 출발점이다. 건강의 사회적 결정요인은 코로나19 감염과 그로 인한 사망 등 직접영향 경로와 코로나19 대응과정의 문제로 건강불평등을 야기하는 간접영향 경로에 모두 관여한다. 공중보건위기로 인한 건강불평등을 줄이기 위해서는 시민참여를 통한 협력적 거버넌스 강화와 모든 건강정책에서 사람중심돌봄의 관점을 견지하는 것이 필요하다."

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Original Articles
Household Overcrowding in Iran, a Low-middle-income Country: How Major of a Public Health Concern Is It?
Leila Jansar Hosseini, Ali Hussein Samadi, Abraha Woldemichael, Masoumeh Najaf Gharebelagh, Satar Rezaei, Enayatollah Homaie Rad
J Prev Med Public Health. 2021;54(1):73-80.   Published online January 11, 2021
DOI: https://doi.org/10.3961/jpmph.20.568
  • 4,864 View
  • 126 Download
  • 5 Web of Science
  • 3 Crossref
AbstractAbstract PDFSupplementary Material
Objectives
Household overcrowding (HC) can contribute to both physical and mental disorders among the members of overcrowded households. This study aimed to measure the status of HC and its main determinants across the provinces of Iran.
Methods
Data from 39 864 households from the 2016 Iranian Household Income and Expenditures Survey were used in this study. The Equivalized Crowding Index (ECI) and HC index were applied to measure the overcrowding of households. Regression models were estimated to show the relationships between different variables and the ECI.
Results
The overall, urban, and rural prevalence of HC was 8.2%, 6.3%, and 10.1%, respectively. The highest prevalence of HC was found in Sistan and Baluchestan Province (28.7%), while the lowest was found in Guilan Province (1.8%). The number of men in the household, rural residency, the average age of household members, yearly income, and the household wealth index were identified as the main determinants of the ECI and HC.
Conclusions
The study demonstrated that the ECI and HC were higher in regions near the borders of Iran than in other regions. Therefore, health promotion and empowerment strategies are required to avoid the negative consequences of HC, and screening programs are needed to identify at-risk families.
Summary

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  • Social determinants of health and diabetes: Results from a cohort study in Iran
    SeyedJalal Hashemi, Mehrnoosh Jasemzadeh, Nader Saki, Bahman Cheraghian, Sara Sarvandian, Ali Montazeri, Maedeh Raeisizadeh, Marzieh Araban
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Measuring and Decomposing Socioeconomic Inequalities in Adult Obesity in Western Iran
Farid Najafi, Yahya Pasdar, Behrooz Hamzeh, Satar Rezaei, Mehdi Moradi Nazar, Moslem Soofi
J Prev Med Public Health. 2018;51(6):289-297.   Published online October 29, 2018
DOI: https://doi.org/10.3961/jpmph.18.062
  • 7,340 View
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  • 17 Crossref
AbstractAbstract PDF
Objectives
Obesity is a considerable and growing public health concern worldwide. The present study aimed to quantify socioeconomic inequalities in adult obesity in western Iran.
Methods
A total of 10 086 participants, aged 35-65 years, from the Ravansar Non-communicable Disease Cohort Study (2014-2016) were included in the study to examine socioeconomic inequalities in obesity. We defined obesity as a body mass index ≥30 kg/m2 . The concentration index and concentration curve were used to illustrate and measure wealth-related inequality in obesity. Additionally, we decomposed the concentration index to identify factors that explained wealth-related inequality in obesity.
Results
Overall, the prevalence of obesity in the total sample was 26.7%. The concentration index of obesity was 0.04; indicating that obesity was more concentrated among the rich (p<0.001). Decomposition analysis indicated that wealth, place of residence, and marital status were the main contributors to the observed inequality in obesity.
Conclusions
Socioeconomic-related inequalities in obesity among adults warrant more attention. Policies should be designed to reduce both the prevalence of obesity and inequalities in obesity by focusing on those with higher socioeconomic status, urban residents, and married individuals.
Summary

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The Role of Social Support and the Neighborhood Environment on Physical Activity in Low-income, Mexican-American Women in South Texas
Jennifer J. Salinas, Marisol McDaniel, Deborah Parra-Medina
J Prev Med Public Health. 2018;51(5):234-241.   Published online July 25, 2018
DOI: https://doi.org/10.3961/jpmph.18.052
  • 6,244 View
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  • 9 Crossref
AbstractAbstract PDF
Objectives
To determine the relationships between physical activity (PA), the neighborhood environment support for PA, and social support for PA among Mexican-American women living in South Texas. The Enlace study was a randomized controlled trial that tested the effectiveness of a promotora-led PA intervention among low-income Mexican origin women (n=614) living in colonias.
Methods
The dependent measures included accelerometer-measured average moderate to vigorous physical activity (MVPA) and sedentary breaks and the Community Health Activities Model Program for Seniors PA 41-item questionnaire. The independent measures included the Physical Activity and Neighborhood Environment Scale (PANES) and the 13-item Physical Activity Social Support (PASS) scale.
Results
Enlace participants were on average 40.4 (standard deviation, 10.3) years old, born in Mexico (86.1%), and uninsured (83.1%). Adjusted linear regression results indicated that each 1-point increment in the PANES overall score was associated with 0.050 (p<0.001) unit increase in sedentary break and a −0.043 (p=0.001) unit decrease in sedentary break duration. Both PANES (β=0.296; p=0.002) and PASS scores (β=0.076; p<0.001) were associated with weekly average self-reported MVPA. Interaction effects were observed between PASS scores and accelerometer-measured frequency of sedentary breaks and sedentary time duration.
Conclusions
The findings of this study indicate that the relationships between PA and built environment and social support are measure-dependent and suggest that reducing sedentary time in this population may require a closer assessment of social support for PA.
Summary

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    International Journal of Behavioral Nutrition and Physical Activity.2024;[Epub]     CrossRef
  • Bridging the Built and Social Environments: A Systematic Review of Studies Investigating Influences on Physical Activity
    Tyler Prochnow, Laurel S. Curran, Christina Amo, Meg S. Patterson
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Effects of Iranian Economic Reforms on Equity in Social and Healthcare Financing: A Segmented Regression Analysis
Hamed Zandian, Amirhossein Takian, Arash Rashidian, Mohsen Bayati, Telma Zahirian Moghadam, Satar Rezaei, Alireza Olyaeemanesh
J Prev Med Public Health. 2018;51(2):83-91.   Published online February 6, 2018
DOI: https://doi.org/10.3961/jpmph.17.050
  • 11,422 View
  • 203 Download
  • 11 Crossref
AbstractAbstract PDF
Objectives
One of the main objectives of the Targeted Subsidies Law (TSL) in Iran was to improve equity in healthcare financing. This study aimed at measuring the effects of the TSL, which was implemented in Iran in 2010, on equity in healthcare financing. Methods: Segmented regression analysis was applied to assess the effects of TSL implementation on the Gini and Kakwani indices of outcome variables in Iranian households. Data for the years 1977-2014 were retrieved from formal databases. Changes in the levels and trends of the outcome variables before and after TSL implementation were assessed using Stata version 13. Results: In the 33 years before the implementation of the TSL, the Gini index decreased from 0.401 to 0.381. The Gini index and its intercept significantly decreased to 0.362 (p<0.001) 5 years after the implementation of the TSL. There was no statistically significant change in the gross domestic product or inflation rate after TSL implementation. The Kakwani index significantly increased from -0.020 to 0.007 (p<0.001) before the implementation of the TSL, while we observed no statistically significant change (p=0.81) in the Kakwani index after TSL implementation. Conclusions: The TSL reform, which was introduced as part of an economic development plan in Iran in 2010, led to a significant reduction in households’ income inequality. However, the TSL did not significantly affect equity in healthcare financing. Hence, while measuring the long-term impact of TSL is paramount, healthcare decision-makers need to consider the efficacy of the TSL in order to develop plans for achieving the desired equity in healthcare financing.
Summary

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  • 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
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  • Socio-economic inequality in prevalence of type 2 diabetes among adults in north-west of Iran: a Blinder-Oaxaca decomposition
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Socioeconomic Inequalities in the Oral Health of People Aged 15-40 Years in Kurdistan, Iran in 2015: A Cross-sectional Study
Ghobad Moradi, Ardavan Moinafshar, Hemen Adabi, Mona Sharafi, Farideh Mostafavi, Amjad Mohamadi Bolbanabad
J Prev Med Public Health. 2017;50(5):303-310.   Published online July 25, 2017
DOI: https://doi.org/10.3961/jpmph.17.035
  • 7,404 View
  • 193 Download
  • 16 Crossref
AbstractAbstract PDF
Objectives
The aim of this study was to evaluate socioeconomic inequalities in the prevalence of dental caries among an urban population. Methods: This study was conducted among 2000 people 15-40 years of age living in Kurdistan, Iran in 2015. Using a questionnaire, data were collected by 4 trained dental students. The dependent variable was the decayed, missing, and filled teeth (DMF) index. Using principal component analysis, the socioeconomic status (SES) of families was determined based on their household assets. Inequality was measured using the concentration index; in addition, the Oaxaca analytical method was used to determine the contribution of various determinants to the observed inequality. Results: The concentration index for poor scores on the DMF index was -0.32 (95% confidence interval [CI], -0.40 to -0.36); thus, poor DMF indices had a greater concentration in groups with a low SES (p<0.001). Decomposition analysis showed that the mean prevalence of a poor DMF index was 43.7% (95% CI, 40.4 to 46.9%) in the least privileged group and 14.4% (95% CI, 9.5 to 9.2%) in the most privileged group. It was found that 85.8% of the gap observed between these groups was due to differences in sex, parents’ education, and the district of residence. A poor DMF index was less prevalent among people with higher SES than among those with lower SES (odds ratio, 0.31; 95% CI, 0.19 to 0.52). Conclusions: An alarming degree of SES inequality in oral health status was found in the studied community. Hence, it is suggested that inequalities in oral health status be reduced via adopting appropriate policies such as the delivery of oral health services to poorer groups and covering such services in insurance programs.
Summary

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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
DOI: https://doi.org/10.3961/jpmph.2013.46.5.237
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AbstractAbstract PDF
Objectives

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.

Methods

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.

Results

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.

Conclusions

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.

Summary

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Geographical distribution of physician manpower by specialty and care level.
Seung Hum Yu, Sang Hyuk Jung, Byung Yool Cheon, Tae Yong Shn, Hyohn Joo Oh
Korean J Prev Med. 1993;26(4):661-671.
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AbstractAbstract PDF
In order to compare the geographical distribution of physician by level of medical care and specialty, a log linear model was applied to the annual registration data of the Korean Medical Association as of the end of December, 1991 which was supplemented from related institutions and adjusted with relevant sources. Those physicians in primary and secondary care institutions were not statistically significantly unevenly distributed by province-level catchment area. There were some differences in physician distribution among big cities, medium and small-sized cities, and counties; however, those physicians for primary care level were equitably distributed between cities and counties. Specialties for secondary care physicians were less evenly distributed in county areas than in city areas, and generalists are distributed more evenly in cities and counties than in big cities. There is a certain limitation due to underregistration in the annual physician registration to the Korean Medical Association; however, the geographical distribution of physicians has been improved quantitatively. It is strongly suggested that specialties and the level of medical care should be considered for further physician manpower studies.
Summary
A Study on the Insurance Contribution and Health Care Utilization of the Regional Medical Insurance Scheme.
Sang Il Lee, Hyun Rim Choi, Hyeong Sik Ahn, Yong Ik Kim, Young Soo Shin
Korean J Prev Med. 1989;22(4):578-590.
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AbstractAbstract PDF
This study was conducted to assess the equity in the regional insurance scheme through analysis of the computerized data from one regional insurance society and National Federation of Medical Insurance. We analysed the insurance contribution and benefit by the classes based on total and income-related contribution per household. The major findings of this study are as follows: 1. The average proportion of income-related contribution among the total was 39.2% and the upper classes show higher proportion of the income-related contribution. 2. The upper classes show higher health care utilization rate than the lower classes. It suggests that the lower classes have relatively large unmet medical needs. 3. The analysis through the Lorenz curve reveals that there exists transference of contributions from the upper to lower classes. But the cumulative percentage of insurance benefit is smaller than that of the number of the insured. It implies that regional medical insurance scheme in Korea has still some inequity in the context of social security principles.
Summary
English Abstract
Changes in Distributive Equity of Health Insurance Contribution Burden.
Hee Chung Kang, Eun Cheol Park, Kyu Sik Lee, Tae Kyu Park, Woo Jin Chung, Han Joong Kim
J Prev Med Public Health. 2005;38(1):107-116.
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AbstractAbstract PDF
OBJECTIVES
We analyzed the changes from 1996 to 2002 in distributive equity of the contribution burden in the Korean National Health Insurance. METHODS: The study subjects were a total of 8, 923 employee households and a total of 7, 296 self-employed households over the period from 1996 to 2002. Those were the households meeting the two criteria as completing each annual survey and having no change in the job of head of the household during that period from the raw data of the Household Income and Expenditure Survey annually conducted by the Korean National Statistical Office. The unit of analysis was a household, and this was the standard for assessing the contribution that is now applied on a monthly basis. Deciles Distribution Ratio, Contribution Concentration Curve and Contribution Concentration Index were estimated as the index of inequality. Multiple regression analysis was conducted to compare the annual ability-to-pay elasticity of the contribution to the reference year of 1996 for three groups (all households, the employee households, and the self-employed households). RESULTS: For the index of inequality, the distributive equity of contribution was improved in all three groups. In particular, the employee group experienced a substantial improvement. Using multiple regression analysis, the ability-to-pay elasticity of the contribution in the employee group significantly increased ( beta=0.232, p< 0.0001) in the year 2002 as compared to the reference year of 1996. The elasticity in the self-employed group also significantly increased ( beta=0.186, p< 0.05), although its change was smaller than that in the employee group. CONCLUSIONS: The employee group had a greater improvement for the distributive equity of the contribution burden than the self-employed group. Within the observation period, there were two important integration reforms: one was the integration of 227 self-employed societies in 1998 and the other was the integration of 139 employee societies in 2000. We expected that the equity of the contribution burden would be improved for the self-employed group since the integration reform of 1998. However, it was not improved for the self-employed group until the year 2000. This result suggests that capturing exactly the beneficiaries' ability-to-pay such as income is the precedent for distributive equity of the contribution burden, although a more sophisticated imposition standard of contribution is needed.
Summary

JPMPH : Journal of Preventive Medicine and Public Health
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