Journal of Preventive Medicine and Public Health

Original Articles

Inequality in Private Health Care Expenditures: A 36-Year Trend Study of Iranian Households: Ehsan Aghapour, Mehdi Basakha, Seyed Hossein Mohaqeqi Kamal, Abolghasem Pourreza; J Prev Med Public Health. 2022;55(4):379-388. Published online June 27, 2022; DOI: https://doi.org/10.3961/jpmph.22.123

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Objectives
Throughout history, societies have been impacted by inequality. Many studies have been conducted on the topic more broadly, but only a few have investigated inequalities in out-of-pocket health payments (OHP). This study measures OHP inequality trends among the Iranian households.
Methods
This study used data from the Iranian Statistics Center on Iranian household income and expenditures. The analysis included a total of 995 300 households during the 36 years from 1984 to 2019. The Gini coefficient, Atkinson index, and Theil index were calculated for Iranian OHP.
Results
Average Iranian household OHP increased from 33 US dollar (USD) in 1984 to 47 USD in 2019. During this 36-year span, the average±standard deviation Gini coefficient for OHP was 0.73±0.04, and the Atkinson and Theil indexes were 0.68±0.05 and 1.14±0.29, respectively. The Gini coefficients for the subcategories of OHP of outpatient diagnostic services, medical assistant accessories, hospital inpatient services, and addiction cessation were 0.70, 0.61, 0.84, and 0.64, respectively.
Conclusions
In this study, we scrutinized trends of inequality in the OHP of Iranian households. Inequality in OHP decreased slightly over the past four decades. An analysis of trends among different subgroups revealed that affluent households, such as households with insurance coverage and households in higher income deciles, experienced higher inequality. Therefore, lower inequality in health care expenditures may be related to restricted access to health care services in Iran.

Summary

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Decomposition of Healthcare Utilization Inequality in Iran: The Prominent Role of Health Literacy and Neighborhood Characteristics
Neda Soleimanvandiazar, Seyed Hossein Mohaqeqi Kamal, Mehdi Basakha, Salah Eddin Karimi, Sina Ahmadi, Gholamreza Ghaedamini Harouni, Homeira Sajjadi, Ameneh Setareh Forouzan
INQUIRY: The Journal of Health Care Organization, Provision, and Financing.2024;[Epub] CrossRef

Analysis of Differences in Preterm Birth Rates According to Household Occupation in Japan From 2007 to 2019: Tasuku Okui, Naoki Nakashima; J Prev Med Public Health. 2022;55(4):371-378. Published online June 20, 2022; DOI: https://doi.org/10.3961/jpmph.22.178

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Abstract PDF

Objectives
No studies have examined the association between preterm birth rates and socioeconomic factors in Japan using nationwide statistical data. We analyzed the association between preterm birth rates and household occupation using Vital Statistics data.
Methods
Aggregated Vital Statistics data from Japan from 2007 to 2019 were obtained from the Ministry of Health, Labour and Welfare. From the data, the number of births according to year, age group, gestational period, number of pregnancies, and household occupation were used in this study. Crude preterm birth rates and preterm birth rates adjusted by maternal age according to household occupation were calculated for each year. Poisson regression analysis was conducted to evaluate the association between household occupation and preterm births.
Results
Unemployed households had the highest preterm birth rate, and households with an occupation classification of “full-time worker 2” (an employee at a large company, civil servant, or board member) had the lowest preterm birth rate throughout each period. Poisson regression analysis revealed that unemployed households were statistically significantly associated with a high preterm birth risk. In contrast, the preterm birth rate adjusted by maternal age remained stable throughout each period regardless of household occupation, and preterm birth rates were found not to have increased in recent years in Japan.
Conclusions
Unemployed households had higher preterm birth rates than other household occupations. Further studies investigating the characteristics of unemployed households are needed to identify the reasons for this disparity.

Summary

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Analysis of an Association between Preterm Birth and Parental Educational Level in Japan Using National Data
Tasuku Okui
Children.2023; 10(2): 342. CrossRef
Association of maternal nationality with preterm birth and low birth weight rates: analysis of nationwide data in Japan from 2016 to 2020
Tasuku Okui, Yoko Sato, Seiichi Morokuma, Naoki Nakashima
Maternal Health, Neonatology and Perinatology.2023;[Epub] CrossRef
Does the father’s job matter? Parental occupation and preterm birth in Korea
Taemi Kim, Eunseon Gwak, Bolormaa Erdenetuya, Jeong-Won Oh, Jung-won Yoon, Myoung-Hee Kim, Jia Ryu, Seung-Ah Choe
Epidemiology and Health.2023; 45: e2023078. 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; J Prev Med Public Health. 2022;55(3):297-306. Published online May 3, 2022; DOI: https://doi.org/10.3961/jpmph.22.051

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Abstract PDF Supplementary Material

Objectives
The incidence of cardiovascular disease (CVD) mortality is increasing in developing countries. This study aimed to decompose the socioeconomic inequality of CVD in Iran.
Methods
This cross-sectional population-based study was conducted on 20 519 adults who enrolled in the Ardabil Non-Communicable Disease cohort study. Principal component analysis and multivariable logistic regression were used, respectively, to estimate socioeconomic status and to describe the relationships between CVD prevalence and the explanatory variables. The relative concentration index, concentration curve, and Blinder-Oaxaca decomposition model were used to measure and decompose the socioeconomic inequality.
Results
The overall age-adjusted prevalence of CVD was 8.4% in northwest Iran. Multivariable logistic regression showed that older adults, overweight or obese adults, and people with hypertension and diabetes were more likely to have CVD. Moreover, people with low economic status were 38% more likely to have CVD than people with high economic status. The prevalence of CVD was mainly concentrated among the poor (concentration index, -0.077: 95% confidence interval, -0.103 to -0.060), and 78.66% of the gap between the poorest and richest groups was attributed to differences in the distribution of the explanatory variables included in the model.
Conclusions
The most important factors affecting inequality in CVD were old age, chronic illness (hypertension and diabetes), marital status, and socioeconomic status. This study documented stark inequality in the prevalence of CVD, wherein the poor were more affected than the rich. Therefore, it is necessary to implement policies to monitor, screen, and control CVD in poor people living in northwest Iran.

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A Global Perspective on Socioeconomic Determinants of Cardiovascular Health
Bart Wilder, Alejandro Pinedo, Salaheldin Abusin, David Ansell, Adrian Matias Bacong, James Calvin, Sung Whoy Cha, Rami Doukky, Faisal Hasan, Shengyuan Luo, Ahmet Afşin Oktay, Latha Palaniappan, Natasha Rana, Frederick Berro Rivera, Basmah Fayaz, Ahmed Al
Canadian Journal of Cardiology.2024;[Epub] CrossRef

Socioeconomic Predictors of Diabetes Mortality in Japan: An Ecological Study Using Municipality-specific Data: Tasuku Okui; J Prev Med Public Health. 2021;54(5):352-359. Published online August 14, 2021; DOI: https://doi.org/10.3961/jpmph.21.215

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Objectives
The aim of this study was to examine the geographic distribution of diabetes mortality in Japan and identify socioeconomic factors affecting differences in municipality-specific diabetes mortality.
Methods
Diabetes mortality data by year and municipality from 2013 to 2017 were extracted from Japanese Vital Statistics, and the socioeconomic characteristics of municipalities were obtained from government statistics. We calculated the standardized mortality ratio (SMR) of diabetes for each municipality using the empirical Bayes method and represented geographic differences in SMRs in a map of Japan. Multiple linear regression was conducted to identify the socioeconomic factors affecting differences in SMR. Statistically significant socioeconomic factors were further assessed by calculating the relative risk of mortality of quintiles of municipalities classified according to the degree of each socioeconomic factor using Poisson regression analysis.
Results
The geographic distribution of diabetes mortality differed by gender. Of the municipality-specific socioeconomic factors, high rates of single-person households and unemployment and a high number of hospital beds were associated with a high SMR for men. High rates of fatherless households and blue-collar workers were associated with a high SMR for women, while high taxable income per-capita income and total population were associated with low SMR for women. Quintile analysis revealed a complex relationship between taxable income and mortality for women. The mortality risk of quintiles with the highest and lowest taxable per-capita income was significantly lower than that of the middle-income quintile.
Conclusions
Socioeconomic factors of municipalities in Japan were found to affect geographic differences in diabetes mortality.

Summary

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Worldwide burden and trends of diabetes among people aged 70 years and older, 1990–2019: A systematic analysis for the Global Burden of Disease Study 2019
Shimin Jiang, Tianyu Yu, Dingxin Di, Ying Wang, Wenge Li
Diabetes/Metabolism Research and Reviews.2024;[Epub] CrossRef
The Effect of Neighborhood Deprivation on Mortality in Newly Diagnosed Diabetes Patients: A Countrywide Population-Based Korean Retrospective Cohort Study, 2002–2013
Kyoung-Hee Cho, Juyeong Kim, Young Choi, Tae-Hyun Kim
International Journal of Environmental Research and Public Health.2022; 19(7): 4324. CrossRef
Depression, cognitive dysfunction and other factors associated with 5-year overall mortality in type 2 diabetes mellitus: a pilot prospective observational study
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Diabetes mellitus.2022; 25(4): 327. CrossRef

COVID-19: Original Article

Did the Timing of State Mandated Lockdown Affect the Spread of COVID-19 Infection? A County-level Ecological Study in the United States: Megh M. Trivedi, Anirudha Das; J Prev Med Public Health. 2021;54(4):238-244. Published online July 2, 2021; DOI: https://doi.org/10.3961/jpmph.21.071

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Abstract PDF

Objectives
Previous pandemics have demonstrated that several demographic, geographic, and socioeconomic factors may play a role in increased infection risk. During this current coronavirus disease 2019 (COVID-19) pandemic, our aim was to examine the association of timing of lockdown at the county level and aforementioned risk factors with daily case rate (DCR) in the United States.
Methods
A cross-sectional study using publicly available data was performed including Americans with COVID-19 infection as of May 24, 2020. The United States counties with >100 000 population and >50 cases per 100 000 people were included. The independent variable was the days required from the declaration of lockdown to reach the target case rate (50/100 000 cases) while the dependent (outcome) variable was the DCR per 100 000 on the day of statistical calculation (May 24, 2020) after adjusting for multiple confounding socio-demographic, geographic, and health-related factors. Each independent factor was correlated with outcome variables and assessed for collinearity with each other. Subsequently, all factors with significant association to the outcome variable were included in multiple linear regression models using stepwise method. Models with best R2 value from the multiple regression were chosen.
Results
The timing of mandated lockdown order had the most significant association on the DCR per 100 000 after adjusting for multiple socio-demographic, geographic and health-related factors. Additional factors with significant association with increased DCR include rate of uninsured and unemployment.
Conclusions
The timing of lockdown order was significantly associated with the spread of COVID-19 at the county level in the United States.

Summary

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Predisposing, Enabling, and Reinforcing Factors of COVID-19 Prevention Behavior in Indonesia: A Mixed-methods Study
Putri Winda Lestari, Lina Agestika, Gusti Kumala Dewi
Journal of Preventive Medicine and Public Health.2023; 56(1): 21. CrossRef
Assessing the Impacts of COVID-19 and Social Isolation on Mental Health in the United States of America
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COVID.2023; 3(6): 807. CrossRef
Understanding mental health trends during COVID-19 pandemic in the United States using network analysis
Hiroko Kobayashi, Raul Saenz-Escarcega, Alexander Fulk, Folashade B. Agusto, Karina Cardoso Meira
PLOS ONE.2023; 18(6): e0286857. CrossRef
Conspiratorial Ideation Is Associated with Lower Perceptions of Policy Effectiveness: Views from Local Governments during the COVID-19 Pandemic
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Effectiveness of social distancing measures and lockdowns for reducing transmission of COVID-19 in non-healthcare, community-based settings
Caitriona Murphy, Wey Wen Lim, Cathal Mills, Jessica Y. Wong, Dongxuan Chen, Yanmy Xie, Mingwei Li, Susan Gould, Hualei Xin, Justin K. Cheung, Samir Bhatt, Benjamin J. Cowling, Christl A. Donnelly
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Effects of Closures and Openings on Public Health in the Time of COVID-19: A Cross-Country and Temporal Trend Analysis
Long Chu, R. Quentin Grafton, Tom Kompas, Mary-Louise McLaws
SAGE Open.2023;[Epub] CrossRef
Association mining based approach to analyze COVID-19 response and case growth in the United States
Satya Katragadda, Raju Gottumukkala, Ravi Teja Bhupatiraju, Azmyin Md. Kamal, Vijay Raghavan, Henry Chu, Ramesh Kolluru, Ziad Ashkar
Scientific Reports.2021;[Epub] CrossRef

COVID-19: Brief Report

Association of Lower Socioeconomic Status and SARS-CoV-2 Positivity in Los Angeles, California: Lao-Tzu Allan-Blitz, Cameron Goldbeck, Fred Hertlein, Isaac Turner, Jeffrey D. Klausner; J Prev Med Public Health. 2021;54(3):161-165. Published online April 13, 2021; DOI: https://doi.org/10.3961/jpmph.21.126

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Abstract PDF

Objectives
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spreads heterogeneously, disproportionately impacting poor and minority communities. The relationship between poverty and race is complex, with a diverse set of structural and systemic factors driving higher rates of poverty among minority populations. The factors that specifically contribute to the disproportionate rates of SARS-CoV-2 infection, however, are not clearly understood.
Methods
We evaluated SARS-CoV-2 test results from community-based testing sites in Los Angeles, California, between June and December, 2020. We used tester zip code data to link those results with United States Census report data on average annual household income, rates of healthcare coverage, and employment status by zip code.
Results
We analyzed 2 141 127 SARS-CoV-2 test results, of which 245 154 (11.4%) were positive. Multivariable modeling showed a higher likelihood of SARS-CoV-2 test positivity among Hispanic communities than among other races. We found an increased risk for SARS-CoV-2 positivity among individuals from zip codes with an average annual household income Conclusions
Residence in zip codes with lower average annual household income, lower rates of employment, or lower rates of health insurance was associated with SARS-CoV-2 positivity. Further research is needed into how those factors increase the spread of SARS-CoV-2 infection among populations of lower socioeconomic status in order to develop targeted public health interventions.

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Anna K. Porter, Sarah E. Kleinschmidt, Kara L. Andres, Courtney N. Reusch, Ryan M. Krisko, Oyebode A. Taiwo, Geary W. Olsen, Matthew P. Longnecker
Global Epidemiology.2024; 7: 100137. CrossRef
Bayesian hierarchical spatiotemporal models for prediction of (under)reporting rates and cases: COVID-19 infection among the older people in the United States during the 2020–2022 pandemic
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Spatial and Spatio-temporal Epidemiology.2024; 49: 100658. CrossRef
Detection of SARS-CoV-2 Variants Imported Through Land Borders at the Height of the COVID-19 Pandemic in Ghana, 2022
Ivy A Asante, Charles N Lwanga, Cecilia Takyi, Ama N Sekyi-Yorke, Joseph A Quarcoo, Magdalene A Odikro, Emma E Kploanyi, Irene O Donkor, Adolphina Addo–Lartey , Nyarko A Duah, Daniel A Odumang, Elvis S Lomotey, Linda Boatemaa, Lorreta Kwasah, Step
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Alein Y. Haro‐Ramos, Timothy T. Brown, Julianna Deardorff, Adrian Aguilera, Keshia M. Pollack Porter, Hector P. Rodriguez
Health Services Research.2023; 58(S2): 186. CrossRef
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Yannick Munyeku-Bazitama, Gervais T. Folefack, Marc K. Yambayamba, Paul M. Tshiminyi, Benito M. Kazenza, John O. Otshudiema, Noe Tondri Guinko, Moreau D. Umba, Anastasie Mulumba, Lionel K. Baketana, Patrick K. Mukadi, Chris Smith, Jean-Jacques Muyembe-Tam
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Original Article

Effects of Socio-demographic Factors on the Decreasing Trend in the Sex Ratio at Birth in Korea, 1997-2017: Jisuk Bae; J Prev Med Public Health. 2020;53(5):371-380. Published online August 7, 2020; DOI: https://doi.org/10.3961/jpmph.20.282

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Abstract PDF Supplementary Material: Objectives
This study investigated the effects of socio-demographic factors on the decreasing trend in the sex ratio at birth from 1997 to 2017 in Korea.
Methods
Data from 10 349 602 live births registered with Statistics Korea from 1997 to 2017 were analyzed. The secondary sex ratio (SSR), defined as the ratio of male to female live births, during the study period (1997-1999 [phase I], 2000-2002 [phase II], 2003-2005 [phase III], 2006-2008 [phase IV], 2009-2011 [phase V], 2012-2014 [phase VI], and 2015-2017 [phase VII]) was calculated according to selected socio-demographic factors, such as parental age, education, occupation, and birth order. Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals for a male birth after adjusting for potential confounders.
Results
The SSR gradually decreased from 1.10 (in 1998-2000 and 2002) to 1.05 (in 2013-2016). While a decreasing trend in the SSR was not noted among first births, male-biased sex ratios were prominent among third and higher-order births, for which the highest SSR was 1.46 in 1998. Higher birth order was significantly associated with an excess of male births in phases I-VI (≥third vs. first, OR range, 1.03 to 1.35). Advanced maternal age was significantly associated with an excess of female births in phases II, III, and V (≥40 vs. 20-24 years, OR range, 0.92 to 0.95).
Conclusions
This study demonstrated that advanced maternal age and reduction of the artificially-biased SSR among third and higher-order births may partially explain the decreasing trend in the SSR from 1997 to 2017 in Korea.; Summary

Brief Report

Life Expectancy and Inequalities Therein by Income From 2016 to 2018 Across the 253 Electoral Constituencies of the National Assembly of the Korea: Jinwook Bahk, Hee-Yeon Kang, Young-Ho Khang; J Prev Med Public Health. 2020;53(2):143-148. Published online March 5, 2020; DOI: https://doi.org/10.3961/jpmph.20.050

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Objectives
We calculated life expectancy and inequalities therein by income for the period of 2016-2018 across the 253 electoral constituencies of the 20th National Assembly election in Korea.
Methods
We obtained population and death data between 2016 and 2018 from the National Health Information Database and constructed abridged life tables using standard life table procedures according to gender and income quintiles for the electoral constituencies of the 20th National Assembly election held in 2016.
Results
Life expectancy across the 253 constituencies ranged from 80.51 years to 87.05 years, corresponding to a gap of 6.54 years. The life expectancy difference by income across the 253 constituencies ranged from 2.94 years to 10.67 years. In each province, the difference in life expectancy by income across electoral constituencies was generally greater than the inter-constituency differences. Constituencies in capital and metropolitan areas showed a higher life expectancy and a lower life expectancy difference by income than constituencies in rural areas.
Conclusions
Pro-rich inequalities in life expectancy by income existed in every electoral constituency in Korea. Both intra-constituency and inter-constituency socioeconomic inequalities in health should be highlighted in future policy-making in the National Assembly.

Summary

Korean summary
이 연구는 2016년 치뤄진 제20대 국회의원 선거구 253개에서 2016-2018년의 기대수명을 산출하고, 소득 상위 20%와 소득 하위 20% 간 기대수명 격차를 제시하였다. 연구 결과, 253개 모든 선거구에서 소득 상위 20%가 소득 하위 20%보다 기대수명이 높게 나타났으며, 선거구 내의 소득에 따른 기대수명 격차가 선거구들 간의 기대수명 차이보다 더 큰 경향을 보였다. 기대수명의 선거구 간 격차를 줄이고, 선거구 내의 소득 계층 간 기대수명 격차를 해소하기 위한 입법적 조치를 마련하는 데에 이 연구의 결과가 근거자료로 유용하게 사용되기를 기대한다.

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Spatio-temporal Analysis of District-level Life Expectancy from 2004 to 2017 in Korea
Hwa-Kyung Lim, Hee-Yeon Kang, Ikhan Kim, Young-Ho Khang
Journal of Korean Medical Science.2021;[Epub] CrossRef
Cancer-free Life Expectancy in Small Administrative Areas in South Korea and Its Associations with Regional Health Insurance Premiums
Eunjeong Noh, Hee-Yeon Kang, Jinwook Bahk, Ikhan Kim, Young-Ho Khang
Journal of Korean Medical Science.2021;[Epub] CrossRef
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Review

Measurement of Socioeconomic Position in Research on Cardiovascular Health Disparities in Korea: A Systematic Review: Chi-Young Lee, Yong-Hwan Lee; J Prev Med Public Health. 2019;52(5):281-291. Published online August 14, 2019; DOI: https://doi.org/10.3961/jpmph.19.094

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Abstract PDF

Objectives
The validity of instruments measuring socioeconomic position (SEP) has been a major area of concern in research on cardiovascular health disparities. The purpose of this systematic review is to identify the current status of the methods used to measure SEP in research on cardiovascular health disparities in Korea and to provide directions for future research.
Methods
Relevant articles were obtained through electronic database searches with manual searches of reference lists and no restriction on the date of publication. SEP indicators were categorized into compositional, contextual, composite, and life-course measures.
Results
Forty-eight studies published from 2003 to 2018 satisfied the review criteria. Studies utilizing compositional measures mainly relied on a limited number of SEP parameters. In addition, these measures hardly addressed the time-varying and subjective features of SEP. Finding valid contextual measures at the organizational, community, and societal levels that are appropriate to Korea’s context remains a challenge, and these are rarely modeled simultaneously. Studies have rarely focused on composite and life-course measures.
Conclusions
Future studies should develop and utilize valid compositional and contextual measures and appraise social patterns that vary across time, place, and culture using such measures. Studies should also consider multilevel influences, adding a focus on the interactions between different levels of intertwined SEP factors to advance the design of research. More attention should be given to composite and life-course measures.

Summary

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Sex-specific associations between socioeconomic status and ideal cardiovascular health among Korean adults: The Korea National Health and Nutrition Examination Survey, 2007–2017
Yiyi Yang, Hokyou Lee, Kokoro Shirai, Keyang Liu, Hiroyasu Iso, Hyeon Chang Kim, Wei Wang
PLOS ONE.2024; 19(8): e0307040. CrossRef
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Original Articles

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; DOI: https://doi.org/10.3961/jpmph.19.046

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Abstract PDF

Objectives
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.
Methods
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.
Results
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.
Conclusions
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.

Summary

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Household financial burden associated with out-of-pocket payments for healthcare in Iran: insights from a cross-sectional survey
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BMC Health Services Research.2024;[Epub] 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
Prevalence and determinants of catastrophic healthcare expenditures in Iran from 2013 to 2019
Abdoreza mousavi, Farhad lotfi, Samira Alipour, Aliakbar Fazaeli, Mohsen Bayati
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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
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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
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Unmet dental care need in West of Iran: determinants and inequality
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The impact of out-of pocket payments of households for dental healthcare services on catastrophic healthcare expenditure in Iran
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Trend and status of out-of-pocket payments for healthcare in Iran: equity and catastrophic effect
Satar Rezaei, Abraha Woldemichael, Mohammad Ebrahimi, Sina Ahmadi
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Trends in Inequality in Cigarette Smoking Prevalence by Income According to Recent Anti-smoking Policies in Korea: Use of Three National Surveys: Youngs Chang, Sanghyun Cho, Ikhan Kim, Jinwook Bahk, Young-Ho Khang; J Prev Med Public Health. 2018;51(6):310-319. Published online October 30, 2018; DOI: https://doi.org/10.3961/jpmph.18.225

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Abstract PDF Supplementary Material

Objectives
This study examined trends in inequality in cigarette smoking prevalence by income according to recent anti-smoking policies in Korea.
Methods
The data used in this study were drawn from three nationally representative surveys, the Korea National Health and Nutrition Examination Survey, the Korea Community Health Survey, and the Social Survey of Statistics Korea. We calculated the age-standardized smoking prevalence, the slope index of inequality, and the relative index of inequality by income level as a socioeconomic position indicator.
Results
Smoking prevalence among men decreased during the study period, but the downward trend became especially pronounced in 2015, when the tobacco price was substantially increased. Inequalities in cigarette smoking by income were evident in both genders over the study period in all three national surveys examined. Absolute inequality tended to decrease between 2014 and 2015 among men. Absolute and relative inequality by income decreased between 2008 and 2016 in women aged 30-59, except between 2014 and 2015.
Conclusions
The recent anti-smoking policies in Korea resulted in a downward trend in smoking prevalence among men, but not in relative inequality, throughout the study period. Absolute inequality decreased over the study period among men aged 30-59. A more aggressive tax policy is warranted to further reduce socioeconomic inequalities in smoking in young adults in Korea.

Summary

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Socioeconomic Inequalities in e-Cigarette Use in Korea: Comparison with Inequalities in Conventional Cigarette Use Using Two National Surveys
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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

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Abstract 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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Association of a pro-inflammatory diet with type 2 diabetes and hypertension: results from the Ravansar non-communicable diseases cohort study
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The socio-economic inequality in body mass index: a PERSIAN cohort-based cross-sectional study on 20,000 Iranian adults
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What Explains Socioeconomic Inequality in Health-related Quality of Life in Iran? A Blinder-Oaxaca Decomposition: Satar Rezaei, Mohammad Hajizadeh, Yahya Salimi, Ghobad Moradi, Bijan Nouri; J Prev Med Public Health. 2018;51(5):219-226. Published online August 7, 2018; DOI: https://doi.org/10.3961/jpmph.18.012

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Abstract PDF

Objectives
This study aimed to explain the health-related quality of life (HRQoL) gap between the poorest and the wealthiest quintiles in the capitals of Kermanshah and Kurdistan Provinces (Kermanshah and Sanandaj), in western Iran.
Methods
This was a cross-sectional study conducted among 1772 adults. Data on socio-demographic characteristics, socioeconomic status (SES), lifestyle factors, body mass index, and HRQoL of participants were collected using a self-administered questionnaire. The slope and relative indices of inequality (SII and RII, respectively) were employed to examine socioeconomic inequality in poor HRQoL. Blinder-Oaxaca (BO) decomposition was used to quantify the contribution of explanatory variables to the gap in the prevalence of poor HRQoL between the wealthiest and the poorest groups.
Results
The overall crude and age-adjusted prevalence of poor HRQoL among adults was 32.0 and 41.8%, respectively. The SII and RII indicated that poor HRQoL was mainly concentrated among individuals with lower SES. The absolute difference (%) in the prevalence of poor HRQoL between the highest and lowest SES groups was 28.4. The BO results indicated that 49.9% of the difference was explained by different distributions of age, smoking behavior, physical inactivity, chronic health conditions, and obesity between the highest and lowest SES groups, while the remaining half of the gap was explained by the response effect.
Conclusions
We observed a pro-rich distribution of poor HRQoL among adults in the capitals of Kermanshah and Kurdistan Provinces. Policies and strategies aimed at preventing and reducing smoking, physical inactivity, chronic health conditions, and obesity among the poor may reduce the gap in poor HRQoL between the highest and lowest SES groups in Iran.

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Factors Associated With Subjective Life Expectancy: Comparison With Actuarial Life Expectancy: Jaekyoung Bae, Yeon-Yong Kim, Jin-Seok Lee; J Prev Med Public Health. 2017;50(4):240-250. Published online June 27, 2017; DOI: https://doi.org/10.3961/jpmph.17.036

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Abstract PDF

Objectives
Subjective life expectancy (SLE) has been found to show a significant association with mortality. In this study, we aimed to investigate the major factors affecting SLE. We also examined whether any differences existed between SLE and actuarial life expectancy (LE) in Korea. Methods: A cross-sectional survey of 1000 individuals in Korea aged 20-59 was conducted. Participants were asked about SLE via a self-reported questionnaire. LE from the National Health Insurance database in Korea was used to evaluate differences between SLE and actuarial LE. Age-adjusted least-squares means, correlations, and regression analyses were used to test the relationship of SLE with four categories of predictors: demographic factors, socioeconomic factors, health behaviors, and psychosocial factors. Results: Among the 1000 participants, women (mean SLE, 83.43 years; 95% confidence interval, 82.41 to 84.46 years; 48% of the total sample) had an expected LE 1.59 years longer than that of men. The socioeconomic factors of household income and housing arrangements were related to SLE. Among the health behaviors, smoking status, alcohol status, and physical activity were associated with SLE. Among the psychosocial factors, stress, self-rated health, and social connectedness were related to SLE. SLE had a positive correlation with actuarial estimates (r=0.61, p<0.001). Gender, household income, history of smoking, and distress were related to the presence of a gap between SLE and actuarial LE. Conclusions: Demographic factors, socioeconomic factors, health behaviors, and psychosocial factors showed significant associations with SLE, in the expected directions. Further studies are needed to determine the reasons for these results.

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Socioeconomic Inequality in Malnutrition in Under-5 Children in Iran: Evidence From the Multiple Indicator Demographic and Health Survey, 2010: Abdollah Almasian Kia, Aziz Rezapour, Ardeshir Khosravi, Vajiheh Afzali Abarghouei; J Prev Med Public Health. 2017;50(3):201-209. Published online May 10, 2017; DOI: https://doi.org/10.3961/jpmph.17.028

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Abstract PDF

Objectives
The aim of this study was to assess the socioeconomic inequality in malnutrition in under-5 children in Iran in order to help policymakers reduce such inequality.
Methods
Data on 8443 under-5 children were extracted from the Iran Multiple Indicator Demographic and Health Survey. The wealth index was used as proxy for socioeconomic status. Socioeconomic inequality in stunting, underweight, and wasting was calculated using the concentration index. The concentration index was calculated for the whole sample, as well as for subcategories defined in terms of categories such as area of residence (urban and rural) and the sex of children.
Results
Stunting was observed to be more prevalent than underweight or wasting. The results of the concentration index at the national level, as well as in rural and urban areas and in terms of children’s sex, showed that inequality in stunting and underweight was statistically significant and that children in the lower quintiles were more malnourished. The wasting index was not sensitive to socioeconomic status, and its concentration index value was not statistically significant.
Conclusions
This study showed that it can be misleading to assess the mean levels of malnutrition at the national level without knowledge of the distribution of malnutrition among socioeconomic groups. Significant socioeconomic inequalities in stunting and underweight were observed at the national level and in both urban and rural areas. Regarding the influence of nutrition on the health and economic well-being of preschool-aged children, it is necessary for the government to focus on taking targeted measures to reduce malnutrition and to focus on poorer groups within society who bear a greater burden of malnutrition.

Summary

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