Measuring and Decomposing Socioeconomic Inequality in Catastrophic Healthcare Expenditures in Iran

Satar Rezaei,Mohammad Hajizadeh 대한예방의학회 2019 예방의학회지 Vol.52 No.4

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.

What Explains Socioeconomic Inequality in Health-related Quality of Life in Iran? A Blinder-Oaxaca Decomposition

Rezaei, Satar,Hajizadeh, Mohammad,Salimi, Yahya,Moradi, Ghobad,Nouri, Bijan The Korean Society for Preventive Medicine 2018 예방의학회지 Vol.51 No.5

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.

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 대한예방의학회 2018 예방의학회지 Vol.51 No.5

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.

Measuring and Decomposing Socioeconomic Inequality in Catastrophic Healthcare Expenditures in Iran

Rezaei, Satar,Hajizadeh, Mohammad The Korean Society for Preventive Medicine 2019 예방의학회지 Vol.52 No.4

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.

Determinants of health-related quality of life in Iranian adults:

Satar Rezaei,Mohammad Hajizadeh,Ali Kazemi,Masoud Khosravipour,Farid Khosravi,Shahab Rezaeian 한국역학회 2017 Epidemiology and Health Vol.39 No.-

OBJECTIVES: This study aimed to measure the level and determinants of health-related quality of life (HRQoL) in adults in Kermanshah, a city in the western region of Iran. METHODS: Convenience sampling was employed to obtain a sample of 998 adults aged 18 years and older (646 males and 352 females) in the city of Kermanshah. A 2-part self-administered questionnaire was used to collect data over the period between March 1 and May 30, 2017. The first part was designed to collect information on socio-demographic characteristics, socioeconomic status, and lifestyle factors (10 items). The second part consisted of the EuroQoL 5-dimensions (EQ-5D) EuroQoL-3-level and the EuroQoL visual analog scale (EQ-VAS) questions. A multiple linear regression model was used to determine the factors associated with the EQ-5D index and EQ-VAS score among study participants. RESULTS: The mean values for the EQ-5D index and the EQ-VAS score were 0.74 (standard deviation [SD], 0.19) and 80.9 (SD, 16.5), respectively. The highest percentage of self-reported problems (‘some’ and ‘severe’ problems) across the 5 dimensions of the EQ-5D index were associated with the dimensions of anxiety/depression (35.3%) and pain/discomfort (32.9%). The percentage of self-reported problems for the dimensions of usual activities, mobility, and self-care were 19.0, 12.8, and 8.9%, respectively. Our regression analyses indicated that there were statistically significant positive associations between being physically active, monthly household income per capita, and post-secondary education and the EQ-5D index and EQ-VAS score. In contrast, negative associations were found between older age, being married, having a chronic disease, and smoking and the EQ-5D index and EQ-VAS score. A negative association was also found between being uninsured and the EQ-5D index. CONCLUSIONS: Our findings suggest that interventions aiming to improve physical activity, to prevent chronic diseases, and to reduce the smoking rate among adults living in the city of Kermanshah may improve their HRQoL.

Estimating the Economic Burden of Lung Cancer in Iran

Rezaei, Satar,Sari, Ali Akbari,Woldemichael, Abraha,Soofi, Moslem,Kazemi, Ali,Matin, Behzad Karami Asian Pacific Journal of Cancer Prevention 2016 Asian Pacific journal of cancer prevention Vol.17 No.10

Objectives: Lung cancer is a major public health problem and one of the most costly illnesses. The study aimed to estimate the economic burden of lung cancer in Iran in 2014. Methods: A cross-sectional study was conducted to estimate the direct and indirect costs for patients with lung cancer using a prevalence-based approach. A human capital approach was employed to estimate the indirect costs. Data were obtained from several sources such as through patient interview using structured questionnaire, medical records, the GLOBOCAN databases, the Iranian Statistical Center, the Iranian Ministry of Cooperation, Labor and Social Welfare, and the Institute for Health Metrics and Evaluation (IHME). Results: The economic burden of lung cancer in Iran in the year 2014 was 3,225,998,555,090 IR. The main components of the cost were associated with mortality (81.9 %) and hospitalization (7.6 %). The costs of direct medical care, non-medical aspects, patient time, and mortality accounted for 10.8%, 2.7%, 4.5%, and 81.5% of the total cost, respectively. Conclusion: Findings from this study indicated that the economic burden of lung cancer is substantial both to Iran's health system and to society as a whole. Early diagnosis, strengthening cancer prevention, implementing new cancer therapy and medical technology, and effective smoking-cessation interventions could offset some of the costs associated with lung cancer in Iran.

Years of Potential Life Lost and Productivity Costs Due to Premature Cancer-Related Mortality in Iran

Khorasani, Soheila,Rezaei, Satar,Rashidian, Hamideh,Daroudi, Rajabali Asian Pacific Journal of Cancer Prevention 2015 Asian Pacific journal of cancer prevention Vol.16 No.5

Background: Cancer is recently one of the major concerns of the public health both in the world and Iran. To inform priorities for cancer control, this study estimated years of potential life lost (YPLL) and productivity losses due to cancer-related premature mortality in Iran in 2012. Materials and Methods: The number of cancer deaths by sex for all cancers and the ten leading causes of cancer deaths in Iran in 2012 were obtained from the GLOBOCAN database. The life expectancy method and the human capital approach were used to estimate the YPLL and the value of productivity lost due to cancer-related premature mortality. Results: There were 53,350 cancer-related deaths in Iran. We estimated that these cancer deaths resulted in 1,112,680 YPLL in total, 563,332 (50.6%) in males and 549,348 (49.4%) in females. The top 10 ranked cancers accounted for 75% of total death and 70% of total YPLL in the males and 69% for both death and YPLL in the females. The largest contributors for YPLL in the two genders were stomach and breast cancers, respectively. The total cost of lost productivity due to cancer-related premature mortality discounted at 3% rate in Iran, was US$ 1.93 billion. The most costly cancer for the males was stomach, while for the females it was breast cancer. The percentage of the total costs that were attributable to the top 10 cancers was 67% in the males and 71% in the females. Conclusions: The YPLL and productivity losses due to cancer-related premature mortality are substantial in Iran. Setting resource allocation priorities to cancers that occur in younger working-age individuals (such as brain and central nervous system) and/or cancers with high incidence and mortality rates (such as stomach and breast) could potentially decrease the productivity losses and the YPLL to a great extent in Iran.

Effects of Smoking on Cost of Hospitalization and Length of Stay among Patients with Lung Cancer in Iran: a Hospital-Based Study

Sari, Ali Akbari,Rezaei, Satar,Arab, Mohammad,Majdzadeh, Reza,Matin, Behzad Karami,Zandian, Hamed Asian Pacific Journal of Cancer Prevention 2016 Asian Pacific journal of cancer prevention Vol.17 No.9

Background: Smoking is recognized as a main leading preventable cause of mortality and morbidity worldwide. It is responsible for a considerable financial burden both on the health system and in society. This study aimed to examine the effect of smoking on cost of hospitalization and length of stay (LoS) among patients with lung cancer in Iran in 2014. Materials and Methods: A total of 415 patients were included in the study. Data on age, sex, insurance status, type of hospitals, type of insurance, geographic local, length of stay and cost of hospitalization was extracted by medical records and smoking status was obtained from a telephone survey. To compare cost of hospitalization and LoS for different smoking groups, current smokers, former smokers, and never smokers, a gamma regression model and zero-truncated poisson regression were used, respectively. Results: Compared with never smokers, current and former smokers showed a 48% and 35% increase in hospitalization costs, respectively. Also, hospital LoS for current and former smokers was 72% and 31% higher than for never smokers, respectively. Conclusions: Our study indicated that cigarette smoking imposes a significant financial burden on hospitals in Iran. It is, however, recommended that more research should be done to implement and evaluate hospital based smoking cessation interventions to better increase cessation rates in these settings.

The COVID-19 pandemic and healthcare utilization in Iran: evidence from an interrupted time series analysis

Monireh Mahmoodpour-Azari,Satar Rezaei,Nasim Badiee,Mohammad Hajizadeh,Ali Mohammadi,Ali Kazemi-Karyani,Shahin Soltani,Mehdi Khezeli 질병관리본부 2023 Osong Public Health and Research Persptectives Vol.14 No.3

Objectives: This study aimed to examine the effect of the coronavirus disease 2019 (COVID-19) outbreak on the hospitalization rate, emergency department (ED) visits, and outpatient clinic visits in western Iran.Methods: We collected data on the monthly hospitalization rate, rate of patients referred to the ED, and rate of patients referred to outpatient clinics for a period of 40 months (23 months before and 17 months after the COVID-19 outbreak in Iran) from all 7 public hospitals in the city of Kermanshah. An interrupted time series analysis was conducted to examine the impact of COVID-19 on the outcome variables in this study.Results: A statistically significant decrease of 38.11 hospitalizations per 10,000 population (95% confidence interval [CI], 24.93–51.29) was observed in the first month of the COVID-19 outbreak. The corresponding reductions in ED visits and outpatient visits per 10,000 population were 191.65 (95% CI, 166.63–216.66) and 168.57 (95% CI, 126.41–210.73), respectively. After the initial reduction, significant monthly increases in the hospitalization rate (an increase of 1.81 per 10,000 population), ED visits (an increase of 2.16 per 10,000 population), and outpatient clinic visits (an increase of 5.77 per 10,000 population) were observed during the COVID-19 pandemic.Conclusion: Our study showed that the utilization of outpatient and inpatient services in hospitals and clinics significantly declined after the COVID-19 outbreak, and use of these services did not return to pre-outbreak levels as of June 2021.

Measuring and Decomposing Socioeconomic Inequalities in Adult Obesity in Western Iran

Farid Najafi,Yahya Pasdar,Behrooz Hamzeh,Satar Rezaei,Mehdi Moradinazar,Moslem Soofi 대한예방의학회 2018 예방의학회지 Vol.51 No.6

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.