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

Satar Rezaei,Mohammad Hajizadeh,Yahya Salimi,Seyed Fahim Irandoost

doi:10.1186/s12939-019-1072-5

Abstract

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

Highlights

Inequalities in the utilization of dental care services are a major public health concern globally
Data and variables Data were derived from the 2017 Household Income and Expenditure Survey (HIES), which collected annually by the Iranian Statistical Center (ISC)
There is a large variation among the provinces in dental care utilization in Iran

Summary

Introduction

Inequalities in the utilization of dental care services are a major public health concern globally. Individuals should receive healthcare services as needed regardless of their social and economic status [1,2,3], there exists clear evidence that the distribution of dental care utilization is not distributed across different socioeconomic groups in different countries [4,5,6]. The current studies [7,8,9] have documented the differences in the utilization of dental care across the different socioeconomic segment of the population in Iran and its different regions. Kiadaliri and colleagues [10] highlighted inequalities in the distribution of dentists across provinces of Iran. The latter study showed that the number of dentists per 100,000 population in Tehran province was 11 times higher than that of Northern Khorasan province.

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