Statistical Center Of Iran Research Articles

Measuring and decomposing socioeconomic inequality in catastrophic healthcare expenditures in Iran.

ObjectivesEquity 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.MethodsA 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.ResultsThe 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.ConclusionsThis 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.

Self-Medication and its Effective Factors in Islamic Republic of Iran: A population based Study

Background: Self-medication is the use of drugs which have not been prescribed by health professionals. It is considered an important issue especially in developing countries because of side effects of irrational use of drugs and economic burden of disease. This study aim to analyze the prevalence of self-medication in Iran by provinces and socio economic and demographic factors that affect it. Methods: Data of Iranian household income and expenditures survey (HEIS) in 2016 (source Iranian Statistical Center) was used in this study. Multilevel mixed effect regression was used to find relation between explanatory variables and self-medication ratio. STATA SE v 14 was used to perform the analysis. Results: the results of this study showed that income (coefficient = - 0.00286) and socioeconomic status had negative significant relationship with self-medication ratio, while self-medication ratio was higher in some provinces like Ardebil, Sistan va Baluchistan and Ilam and it was lower in some provinces like Khuzestan and Kurdistan. Conclusion: The prevalence of self-medication among Iranian people was relatively high and this ratio varies in provinces. In addition to promote population awareness about undesirable effects of the irrational drug consumption, developing strategies for drug consumption by improving prescribing pattern, OTC drugs and also increasing inspection of pharmacies is needed.

A multi-criteria approach for assessing urban flood resilience in Tehran, Iran

Operationalizing the concept of urban disaster resilience is a major milestone toward understanding both the characteristics that contribute to the resilience of cities to natural hazards and the interactions required to build and sustain it. While the measurement of urban disaster resilience has recently gained much attention, there is so far no optimal approach for operationalizing this concept and therefore there is a need to conduct more empirical studies on what constitutes disaster resilience and how to assess it. In this study, a resilience assessment focuses on the inherent characteristics and capacities of Tehran in the context of flash floods from surface water or from the overflow of rivers. The measurement approach is based on constructing a composite index based on six resilience dimensions social, economic, institutional, infrastructural, community capital and environmental of community flood resilience. This follows by developing a hybrid multi-criteria decision-making method. The applied method is a combination of the AHP for prioritizing the selected indicators and the TOPSIS tools in order to get Tehran's urban districts ranked based on their resilience levels. Data were mostly from the Statistical Center of Iran and Tehran Municipality's accessible data sources. The results clarify that Districts 6 and 22 are comparatively the most resilient districts, while District 1 is the only district with the lowest level of resilience. Such place-based assessments have an opportunity to track community performance over time and provide the tool to decision-makers in order to integrate resilience thinking into urban development and resilience-oriented urban planning.

Epidemiology of suicide attempts and deaths: a population-based study in Fars, Iran (2011-16).

Suicide is a critical psychological issue worldwide with an increasing trend. This study investigated suicide comprehensively. In this cross-sectional study, we reviewed data of 28 552 suicide attempts during 2011-16, in Southern Iran. To calculate age-standardized incidence rates, population statistics were derived from the Statistical Center of Iran and the National Organization for Civil Registration. We used the standard population of World Health Organization 2012 to adjust the suicide attempts and deaths rates by age. The mean age of participants was 26.8 ± 10.6 years with the highest suicide attempts rates in the age groups of 15-24 and 25-34 years (48% and 32.5%, respectively); 58.7% were women and 52.9% were single. Case-fatality rate (CFR) was 6.27%. Annual age-standardized incidence rates of suicide attempts during the 6-year period has increased (P < 0.001), and that of deaths were not incremental (P > 0.05). Logistic regression model showed male sex, rural area, older age, psychological and somatic disorders, and family history of suicide as significant factors. In this comprehensive study, although the age-standardized mortality rate of suicide in southern Iran was lower than in other countries, the increasing trend of suicide attempts during the study period served as an alarming sign in this province.

Environmental factors affecting the frequency of traffic accidents leading to death in 22 districts of Tehran during 2014–2016

Background: In many developed and developing countries, a significant proportion of deaths from road traffic accidents occur in the passages within cities. Considering the importance of this issue, this study was conducted to determine the environmental factors affecting the frequency of deaths in 22 areas of Tehran. Materials and Methods: In this study, the statistical population consisted of traumatic traffic incidents during the period of 2014–2016, all of which were studied. The data necessary for conducting the study were extracted from the traffic police databases, Tehran Municipality, and the Statistics Center of Iran. In order to analyze the role of regional and environmental factors in the frequency of traffic accidents related to pedestrians in geographic units (22 districts of Tehran), the Poisson regression and geographically weighted regression models were used. The likelihood ratio test was used to compare the models. The goodness-of-fit of models was evaluated using R2, Bayesian information criterion, and Akaike's information criterion statistics. Results: In this study, 519 incidents were studied, 175 of which (33.7%) were related to motorcyclists, 174 (33.5%) related to automobile drivers, and 170 (32.8%) pedestrians. The frequency distribution of the incidents studied varied in Tehran's 22 districts. The incidence of accidents in the central regions of Tehran was lower, while marginal areas located in the north, south, east, and west of Tehran had the highest frequency of fatal accidents. The both final Bayesian Poisson and GWR models showed that the relationship between the length of highways and educational land used with dependent variable was statistically significant. Conclusion: Various demographic and environmental variables play a role in determining the distribution pattern of these types of events. Through regional planning, proper traffic management, controlling environmental risk factors, and training people the pedestrian safety in Tehran can be improved.

The burden of road traffic injuries in the northeast of Iran: the result of a population-based registry.

:Background:Road traffic injuries (RTIs) are an important public health problem around the world, with the majority of RTIs occurring in low- and middle-income countries. This study aimed to determine disability-adjusted life years (DALY) of RTIs in the northeast of Iran.Methods:In this cross-sectional study, we used the death registration system to calculate years of life lost (YLL) due to RTIs. To determine the years lost due to disability (YLD), hospital records of all peo-ple injured in road accidents were used. To estimate DALY, we used YLD and YLL to calculate DALY according to the Global Burden of Disease (GBD) 2003 guideline and the age/sex composition of the population was taken from the Statistical Centre of Iran (SCI) in 2016. All collected data entered into Excel software and performed calculations.Results:Our findings showed that a total of 3403 RTIs and 132 deaths were recorded in 2016. The DALY was 38 per 1,000 of which 26.9 per 1,000 were related to YLL and 11.1 per 1,000 were related to YLD. The highest YLL rate in both sexes was in the 15-29 and 30-44 age groups with 49.8 per 1,000 and 46.0 per 1,000, respectively. This reflects a sex ratio of DALY in males (57.7 per 1,000) to females (8.6 per 1,000) was 6.7.Conclusions:It seems to be necessary, appropriate effective intervention programs and periodic evaluations are required regarding prevention and reducing traffic accidents mostly in middle-aged men.

Targeted subsidy plan and Kakwani index in Iran health system.

INTRODUCTION:Health care is considered as a human right, and fair financial contribution to health care plays an important role in providing effective services for all members of society. This study aimed at investigating the effects of targeted subsidy plan (since 2010) on equality in health-care financing in Iran from 2004 to 2014.MATERIALS AND METHODS:This was a descriptive-analysis, cross-sectional study that was conducted using data obtained from households’ expenditure-income survey that is performed every year by the Statistical Center of Iran. The Lorenz curve, Gini coefficient, and Theil index were applied to measure inequality in healthcare expenditures (HEs). Furthermore, the Kakwani index was used to examine inequality in health-care finance during the study period. The analysis was performed using Stata version 13.RESULTS:Kakwani index was negative for all the studied years, except 2007. The value of this index was equal to −0.032, −0.045, and −0.046 in 2004, 2008, and 2014 for rural areas and was equal to −0.041, −0.029, and −0.0001 for urban areas, respectively. Despite the Kakwani index has been negative for most of the years, which reflects regressive financing in health care, there is no significant change in the trend of this indicator after the implementation of the subsidies. In addition, this indicator is moving toward being positive (progressive) in urban areas in 2014, which represents increased share of the poor in health payments.CONCLUSIONS:According to the results, the targeted subsidy plan could not reach to its purpose in health-care system for supporting the poor from HEs. It is recommended for policy-makers to design a specific plan for health-care financing and to allocate some defined resources such as taxes or subsidies to health-care sector.

Estimation of Government Health Expenditures in Iran During 2006 to 2011, Using Panel Data.

The status of public resources in health has a positive and direct impact on this sector's outcomes because of its effect on the increase of social services. The government's ability to manage health expenditures greatly depends on identifying the determinants of these expenditures. Therefore, this study aimed to determine factors affecting the government health expenditures and estimate the related function in Iran during 2006-2011 using panel data. This was a cross-sectional and time-series study that was conducted using panel data analysis. In this study, the data were collected and categorized separately for each province from documents in the Ministry of Health and the Statistical Center of Iran. The results showed that there were positive associations between health expenditures and some factors including age group of 20 to 39 years (P = .04), the number of women (P = .001), the number of physicians, the number of hospital beds, and annual budget (P < .001). According to the results, it seems that allocating a part of health subsidies for increasing the insurance coverage of the age group of 20 to 39 years and also starting saving accounts can have an important effect on reducing health expenditures of this age group.

Urban morphology and landscape structure effect on land surface temperature: Evidence from Shiraz, a semi-arid city

Urbanization process contributes to more urban climate changes, specifically the land surface temperature (LST). Higher LST of urban areas compared to the surroundings is regarded as the side effect of urban morphology and landscape structure features. The primary purpose of the study is to investigate the relationship between the pattern of built-up areas and land surface temperature in a semi-arid urban environment. In this study, spectral and landscape indices, such as Normalized Difference Vegetation Index (NDVI), Normalized Difference Built-up Index (NDBI), Shannon’s Diversity Index (SHDI), Landscape Shape Index (LSI), Fractal Dimension Index (FRAC), and Landscape Division Index (DIVISION), along with morphological variables (parcel density, housing density, road density, Floor area ratio, Mass-Space proportion, land use pattern, and distance to CBD) were applied to investigate the correlation of urban morphology with LST. Landscape and morphological variables are provided from Landsat 5, statistical center of Iran and Shiraz’s master plan and also gathered at the census district level. The results revealed that all the variables had a relatively strong correlation with LST except for distance to CBD. While landscape diversity and fragmentation had the highest correlation with LST, housing and parcel density were the most effective morphological variables. Also, while SHDI, DIVISION, FRAC, LSI, and road density had positive correlation coefficient, NDBI, housing and parcel density, FAR and Mass-Space proportion were negative. Moreover, examining land use pattern and its relation to LST revealed that bare lands, industrial and green spaces had a remarkable negative effect on LST. Also, residential areas with moderate and high building density alleviated the surface temperature. Alongside that, dense gardens, lower road density, and more developed districts declined LST in Shiraz, a semi-arid urban environment in Iran.

Socio-demographic and economics factors associated with suicide mortality in Iran, 2001\u20132010: application of a decomposition model

BackgroundSuicide is a major global health problem, especially among youth. Suicide is known to be associated with a variety of social, economic, political and religious factors, vary across geographical and cultural regions. The current study aimed to investigate the effects of socioeconomic factors on suicide mortality rate across different regions in Iran.MethodsThe data on distribution of population and socio-economic factors (such as unemployment rate, divorce rate, urbanization rate, average household expenditure etc.) at province level were obtained from the Statistical Centre of Iran and the National Organization for Civil Registration. The data on the annual number of deaths caused by suicide in each province was extracted from the published reports of the Iranian Forensic Medicine Organization. We used a decomposition model to distinguish between spatial and temporal variation in suicide mortality.ResultsThe average rate of suicide mortality was 5.5 per 100,000 population over the study period. Across the provinces (spatial variation), suicide mortality rate was positively associated with household expenditure and the proportion of people aged 15–24 and older than 65 years and was negatively associated with the proportion of literate people. Within the provinces (temporal variation), higher divorce rate was associated with higher suicide mortality. By excluding the outlier provinces, the results showed that in addition to the proportion of people aged 15–24 and older than 65, divorce and unemployment rates were also significant predictors of spatial variation in suicide mortality while divorce rate was associated with higher suicide mortality within provinces.ConclusionThe findings indicate that both spatial and temporal variations in suicide mortality rates across the provinces and over time are determined by a number of socio-economic factors. The study provides information that can be of importance in developing preventive strategies.

Inequality in Distribution of Health Care Resources in Iran: Human Resources, Health Centers and Hospital Beds

Background: One of the most important goals of health systems is equality in access to health services and one of the important dimensions of health equality in relation to resources distribution in this sector. Objectives: This study was done to examine the equality in resource distribution between provinces of Iran in 2014. Methods: In the present retrospective study, the population included the public health sector human resources, hospital beds, and health centers in Iran. The data were collected from the Iran statistics center and ministry of health and Medical education. The inequality was estimated by Lorenz curve, Gini coefficient, Hoover index, and by using Excel and Stata 12 software. Results: The Gini coefficients were 0.13797, 0.19980, and 0.1499 for the manpower, health care centers, and hospital beds, respectively. Thus, they were significant. In addition, the Hoover index was 7, 8.60, and 6.70 for the three studied resources, respectively. Conclusions: The distribution of the health sector resources between Iran provinces was relatively equal. Therefore, health policy makers should be focused on the other aspects of accessibility such as distribution of resources according to health needs, resources distribution within provinces, and quality of provided services.

Determinants of Households Health Expenditure : A Population-Based Study

Studies have shown that the determinants of households’ health expenses are in doubt in Iran. Patients deal with pain and trouble while facing with increasing health services payments. Thus, their quality of life decreases in all aspects. The objective of this research lies on the analysis of Iranian households’ health expenditure (HHE) using multilevel modelling methodology. Data collected through Household Income and Expenditure Survey by Statistical Center of Iran. A total of 38299 Iranian households were sampled. This nationally-representative cross-sectional survey collected information from March 2013 to March 2014 using a three-staged cluster sampling method. Descriptive statistics and multilevel modelling employed for data analysis. Data analysis was performed using R programming language version 3.3.2 and SPSS version 20. P 0.05). More attention on HHE will be needed from researchers and politicians, as it has proved to be no easy matter in the low-income and deprived areas.

Decomposing inequality in financial protection situation in Iran after implementing the health reform plan: What does the evidence show based on national survey of households' budget?

Lack of well-designed healthcare financing mechanisms and high level of out-of-pocket payments in Iran over the last decades led to implementing Health Transformation Plan, in 2014. This study aims to decompose inequality in financial protection of Iranian households after the implementation of the Health Transformation Plan. The data of Statistical Center of Iran (SCI) Survey on Rural and Urban Households Income-Expenditure in 2015 to 2016 were used. The headcount ratio of catastrophic health expenditures was calculated. The corrected concentration index was estimated. The role of contributors on inequality in the exposure to catastrophic health expenditures among poor and nonpoor households was calculated using Farelie's model. The headcount ratio of the exposure to catastrophic health expenditures in urban and rural households was 2.5% (2.43% - 2.64%) and 3.6% (3.48% - 3.76%), respectively. The difference in households' income levels was the main contributor in explaining the inequality in facing catastrophic health expenditures between poor and nonpoor households. [Correction added on 02 June 2018, after first online publication: The "Results" section of the Abstract of the published article has been correctly updated on this version.] CONCLUSION: Even after implementing the HTP, the headcount ratios of catastrophic health expenditure are still considerable. The results show that income is the greatest determinant of inequality in facing catastrophic health expenditure and in urban households.

A Feasibility Study of Implementing the Policies on Increasing Birth Rate with an Emphasis on Socio-economic Status: A Case Study of Kermanshah Metropolis, Western Iran

Population and development have a mutual relationship, and more to the point, lack of sufficient knowledge on population development and fertility can lead to the presentation of inappropriate population plans in such a way that they may turn out to be useless and ineffective even in the event of implementation. So, the present study aimed to delve into the feasibility of implementing the new governmental policies on increasing birth rate with an emphasis on the socioeconomic status in Kermanshah Metropolis, Iran. To evaluate poverty and fertility in Kermanshah Metropolis, the present cross-sectional study used the latest statistics obtained from the Statistical Center of Iran (2011), and as for the data analysis, such tests in Arc/GIS and SPSS 20 software. The results of the present study showed that the spatial patterns of poverty and fertility were formed in clusters across the city, and the results of variance analysis of the relationship between the variables of fertility and poverty demonstrated that there was a significant difference between the selected neighborhoods in terms of the variables of poverty and total fertility (P < 0.001). Furthermore, the spatial autocorrelations of fertility and poverty in Kermanshah were positive and showed that the spatial means and standard distances of poverty and fertility were overlapping. Not all districts and urban neighborhoods were equal in the total fertility rate. So, given the societal classes’ different socioeconomic and cultural status across different neighborhoods, the government’s new approaches to increasing birthrate cannot be applied to all classes throughout Kermanshah Metropolis.

Spatial factors related to traffic crashes on pedestrians in all districts of Tehran

Background: A great proportion of deaths due to traffic crashes occur for pedestrians, both in developing and developed countries. Objectives: The aim of the present study was to determine the spatial factors related to the frequency of traffic crashes on pedestrians in districts of Tehran city. Methods: This was a cross-sectional study. All traffic crashes on pedestrians during 2013–2015 were included in this study. The data were extracted from different sources such as traffic police main office, Tehran municipal office, and Iran statistics center. Poisson and negative binomial regression models were used to analyze the role of environment and district on frequency of traffic crashes. Moreover, the likelihood-ratio test has been used for comparison between models, while assessment of goodness-of-fit has been reported using R2, Akaike information criteria, and Bayesian information criteria. Results: Of 12,090 crashes, 11,895 (98.4%) had led to injuries, while 195 (1.6%) had led to deaths. The frequency of crashes varied substantially in different districts of Tehran. The incidence of injuries did not show any particular pattern, whereas the pattern of incidence of deaths was lower in central districts in comparison to higher incidence in marginal districts (e.g., north, south, west, and east of Tehran). The results of the final model showed a statistically significant association among various variables such as demographics, web of roads, rate of traveling, and land use with the outcome as number of crashes in geographic units. Conclusions: Frequency distribution of traffic crashes leading to injury and/or death is completely different in various districts of Tehran. Demographic as well as spatial characteristics also play an important role in determining this distribution. Regional planning, appropriate traffic management, control measures on spatial risk factors, and educational programs could substantially improve the safety of pedestrians in Tehran.

What is the Best Index for Unemployment?

A regular activity in all human societies is the evaluation and control of important socioeconomicindices. Unemployment rate is one of these indices, which is very important in evaluating andapplying policies for control or preparation of desired changes in economy; in fact, it is a challengefor policy makers. Employment and unemployment are 2 words that have different definitions amongpeople and professional centers of statistics. Since the statistics and methods applied for calculatingIranian employed and unemployed people have been provided by Statistical Center of Iran (SCI), thecomparison of these definitions with recommended ones defined by International labor organization(ILO) may project 2 different items. In accordance with the definition of unemployment by ILO andSCI, each person who works at least 1 to 2 hours a week, even without receiving money, is consideredas an employed person, otherwise is named as unemployed. Considering this definition, a newquestion may arise: in Iran, with consideration of location, subsistence, and labor market conditions,could people be satisfied with their living situation? Perhaps in some countries, this definition may beoperational but not for Iranian worker community; in fact, no one in Iran and many other countrieswould be satisfied with one-hour work per week as an employed person.

An Investigation into Income Distribution in Zanjan Province: A Case Study of Rural Households in Abhar County

The present study aims to investigate income distribution in Zanjan Province, for which the statistics of cost-income of the households in rural areas of Abhar County were used. They were available in the Statistical Center of Iran. In order to measure income distribution, the indicators of Lorenz curve, the Gini coefficient, the proportion of high-income groups to low-income groups, as well as the comparison of decades and quintiles are described below. The results indicated that 20% of the richest households in the rural community of Abhar County had more than half of the revenue, and four poor decades had less than 10% of revenue. The richest farmer docile had an income about 28 times as high as the poorest decade, and the richest non-farmer docile had an income about 74 times as high as the poorest non-farmer docile. The results of the Gini coefficient of the two occupational groups suggested that the Gini coefficient of people working in the agricultural sector was equal to 0.55, and that it was 0.56 for non-agricultural workers by comparison. The results of correlation analysis indicated a negative relationship between the age of household’s head and their annual income. Moreover education level of household’s head had a positive relationship with their annual income. In addition, there was no significant difference among annual incomes of households heads with different occupational groups.

Health Expenditure Modelling in Southeast of Iran: A Population-Based Setting Using Quantile Regression Perspective

Abstract Background: Equity in health is the focus of attention in the world health circles in recent decades. The financing of household health expenditure is, therefore, a concern in any region. Objectives: The current study aimed at exploring the determinants of household health expenditure in Sistan and Baluchistan province, Southeast of Iran. Methods: The data of the current study were a part of the Iranian households’ income and expenditure survey, administered by the Iranian statistical center (ISC) from March 2013 to March 2014. A 3-stage stratified cluster sampling method was employed in the current cross sectional survey. A total of 1391 households from Sistan and Baluchistan province were randomly selected. The study employed quantile regression modelling to determine the effective explanatory variables of household health expenses. R programming language version 3.3.2 was used for data analysis. Results: It was found that annual median per capita medical expenditure was US$ 5.36 (first quartile = 0; third quartile = 38.31). Households also spent about 3.9% of their annual income on health expenses per capita. Literacy, occupational status of household head, and family income had significant effect on the median of household health expenses. Conclusions: Researchers and policy makers should pay more attention to household health expenses, as it is an important matter in the low-income and deprived areas. Keywords: Health Expenditure, Household, Quantile Regression, Sistan and Baluchistan

An Analysis of the Spatial Distribution of expense and Income of Rural Households in Iran

An Analysis of the Spatial Distribution of expense and Income of Rural Households in Iran

The Prevalence and Determinants of Catastrophic Health Expenditures in Iran: A Systematic Review and Meta-Analysis

Objective: In this systematic review, we aimed at estimating the pooled prevalence of catastrophic health expenditures (CHE) in Iran and identifying and summarizing the determinants of CHE among Iranian households. Methods: We comprehensively searched the literature on November 2016 in PubMed, Scopus, Web of Science, the Cochrane Library, and 3 Persian databases. We also obtained the literature through colleague communications. Two review authors independently selected studies, extracted data, and evaluated them. We performed meta-analysis of prevalence of CHE and subgroup meta-analyses to assess the influence of data source and scope of research. Moreover, we categorized the determinants of CHE in Ian. Results: In this review, 16 studies met the inclusion criteria, and of them, 2 presented the results of multiple surveys. Results of 27 cross-sectional studies were used to estimate the pooled prevalence of CHE in Iran during 1995 and 2015, which was found to be 3.91% (95% confidence interval, CI: -3.26- 11.07). Subgroup meta-analyses based on data source revealed that the highest prevalence estimate of facing CHE was associated with author-made questionnaires, and the lowest to the statistical Centre of Iran (SCI) questionnaire. Also, meta-regression showed that the difference in sample size and year of study did not have any significant effect on the prevalence of CHE. Some of the variables such as use of inpatient, outpatient, and dentistry services, education, place of residence, and household income, which were considered as determinants of CHE in Iran, increased the possibility of facing CHE. Conclusions: Decrease in CHE to less than 1%, which was the objective of the 2 of Iran’s five-year development plans in 2007 and 2015, was not met. This percentage may need to be reconsidered according to the pooled estimate of CHE. Also, the factors revealed to be the determinants of an increase in the probability of facing CHE could indicate the need for health care services and socioeconomic variables that lower one’s capacity to pay for health services.