Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Int J Equity Health. 2017 May 18;16(1):83. doi: 10.1186/s12939-017-0570-6.
Over the past three decades, interventions have been implemented to reduce childhood mortality in Iran. Despite declines in overall mortality rates, inequalities in mortality across socioeconomic groups have remained unchanged. In this study, we assessed inequalities in infant mortality in rural regions of Iran.
We obtained data from the Iranian vital registration system, which includes data on 5,626,158 live births, 79,457 neonatal deaths, and 36,397 postneonatal deaths in rural areas of Iran over the course of a 16-year period, which was then divided into 4 four-year intervals. In addition to building multivariate regression models to identify factors associated with mortality, we calculated a concentration index for each province to measure inequalities in neonatal and postneonatal mortality, using wealth index as the socioeconomic variable of interest. We further assessed these inequalities as a component of their contributors by using the decomposition method.
Although both neonatal (17.62 to 10.92) and postneonatal (8.11 to 5.14) mortality rates exhibited decreasing trends from 1998-2001 to 2010-2013, the inequalities observed in these indices remained nearly unchanged (concentration indices of -0.062 to -0.047 and -0.098 to -0.083, respectively). Furthermore, fraction of births occurred in hospitals and literate women contributed positively to the inequalities observed in both neonatal and postneonatal mortality rates, whereas the proportion of infants classified as low birth weight contributed negatively over all study periods. We also identified decreasing trends in inequalities of the proportion of infants classified as having low birth weight, being born in hospitals, being covered by health insurance, mothers' age, and literacy of women within the time intervals under study.
Although infant mortality rates in Iran decreased over the studied time period, we observed notable inequalities in these measures. Several steps are needed to overcome these inequalities, including improving access to professional health services for lower income households, fairly distributing facilities and human resources, and improving insurance coverage to protect families from financial hardships. Moreover, social factors, such as literacy of women, were found to be important in decreasing inequalities in infant mortality. These steps require improving societal awareness of infant mortality and implementing improved and problem-oriented health policies.
在过去的三十年中，伊朗实施了干预措施以降低儿童死亡率。尽管总体死亡率有所下降，但社会经济群体之间的死亡率不平等仍然没有改变。在这项研究中，我们评估了伊朗农村地区婴儿死亡率的不平等。
我们从伊朗生命登记系统中获取了数据，该系统包含了 16 年期间伊朗农村地区 5626158 例活产、79457 例新生儿死亡和 36397 例后期新生儿死亡的数据，然后将其分为四个 4 年的间隔。除了构建多元回归模型来确定与死亡率相关的因素外，我们还为每个省份计算了一个集中指数，以衡量新生儿和后期新生儿死亡率的不平等，使用财富指数作为感兴趣的社会经济变量。我们还通过分解方法进一步评估了这些不平等作为其贡献者的组成部分。
尽管新生儿（17.62 至 10.92）和后期新生儿（8.11 至 5.14）死亡率从 1998-2001 年至 2010-2013 年呈下降趋势，但这些指数中观察到的不平等几乎没有变化（集中指数分别为-0.062 至-0.047 和-0.098 至-0.083）。此外，医院分娩的分娩比例和识字妇女对新生儿和后期新生儿死亡率的不平等有积极贡献，而在所有研究期间，低出生体重婴儿的比例则产生了负面影响。我们还发现，在研究期间，低出生体重婴儿比例、医院分娩、医疗保险覆盖、母亲年龄和妇女识字率等不平等因素的趋势都呈下降趋势。
尽管伊朗的婴儿死亡率在研究期间有所下降，但我们观察到这些措施存在显著的不平等。需要采取几个步骤来克服这些不平等，包括改善低收入家庭获得专业卫生服务的机会，公平分配设施和人力资源，并扩大保险覆盖范围，以保护家庭免受经济困难的影响。此外，妇女识字等社会因素被发现对降低婴儿死亡率不平等至关重要。这些步骤需要提高社会对婴儿死亡率的认识，并实施改进和以问题为导向的卫生政策。
