Raznahan Maedeh, Emamian Mohammad Hassan, Alipour Fateme, Hashemi Hassan, Zeraati Hojjat, Fotouhi Akbar
Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran.
Deputy of Research, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Med J Islam Repub Iran. 2019 Oct 30;33:116. doi: 10.34171/mjiri.33.116. eCollection 2019.
Since there was no evidence about economic inequity in utilization of cataract surgery in developing countries, such as Iran, this study was designed to measure horizontal inequity in the utilization of cataract surgery and its changes in an Iranian middleaged population in 2009 and 2014. Using data from the first and second phases of Shahroud Eye Cohort Study (2009-2014), the economic inequity in the utilization of cataract surgery in an Iranian middle-aged population aged 40-64 years in 2009 and 2014 was evaluated. The horizontal inequity index (HI) was determined using the indirect standardization method based on a nonlinear (probit) model and the concentration index (C) was decomposed into the contribution of each factor. The analyses were performed using STATA software version 12/SE, and significance level was set at less than 0.05. The HI in the utilization of cataract surgery increased from 0.080 (95% CI: 0.011-0.098) in 2009 to 0.166 (95% CI: 0.0821- 0.228) in 2014. Decomposition of changes in the concentration index showed that among need and non-need variables, older age and economic status (being among the wealthiest 20%) were the greatest contributors, with shares of 67.5% and 57.5%%, respectively, which led to pro-rich inequity during the study periods. The present study demonstrated that utilization of cataract surgery did not have an equal distribution among economic quintiles, despite considering equal needs based on cataract severity. Results demonstrated that older age and economic status were the greatest contributors to HI increase in 2009 and 2014.
由于在伊朗等发展中国家，尚无关于白内障手术利用方面经济不平等的证据，本研究旨在衡量2009年和2014年伊朗中年人群中白内障手术利用的横向不平等及其变化。利用沙赫鲁德眼病队列研究（2009 - 2014年）第一阶段和第二阶段的数据，评估了2009年和2014年伊朗40 - 64岁中年人群中白内障手术利用的经济不平等情况。横向不平等指数（HI）采用基于非线性（概率单位）模型的间接标准化方法确定，集中指数（C）被分解为各因素的贡献。分析使用STATA软件版本12/SE进行，显著性水平设定为小于0.05。白内障手术利用的HI从2009年的0.080（95%可信区间：0.011 - 0.098）增加到2014年的0.166（95%可信区间：0.0821 - 0.228）。集中指数变化的分解表明，在需求和非需求变量中，年龄较大和经济状况（属于最富有的20%）是最大的贡献因素，分别占67.5%和57.5%，这导致了研究期间有利于富人的不平等。本研究表明，尽管根据白内障严重程度考虑了平等需求，但白内障手术的利用在经济五分位数之间分布并不均匀。结果表明，年龄较大和经济状况是2009年和2014年HI增加的最大贡献因素。
