Socioeconomic-related inequalities in self-rated health status in Kermanshah city, Islamic Republic of Iran: a decomposition analysis.

BACKGROUND: Socioeconomic-related inequalities in health are a major public health challenge in both developed and developing countries. Little evidence is available on socioeconomic-related inequalities in health in different regions of the Islamic Republic of Iran. AIMS: This study aimed to determine socioeconomic-related inequality in poor self-rated health in adults in Kermanshah city, western Islamic Republic of Iran. METHODS: This cross-sectional study with stratified sampling obtained data on socioeconomic status, demographic characteristics, behavioural risk factors and self-rated health of 2040 adults (≥ 18 years) in Kermanshah city. A self-administrated questionnaire was used to collect data from the participants. The concentration (C) index and C curve were used to determine the socioeconomic-related inequality in poor self-rated health. A decomposition analysis of the C index was done to identify the factors explaining socioeconomic-related inequality in poor self-rated health. RESULTS: The crude and age-adjusted prevalence of poor self-rated health was 13.8% and 18.1%, respectively. The estimated C for the whole sample was -0.295, indicating that poor SRH was concentrated in the poor. The decomposition results suggested that socioeconomic status (45.5%), having a chronic health condition (11.9%) and smoking (7.3%) were the main factors contributing to the concentration of poor self-rated health among those of lower socioeconomic status. CONCLUSION: The concentration of poor self-rated health among the poor in Kermanshah city warrants policy attention. Policies aimed at reducing inequality in wealth distribution and risky health behaviour and preventing chronic health conditions among the poor may mitigate socioeconomic-related inequalities in poor self-rated health in Kermanshah.

Socioeconomic Inequalities in Poor Health-Related Quality of Life in Kermanshah, Western Iran: A Decomposition Analysis.

BACKGROUND: Socioeconomic status (SES) is an important determinant of health-related quality of life (HRQoL). We aimed to quantify socioeconomic-related inequality in poor-HRQoL among adults in Kermanshah, western Iran. STUDY DESIGN: A cross-sectional study. METHODS: Overall, 1730 adults (18-65 yr) were selected using convenience sampling from Kermanshah, Iran. A self-administrated questionnaire was used to collect data on socio-demographic characteristics, SES, lifestyle factors and HRQoL of participants over the period between May and Aug 2017. The concentration curve and concentration index (C) were used to illustrate and measure wealth-related inequality in poor-HRQoL. Additionally, we decomposed the C index to identify factors explaining wealth-related inequality in poor-HRQoL. RESULTS: The overall prevalence of poor-HRQoL was 35.3% (95% confidence interval[CI]: 33.1%, 37.6%). The poor-HRQoL was mainly concentrated among the poor adults (C=-0.256, 95% CI: -0.325, -0.187). Poor-HRQoL was concentrated among men (C=-0.256, 95% CI: -0.345, -0.177) and women (C=-0.261, 95% CI: -0.310, -0.204). Wealth, physical inactivity, the presence of chronic health condition(s), lack of health insurance coverage were the main factors contributing to the concentration of poor-HRQoL among socioeconomically disadvantaged adults. CONCLUSIONS: Socioeconomic-related inequalities in poor-HRQoL among adult should warrant more attention. Policies should be designed to not only improve HRQoL among adults but also reduce the pro-rich distribution of HRQoL among adults in Kermanshah.

Determinants of health-related quality of life in Iranian adults: evidence from a cross-sectional study.

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.