OBJECTIVES: Equity 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. METHODS: A 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. RESULTS: The 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. CONCLUSIONS This 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.

OBJECTIVES: Equity 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. METHODS: A 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.
Delivery of Health Care ; Family Characteristics ; Health Expenditures ; Health Policy ; Humans ; Iran ; Prevalence ; Socioeconomic Factors ; Vulnerable Populations

OBJECTIVES: One of the main objectives of the Targeted Subsidies Law (TSL) in Iran was to improve equity in healthcare financing. This study aimed at measuring the effects of the TSL, which was implemented in Iran in 2010, on equity in healthcare financing. METHODS: Segmented regression analysis was applied to assess the effects of TSL implementation on the Gini and Kakwani indices of outcome variables in Iranian households. Data for the years 1977-2014 were retrieved from formal databases. Changes in the levels and trends of the outcome variables before and after TSL implementation were assessed using Stata version 13. RESULTS: In the 33 years before the implementation of the TSL, the Gini index decreased from 0.401 to 0.381. The Gini index and its intercept significantly decreased to 0.362 (p < 0.001) 5 years after the implementation of the TSL. There was no statistically significant change in the gross domestic product or inflation rate after TSL implementation. The Kakwani index significantly increased from -0.020 to 0.007 (p < 0.001) before the implementation of the TSL, while we observed no statistically significant change (p=0.81) in the Kakwani index after TSL implementation. CONCLUSIONS: The TSL reform, which was introduced as part of an economic development plan in Iran in 2010, led to a significant reduction in households’ income inequality. However, the TSL did not significantly affect equity in healthcare financing. Hence, while measuring the long-term impact of TSL is paramount, healthcare decision-makers need to consider the efficacy of the TSL in order to develop plans for achieving the desired equity in healthcare financing.
Delivery of Health Care* ; Economic Development ; Family Characteristics ; Gross Domestic Product ; Healthcare Financing* ; Inflation, Economic ; Iran ; Jurisprudence ; Regression Analysis* ; Social Justice ; Socioeconomic Factors

OBJECTIVES: This study aimed to explain the health-related quality of life (HRQoL) gap between the poorest and the wealthiest quintiles in the capitals of Kermanshah and Kurdistan Provinces (Kermanshah and Sanandaj), in western Iran. METHODS: This was a cross-sectional study conducted among 1772 adults. Data on socio-demographic characteristics, socioeconomic status (SES), lifestyle factors, body mass index, and HRQoL of participants were collected using a self-administered questionnaire. The slope and relative indices of inequality (SII and RII, respectively) were employed to examine socioeconomic inequality in poor HRQoL. Blinder-Oaxaca (BO) decomposition was used to quantify the contribution of explanatory variables to the gap in the prevalence of poor HRQoL between the wealthiest and the poorest groups. RESULTS: The overall crude and age-adjusted prevalence of poor HRQoL among adults was 32.0 and 41.8%, respectively. The SII and RII indicated that poor HRQoL was mainly concentrated among individuals with lower SES. The absolute difference (%) in the prevalence of poor HRQoL between the highest and lowest SES groups was 28.4. The BO results indicated that 49.9% of the difference was explained by different distributions of age, smoking behavior, physical inactivity, chronic health conditions, and obesity between the highest and lowest SES groups, while the remaining half of the gap was explained by the response effect. CONCLUSIONS: We observed a pro-rich distribution of poor HRQoL among adults in the capitals of Kermanshah and Kurdistan Provinces. Policies and strategies aimed at preventing and reducing smoking, physical inactivity, chronic health conditions, and obesity among the poor may reduce the gap in poor HRQoL between the highest and lowest SES groups in Iran.
Adult ; Body Mass Index ; Cross-Sectional Studies ; Health Status Disparities ; Humans ; Iran* ; Life Style ; Obesity ; Prevalence ; Quality of Life* ; Smoke ; Smoking ; Social Class ; Socioeconomic Factors*

OBJECTIVES: Obesity is a considerable and growing public health concern worldwide. The present study aimed to quantify socioeconomic inequalities in adult obesity in western Iran. METHODS: A total of 10 086 participants, aged 35-65 years, from the Ravansar Non-communicable Disease Cohort Study (2014-2016) were included in the study to examine socioeconomic inequalities in obesity. We defined obesity as a body mass index ≥30 kg/m2. The concentration index and concentration curve were used to illustrate and measure wealth-related inequality in obesity. Additionally, we decomposed the concentration index to identify factors that explained wealth-related inequality in obesity. RESULTS: Overall, the prevalence of obesity in the total sample was 26.7%. The concentration index of obesity was 0.04; indicating that obesity was more concentrated among the rich (p < 0.001). Decomposition analysis indicated that wealth, place of residence, and marital status were the main contributors to the observed inequality in obesity. CONCLUSIONS: Socioeconomic-related inequalities in obesity among adults warrant more attention. Policies should be designed to reduce both the prevalence of obesity and inequalities in obesity by focusing on those with higher socioeconomic status, urban residents, and married individuals.
Adult* ; Body Mass Index ; Cohort Studies ; Health Equity ; Humans ; Iran* ; Marital Status ; Obesity* ; Prevalence ; Public Health ; Social Class ; Socioeconomic Factors*

OBJECTIVES: This study aimed to examine the prevalence and types of medication errors (MEs), as well as barriers to reporting MEs, among nurses working in 7 teaching hospitals affiliated with Kermanshah University of Medical Sciences in 2016. METHODS: A convenience sampling method was used to select the study participants (n=500 nurses). A self-constructed questionnaire was employed to collect information on participants’ socio-demographic characteristics (10 items), their perceptions about the main causes of MEs (31 items), and barriers to reporting MEs to nurse managers (11 items). Data were collected from September 1 to November 30, 2016. Negative binomial regression was used to identify the main predictors of the frequency of MEs among nurses. RESULTS: The prevalence of MEs was 17.0% (95% confidence interval, 13.7 to 20.3%). The most common types of MEs were administering medications at the wrong time (24.0%), dosage errors (16.8%), and administering medications to the wrong patient (13.8%). A heavy workload and the type of shift work were considered to be the main causes of MEs by nursing staff. Our findings showed that 45.0% of nurses did not report MEs. A heavy workload due to a high number of patients was the most important reason for not reporting MEs (mean score, 3.57±1.03) among nurses. Being male, having a second unrelated job, and fixed shift work significantly increased MEs among nurses (p=0.001). CONCLUSIONS: Our study documented a high prevalence of MEs among nurses in the west of Iran. A heavy workload was considered to be the most important barrier to reporting MEs among nurses. Thus, appropriate strategies (e.g., reducing the nursing staff workload) should be developed to address MEs and improve patient safety in hospital settings in Iran.
Hospitals, Teaching* ; Humans ; Iran* ; Male ; Medication Errors* ; Methods ; Nurse Administrators ; Nursing Staff ; Patient Safety ; Prevalence*

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.
Adult ; Chronic Disease ; Cross-Sectional Studies ; Education ; Family Characteristics ; Humans ; Iran ; Life Style ; Linear Models ; Male ; Medically Uninsured ; Motor Activity ; Quality of Life ; Self Care ; Smoke ; Smoking ; Social Class ; Visual Analog Scale

OBJECTIVES: This study aimed to examine the prevalence and types of medication errors (MEs), as well as barriers to reporting MEs, among nurses working in 7 teaching hospitals affiliated with Kermanshah University of Medical Sciences in 2016.METHODS: A convenience sampling method was used to select the study participants (n=500 nurses). A self-constructed questionnaire was employed to collect information on participants’ socio-demographic characteristics (10 items), their perceptions about the main causes of MEs (31 items), and barriers to reporting MEs to nurse managers (11 items). Data were collected from September 1 to November 30, 2016. Negative binomial regression was used to identify the main predictors of the frequency of MEs among nurses.RESULTS: The prevalence of MEs was 17.0% (95% confidence interval, 13.7 to 20.3%). The most common types of MEs were administering medications at the wrong time (24.0%), dosage errors (16.8%), and administering medications to the wrong patient (13.8%). A heavy workload and the type of shift work were considered to be the main causes of MEs by nursing staff. Our findings showed that 45.0% of nurses did not report MEs. A heavy workload due to a high number of patients was the most important reason for not reporting MEs (mean score, 3.57±1.03) among nurses. Being male, having a second unrelated job, and fixed shift work significantly increased MEs among nurses (p=0.001).CONCLUSIONS: Our study documented a high prevalence of MEs among nurses in the west of Iran. A heavy workload was considered to be the most important barrier to reporting MEs among nurses. Thus, appropriate strategies (e.g., reducing the nursing staff workload) should be developed to address MEs and improve patient safety in hospital settings in Iran.
Hospitals, Teaching ; Humans ; Iran ; Male ; Medication Errors ; Methods ; Nurse Administrators ; Nursing Staff ; Patient Safety ; Prevalence

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.
Adult* ; Chronic Disease ; Cross-Sectional Studies* ; Education ; Family Characteristics ; Humans ; Iran ; Life Style ; Linear Models ; Male ; Medically Uninsured ; Motor Activity ; Quality of Life* ; Self Care ; Smoke ; Smoking ; Social Class ; Visual Analog Scale

Objectives: Household overcrowding (HC) can contribute to both physical and mental disorders among the members of overcrowded households. This study aimed to measure the status of HC and its main determinants across the provinces of Iran. Methods: Data from 39 864 households from the 2016 Iranian Household Income and Expenditures Survey were used in this study. The Equivalized Crowding Index (ECI) and HC index were applied to measure the overcrowding of households. Regression models were estimated to show the relationships between different variables and the ECI. Results: The overall, urban, and rural prevalence of HC was 8.2%, 6.3%, and 10.1%, respectively. The highest prevalence of HC was found in Sistan and Baluchestan Province (28.7%), while the lowest was found in Guilan Province (1.8%). The number of men in the household, rural residency, the average age of household members, yearly income, and the household wealth index were identified as the main determinants of the ECI and HC. Conclusions The study demonstrated that the ECI and HC were higher in regions near the borders of Iran than in other regions. Therefore, health promotion and empowerment strategies are required to avoid the negative consequences of HC, and screening programs are needed to identify at-risk families.