Decomposition of Healthcare Utilization Inequality in Iran: The Prominent Role of Health Literacy and Neighborhood Characteristics Article Swipe
Neda SoleimanvandiAzar
,
Seyed Hossein Mohaqeqi Kamal
,
Mehdi Basakha
,
Salah Eddin Karimi
,
Sina Ahmadi
,
Gholamreza Ghaedamini Harouni
,
Homeira Sajjadi
,
Ameneh Setareh Forouzan
·
YOU?
·
· 2024
· Open Access
·
· DOI: https://doi.org/10.1177/00469580241229622
YOU?
·
· 2024
· Open Access
·
· DOI: https://doi.org/10.1177/00469580241229622
Unequal utilization in healthcare can potentially affect the right to health. Access to healthcare services and achieving positive health outcomes and health equity are essential principles in promoting human rights. This study aims to assess and analyze socioeconomic-related inequalities in outpatient health services utilization (OHSU) among various socio-demographic subgroups to inform policies that foster health equity. Data were collected through a cross-sectional survey of 1200 households in Tehran, Iran. Inequality in OHSU among the socio-demographic subgroups was calculated by concentration, Wagstaff, and Erigers indices. Decomposition was used to identify the factors contributing to inequality in OHSU. Marginal effect and elasticity were used to calculate the relative absolute shares of socio-demographic variables in the inequality. The rate of OHSU was 63.61% (CI: 60-66.80) which concentrated among households with better socioeconomic status. Based on the results, living in an affluent neighborhood (Relative share (RS): 85.48) and having a disabled member in the household (RS: 6.58) were the most important factors in the concentration of OHSU in favor of the privileged groups. In contrast, very low levels of health knowledge (RS: −83.79) and having basic insurance coverage (RS: −3.92) concentrated OHSU in favor of the lower socioeconomic households. The study was conducted based on survey data, and this may lead to some limitations. Given that this study was a cross-sectional study, we were unable to establish causal relationships between explanatory variables and outpatient health service utilization and its relevant predictors. Households with disabled member(s), as well as a member(s) with chronic diseases, may experience severe inequalities in access to healthcare services. Policies that facilitate access to health services for these households can play a significant role in improving health equity.
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- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1177/00469580241229622
- https://journals.sagepub.com/doi/pdf/10.1177/00469580241229622
- OA Status
- gold
- Cited By
- 2
- References
- 73
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4391724928
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- OpenAlex ID
-
https://openalex.org/W4391724928Canonical identifier for this work in OpenAlex
- DOI
-
https://doi.org/10.1177/00469580241229622Digital Object Identifier
- Title
-
Decomposition of Healthcare Utilization Inequality in Iran: The Prominent Role of Health Literacy and Neighborhood CharacteristicsWork title
- Type
-
articleOpenAlex work type
- Language
-
enPrimary language
- Publication year
-
2024Year of publication
- Publication date
-
2024-01-01Full publication date if available
- Authors
-
Neda SoleimanvandiAzar, Seyed Hossein Mohaqeqi Kamal, Mehdi Basakha, Salah Eddin Karimi, Sina Ahmadi, Gholamreza Ghaedamini Harouni, Homeira Sajjadi, Ameneh Setareh ForouzanList of authors in order
- Landing page
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https://doi.org/10.1177/00469580241229622Publisher landing page
- PDF URL
-
https://journals.sagepub.com/doi/pdf/10.1177/00469580241229622Direct link to full text PDF
- Open access
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YesWhether a free full text is available
- OA status
-
goldOpen access status per OpenAlex
- OA URL
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https://journals.sagepub.com/doi/pdf/10.1177/00469580241229622Direct OA link when available
- Concepts
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Socioeconomic status, Inequality, Equity (law), Health equity, Health care, Tobit model, Environmental health, Socioeconomics, Demography, Psychology, Medicine, Economics, Economic growth, Mathematics, Sociology, Political science, Econometrics, Population, Mathematical analysis, LawTop concepts (fields/topics) attached by OpenAlex
- Cited by
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2Total citation count in OpenAlex
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2025: 1, 2024: 1Per-year citation counts (last 5 years)
- References (count)
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73Number of works referenced by this work
- Related works (count)
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10Other works algorithmically related by OpenAlex
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| abstract_inverted_index.causal | 223 |
| abstract_inverted_index.effect | 97 |
| abstract_inverted_index.equity | 22 |
| abstract_inverted_index.foster | 53 |
| abstract_inverted_index.having | 144, 180 |
| abstract_inverted_index.health | 18, 21, 41, 54, 175, 230, 263, 275 |
| abstract_inverted_index.inform | 50 |
| abstract_inverted_index.levels | 173 |
| abstract_inverted_index.living | 134 |
| abstract_inverted_index.member | 147 |
| abstract_inverted_index.severe | 251 |
| abstract_inverted_index.shares | 107 |
| abstract_inverted_index.study, | 217 |
| abstract_inverted_index.survey | 62, 201 |
| abstract_inverted_index.unable | 220 |
| abstract_inverted_index.Erigers | 82 |
| abstract_inverted_index.Tehran, | 67 |
| abstract_inverted_index.Unequal | 0 |
| abstract_inverted_index.analyze | 36 |
| abstract_inverted_index.between | 225 |
| abstract_inverted_index.chronic | 247 |
| abstract_inverted_index.equity. | 55, 276 |
| abstract_inverted_index.factors | 90, 157 |
| abstract_inverted_index.groups. | 168 |
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| abstract_inverted_index.rights. | 29 |
| abstract_inverted_index.service | 231 |
| abstract_inverted_index.status. | 129 |
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| abstract_inverted_index.absolute | 106 |
| abstract_inverted_index.affluent | 137 |
| abstract_inverted_index.coverage | 183 |
| abstract_inverted_index.disabled | 146, 239 |
| abstract_inverted_index.identify | 88 |
| abstract_inverted_index.indices. | 83 |
| abstract_inverted_index.outcomes | 19 |
| abstract_inverted_index.policies | 51 |
| abstract_inverted_index.positive | 17 |
| abstract_inverted_index.relative | 105 |
| abstract_inverted_index.relevant | 235 |
| abstract_inverted_index.results, | 133 |
| abstract_inverted_index.services | 14, 42, 264 |
| abstract_inverted_index.−3.92) | 185 |
| abstract_inverted_index.(Relative | 139 |
| abstract_inverted_index.60-66.80) | 121 |
| abstract_inverted_index.Wagstaff, | 80 |
| abstract_inverted_index.achieving | 16 |
| abstract_inverted_index.calculate | 103 |
| abstract_inverted_index.collected | 58 |
| abstract_inverted_index.conducted | 198 |
| abstract_inverted_index.contrast, | 170 |
| abstract_inverted_index.diseases, | 248 |
| abstract_inverted_index.essential | 24 |
| abstract_inverted_index.establish | 222 |
| abstract_inverted_index.household | 150 |
| abstract_inverted_index.important | 156 |
| abstract_inverted_index.improving | 274 |
| abstract_inverted_index.insurance | 182 |
| abstract_inverted_index.knowledge | 176 |
| abstract_inverted_index.member(s) | 245 |
| abstract_inverted_index.promoting | 27 |
| abstract_inverted_index.services. | 257 |
| abstract_inverted_index.subgroups | 48, 75 |
| abstract_inverted_index.variables | 110, 227 |
| abstract_inverted_index.−83.79) | 178 |
| abstract_inverted_index.Households | 237 |
| abstract_inverted_index.Inequality | 69 |
| abstract_inverted_index.calculated | 77 |
| abstract_inverted_index.elasticity | 99 |
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| abstract_inverted_index.facilitate | 260 |
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| abstract_inverted_index.inequality | 93 |
| abstract_inverted_index.member(s), | 240 |
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| abstract_inverted_index.inequality. | 113 |
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| abstract_inverted_index.socio-demographic | 47, 74, 109 |
| abstract_inverted_index.socioeconomic-related | 37 |
| cited_by_percentile_year.max | 95 |
| cited_by_percentile_year.min | 90 |
| corresponding_author_ids | https://openalex.org/A5076255127 |
| countries_distinct_count | 1 |
| institutions_distinct_count | 8 |
| corresponding_institution_ids | https://openalex.org/I4210166308 |
| sustainable_development_goals[0].id | https://metadata.un.org/sdg/4 |
| sustainable_development_goals[0].score | 0.8500000238418579 |
| sustainable_development_goals[0].display_name | Quality Education |
| citation_normalized_percentile.value | 0.7998429 |
| citation_normalized_percentile.is_in_top_1_percent | False |
| citation_normalized_percentile.is_in_top_10_percent | False |