Assessment of Horizontal Inequity in Eye Care Utilization in the Iranian Middle-aged Population
Affiliations
1Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran.
2Office of Deputy of Research, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
3Center for Health-Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran.
4Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Abstract
Purpose: The present study was designed to determine the extent that horizontal inequity was realized regarding eye care utilization in a middle-aged population as well as factors affecting this equity.
Methods: Data were obtained from a population-based study (Shahroud Eye Cohort Study) in 2009 that included 5190 participants from 40 to 64 years of age. Horizontal inequity was determined based on the following variables: (i) economic status, (ii) eye care service needs, (iii) non-need variables, and (iv) eye care utilization (visiting an ophthalmologist or optometrist). Decomposition analysis of the concentration index based on a nonlinear model and indirect standardization was used to ascertain the contribution of each factor in inequity of eye care utilization.
Results: After adjusting for need variables, the results of our study demonstrated that horizontal inequity in eye care utilization in a middle-aged Iranian population remained positive and significant (horizontal inequity: 0.19; 95% confidence interval: 0.17-0.23) indicating that use of services was focused among participants with a better financial situation. Furthermore, decomposition analysis demonstrated that educational level and economic status had the greatest contribution (54.1% and 41.1%, respectively) in comparison to other variables.
Conclusion: This study demonstrated that horizontal inequity exists in eye care utilization among the middle-aged Iranian population.
Keywords: Eye Care Utilization; Horizontal Inequity Index; Iran; Middle-aged Population.