Home Articles List Article Information
International Journal of Health Policy and Management
Journal Archive
Volume Volume 9 (2020)
Volume Volume 8 (2019)
Volume Volume 7 (2018)
Volume Volume 6 (2017)
Volume Volume 5 (2016)
Volume Volume 4 (2015)
Volume Volume 3 (2014)
Volume Volume 2 (2014)
Volume Volume 1 (2013)
Emamian, M., Zeraati, H., Majdzadeh, R., Shariati, M., Hashemi, H., Fotouhi, A. (2014). Economic Inequality in Eye Care Utilization and its Determinants: A Blinder–Oaxaca Decomposition. International Journal of Health Policy and Management, 3(6), 307-313. doi: 10.15171/ijhpm.2014.100
Mohammad Hassan Emamian; Hojjat Zeraati; Reza Majdzadeh; Mohammad Shariati; Hassan Hashemi; Akbar Fotouhi. "Economic Inequality in Eye Care Utilization and its Determinants: A Blinder–Oaxaca Decomposition". International Journal of Health Policy and Management, 3, 6, 2014, 307-313. doi: 10.15171/ijhpm.2014.100
Emamian, M., Zeraati, H., Majdzadeh, R., Shariati, M., Hashemi, H., Fotouhi, A. (2014). 'Economic Inequality in Eye Care Utilization and its Determinants: A Blinder–Oaxaca Decomposition', International Journal of Health Policy and Management, 3(6), pp. 307-313. doi: 10.15171/ijhpm.2014.100
Emamian, M., Zeraati, H., Majdzadeh, R., Shariati, M., Hashemi, H., Fotouhi, A. Economic Inequality in Eye Care Utilization and its Determinants: A Blinder–Oaxaca Decomposition. International Journal of Health Policy and Management, 2014; 3(6): 307-313. doi: 10.15171/ijhpm.2014.100

Economic Inequality in Eye Care Utilization and its Determinants: A Blinder–Oaxaca Decomposition

Article 3, Volume 3, Issue 6, November 2014, Page 307-313  XML PDF (512 K)
Document Type: Original Article
DOI: 10.15171/ijhpm.2014.100
Authors
Mohammad Hassan Emamian1; Hojjat Zeraati2; Reza Majdzadeh2, 3; Mohammad Shariati4; Hassan Hashemi5, 6; Akbar Fotouhi 2
1Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran
2Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
3Knowledge Utilization Research Center (KURC), Tehran University of Medical Sciences, Tehran, Iran
4Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
5Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
6Farabi Eye Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Abstract
Background
The current study aimed to determine eye care utilization, to assess the role of economic inequality in the utilization of eye care services, and to identify its determinants in Shahroud, North of Iran.
 
Methods
Of the 6,311 invited people, 5,190 (82.24%) individuals aged 40 to 64 years old participated in the study. A history of a visit by an ophthalmologist or optometrist was considered as eye care utilization. The gap between low- and high-economic groups was decomposed into its determinants using the Oaxaca decomposition method.
 
Results
Among the participants, 16.32% [95% Confidence Intervals (CI)= 15.31–17.33%] had never been examined by an ophthalmologist or optometrist, and 30.94% (95% CI= 29.69–32.20%) had not undergone an eye examination in the past 5 years. This negative history was significantly higher among female subjects [Odds Ratio (OR)= 1.79, 95% CI= 1.51–2.14], the low-economic group (OR= 2.33, 95% CI= 1.90–2.87), the visually impaired (OR= 1.41, 95% CI= 1.05–1.90), and the uninsured (OR= 1.93, 95% CI= 1.45–2.58). The negative history of eye examination decreased with increasing in age (OR= 0.94, 95% CI= 0.93–0.96) and education (OR= 0.94, 95% CI= 0.92–0.96). In this study, 24.72% (95% CI= 22.30–27.14) of the low-economic group and 9.94% (95% CI= 8.75–11.14) of the high-economic group had no history of eye examination. Decomposition of the gap between the two economic groups showed that education and gender were the most important determinants of inequality.
 
Conclusion
A considerable percentage of adults, even those with visual impairment, do not receive appropriate eye
care. There is a definite economic inequality in the community for which poverty per se could be the major cause
Keywords
Eye; Health Status Disparities; Iran; Inequality
Main Subjects
Health Equity; Public Health; Social Epidemiology
References
  1. World Health Organization (WHO). Global Initiative for the Elimination of Avoidable Blindness: action plan 2006-2011. Geneva: WHO; 2007.
  2. Centers for Disease Control and Prevention (CDC). Eye-care utilization among women aged > or =40 years with eye diseases – 19 states, 2006-2008. MMWR Morb Mortal Wkly Rep 2010; 59: 588-91.
  3. Dandona R, Dandona L, Naduvilath TJ, McCarty CA, Rao GN. Utilisation of eyecare services in an urban population in southern India: the Andhra Pradesh eye disease study. Br J Ophthalmol 2000; 84: 22-7. doi: 10.1136/bjo.84.1.22
  4. du Toit R, Ramke J, Naduvilath T, Brian G. Awareness and use of eye care services in Fiji. Ophthalmic Epidemiol 2006; 13: 309-20. doi: 10.1080/09286580600826629
  5. Fotouhi A, Hashemi H, Mohammad K. Eye care utilization patterns in Tehran population: a population based cross-sectional study. BMC Ophthalmol 2006; 6: 4.
  6. Keeffe JE, Weih LM, McCarty CA, Taylor HR. Utilisation of eye care services by urban and rural Australians. Br J Ophthalmol 2002; 86: 24-7.
  7. Lee DJ, Lam BL, Arora S, Arheart KL, McCollister KE, Zheng DD, et al. Reported eye care utilization and health insurance status among US adults. Arch Ophthalmol 2009; 127: 303-10.
  8. McGwin G, Khoury R, Cross J, Owsley C. Vision impairment and eye care utilization among Americans 50 and older. Curr Eye Res 2010; 35: 451-8. doi: 10.1186/1471-2415-6-4
  9. Morales LS, Varma R, Paz SH, Lai MY, Mazhar K, Andersen RM, et al. Self-reported use of eye care among Latinos: the Los Angeles Latino Eye Study. Ophthalmology 2010; 117: 207-15. doi: 10.1016/j.ophtha.2009.07.015
  10. Ndegwa LK, Karimurio J, Okelo RO, Adala HS. Barriers to utilisation of eye care services in Kibera slums of Nairobi. East Afr Med J 2005; 82: 506-8. doi: 10.4314/eamj.v82i10.9347
  11. Nirmalan PK, Katz J, Robin AL, Krishnadas R, Ramakrishnan R, Thulasiraj RD, et al. Utilisation of eye care services in rural south India: the Aravind Comprehensive Eye Survey. Br J Ophthalmol 2004; 88: 1237-41. doi: 10.1016/s0161-6420(04)00535-4
  12. Orr P, Barrón Y, Schein OD, Rubin GS, West SK. Eye care utilization by older Americans: the SEE Project. Salisbury Eye Evaluation. Ophthalmology 1999; 106: 904-9. doi: 10.1016/s0161-6420(99)00508-4
  13. Rowe S, MacLean CH, Shekelle PG. Preventing visual loss from chronic eye disease in primary care: scientific review. JAMA 2004; 291: 1487-95. doi: 10.1001/jama.291.12.1487
  14. Leigh A, Jencks C, Smeeding TM. Health and Economic Inequality. In: Salverda W, Nolan B, Smeeding TM, editors. Oxford Handbook of Economic Inequality. Oxford: Oxford University Press; 2009. p. 385-405.
  15. Marmot M. The influence of income on health: views of an epidemiologist. Health Aff (Millwood) 2002; 21: 31-46. doi: 10.1377/hlthaff.21.2.31
  16. Dowd JB, Albright J, Raghunathan TE, Schoeni RF, Leclere F, Kaplan GA. Deeper and wider: income and mortality in the USA over three decades. Int J Epidemiol 2011; 40: 183-8. doi: 10.1093/ije/dyq189
  17. Gilbert CE, Shah SP, Jadoon MZ, Bourne R, Dineen B, Khan MA, et al. Poverty and blindness in Pakistan: results from the Pakistan national blindness and visual impairment survey. BMJ 2008; 336: 29-32. doi: 10.1136/bmj.39395.500046.ae
  18. Ho VH, Schwab IR. Social economic development in the prevention of global blindness. Br J Ophthalmol 2001; 85: 653-7.
  19. Khanna R, Raman U, Rao GN. Blindness and poverty in India: the way forward. Clin Exp Optom 2007; 90: 406-14. doi: 10.1111/j.1444-0938.2007.00199.x
  20. Harris B, Sampson G. Gender differences in the utilisation of optometric services in Victoria. Clin Exp Optom 2005; 88: 109-12. doi: 10.1111/j.1444-0938.2005.tb06676.x
  21. Jansen E, Baltussen RM, van Doorslaer E, Ngirwamungu E, Nguyen MP, Kilima PM. An Eye for Inequality: How Trachoma Relates to Poverty in Tanzania and Vietnam. Ophthalmic Epidemiol 2007; 14: 278-87. doi: 10.1080/09286580701299403
  22. Kuper H, Polack S, Eusebio C, Mathenge W, Wadud Z, Foster A. A Case-Control Study to Assess the Relationship between Poverty and Visual Impairment from Cataract in Kenya, the Philippines, and Bangladesh. PLoS Med 2008; 5: 1716-28. doi: 10.1371/journal.pmed.0050244
  23. Chou CF, Barker LE, Crews JE, Primo SA, Zhang X, Elliott AF, et al. Disparities in Eye Care Utilization Among the United States Adults With Visual Impairment: Findings From the Behavioral Risk Factor Surveillance System 2006-2009. Am J Ophthalmol 2012; 154: S45-52. doi: 10.1016/j.ajo.2011.09.025
  24. Jin YP, Trope GE. Eye care utilization in Canada: disparity in the publicly funded health care system. Can J Ophthalmol 2011; 46: 133-38. doi: 10.3129/i10-120
  25. Vela C, Samson E, Zunzunegui MV, Haddad S, Aubin MJ, Freeman EE. Eye care utilization by older adults in low, middle, and high income countries. BMC Ophthalmol 2012; 12: 5 doi: 10.1186/1471-2415-12-5
  26. Fotouhi A, Hashemi H, Shariati M, Emamian MH, Yazdani K, Jafarzadehpur E, et al. Cohort Profile: Shahroud Eye Cohort Study. Int J Epidemiol 2013; 42: 1300-8. doi: 10.1093/ije/dys161
  27. Andersen R, Newman JF. Societal and individual determinants of medical care utilization in the United States. Milbank Q 1973; 51: 95-124. doi:  10.1111/j.1468-0009.2005.00428.x
  28. O’Donnell O, van Doorslaer E, Wagstaff A, Lindelow M. Analyzing Health Equity Using Household Survey Data A Guide to Techniques and Their Implementation. Washington, DC: The World Bank; 2008.
  29. Blinder AS. Wage Discrimination: Reduced Forms and Structural Estimates. J Hum Resour 1973; 8: 436-55. doi: 10.2307/144855
  30. Oaxaca R. Male-Female Wage Differentials in Urban Labor Market. Int Econ Rev 1973; 14: 693-709. doi: 10.2307/2525981
  31. Jimenez-Rubio D, Hernandez-Quevedo C. Inequalities in the use of health services between immigrants and the native population in Spain: what is driving the differences? Eur J Health Econ 201; 12: 17-28. doi: 10.1007/s10198-010-0220-z
  32. Jann B. A Stata implementation of the Blinder-Oaxaca decomposition. Stata J 2008; 8: 453-79.
  33. Schaumberg DA, Christen WG, Glynn RJ, Buring JE. Demographic predictors of eye care utilization among women. Med Care 2000; 38: 638-46. doi: 10.1097/00005650-200006000-00005
  34. Xie E. Income-Related Inequalities of Health and Health Care Utilization. Front Econ China 2011; 6: 131-56. doi: 10.1007/s11459-011-0125-5
  35. van Doorslaer E, Koolman X, Jones AM. Explaining income-related inequalities in doctor utilisation in Europe. Health Econ 2004; 13: 629-47. doi: 10.1002/hec.919
  36. Wagstaff A, Waters H. How Were the Reaching the Poor Studies Done. In: Gwatkin DR WA, Yasbeck AS, editors. Reaching the Poor with Health, Nutrition, and Population Services: What Works, What Doesn’t, and Why. Washington, DC: The World Bank, 2005. P. 27-46.
Statistics
Article View: 12,141
PDF Download: 3,924