International Journal of Health Policy and Management

International Journal of Health Policy and Management

Changes in Socio-Economic Inequality in Neonatal Mortality in Iran Between 1995-2000 and 2005-2010: An Oaxaca Decomposition Analysis

Document Type : Original Article

Authors
Mostafa Amini Rarani 1, 2
Arash Rashidian 1
Ardeshir Khosravi 3
Mohammad Arab 1
Ezatollah Abbasian 4
Esmaeil Khedmati Morasae 5, 6
1 Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
2 Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
3 Deputy of Public Health, Ministry of Health and Medical Education, Tehran, Iran
4 Department of Economics, Bu-Ali Sina University, Hamadan, Iran
5 Department of Public Health, Qom University of Medical Sciences, Qom, Iran
6 Centre for System Studies (CSS), Hull University Business School (HUBS), Hull York Medical School (HYMS), University of Hull, Hull, UK
10.15171/ijhpm.2016.127
Abstract
Background
Exploring changes in health inequality and its determinants over time is of policy interest. Accordingly, this study aimed to decompose inequality in neonatal mortality into its contributing factors and then explore changes from 1995-2000 to 2005-2010 in Iran.
 
Methods
Required data were drawn from two Iran’s demographic and health survey (DHS) conducted in 2000 and 2010. Normalized concentration index (CI) was used to measure the magnitude of inequality in neonatal mortality. The contribution of various determinants to inequality was estimated by decomposing concentration indices in 1995-2000 and 2005-2010. Finally, changes in inequality were investigated using Oaxaca-type decomposition technique.
 
Results
Pro-rich inequality in neonatal mortality was declined by 16%, ie, the normalized CI dropped from -0.1490 in 1995-2000 to -0.1254 in 2005-2010. The largest contribution to inequality was attributable to mother’s education (32%) and household’s economic status (49%) in 1995-2000 and 2005-2010, respectively. Changes in mother’s educational level (121%), use of skilled birth attendants (79%), mother’s age at the delivery time (25-34 years old) (54%) and using modern contraceptive (29%) were mainly accountable for the decrease in inequality in neonatal mortality.
 
Conclusion
Policy actions on improving households’ economic status and maternal education, especially in rural areas, may have led to the reduction in neonatal mortality inequality in Iran.
Keywords
Neonatal Mortality
Socio-Economic Inequality
Oaxaca Decomposition
Iran
Subjects
  1. World Health Organization (WHO). Levels and trend in child mortality, report 2014. Geneva: WHO; 2014.
  2. Fenn B, Kirkwood BR, Popatia Z, Bradley DJ. Inequities in neonatal survival interventions: evidence from national surveys. Arch Dis Child Fetal Neonatal Ed. 2007;92:361-366. doi:10.1136/adc.2006.104836
  3. Gonzalez R, Requejo JH, Nien JK, Merialdi M, Bustreo F. Tackling health inequities in Chile: Maternal, newborn,infant, and child mortality between 1990 and 2004. Am J Public Health. 2009;99(7):1220-1226. doi:10.2105/AJPH.2008.143578
  4. Hoa DP, Nga NT, Målqvist M, Persson LÅ. Persistent neonatal mortality despite improved under‐five survival: a retrospective cohort study in northern Vietnam. Acta Paediatr. 2008;97(2):166-170. doi:10.1111/j.1651-2227.2007.00604.x
  5. Kraft AD, Nguyen KH, Jimenez-Soto E, Hodge A. Stagnant neonatal mortality and persistent health inequality in middle-income countries: a case study of the Philippines. PLoS One. 2013;8(1):e53696. doi:10.1371/journal.pone.0053696
  6. McKinnon B, Harper S, Kaufman JS, Bergevin Y. Socio-economic  inequality in neonatal mortality in countries of low and middle income: a multicountry analysis. Lancet Glob Health. 2014;2(3):e165-e173. doi:10.1016/S2214-109X(14)70008-7
  7. Musafili A, Essén B, Baribwira C, Binagwaho A, Persson LÅ, Selling KE. Trends and social differentials in child mortality in Rwanda 1990–2010: results from three demographic and health surveys. J Epidemiol Community Health. 2015;69(9):834-840 doi:10.1136/jech-2014-204657
  8. Sousa A, Hill K, Dal Poz MR. Sub-national assessment of inequality trends in neonatal and child mortality in Brazil. Int J Equity Health. 2010;9:21. doi:10.1186/1475-9276-9-21
  9. Victora CG, Barros AJD. Socio-economic  inequalities in neonatal mortality are falling: but why? Lancet Glob Health. 2014;2(3):e122-e123. doi:10.1016/S2214-109X(14)70024-5
  10. Chalasani S. Understanding wealth-based inequalities in child health in India: A decomposition approach. Soc Sci Med. 2012;75(12):2160-2169. doi:10.1016/j.socscimed.2012.08.012
  11. Hosseinpoor AR, Van Doorslaer E, Speybroeck N, et al. Decomposing Socio-economic  inequality in infant mortality in Iran. Int J Epidemiol. 2006;35(5):1211-1219. doi:10.1093/ije/dyl164
  12. Nkonki LL, Chopra M, Doherty TM, Jackson D, Robberstad B. Explaining household socio-economic related child health inequalities using multiple methods in three diverse settings in South Africa. Int J Equity Health. 2011;10(1):13. doi:10.1186/1475-9276-10-13
  13. Pradhan J, Arokiasamy P. Socio-economic inequalities in child survival in India: A decomposition analysis. Health Policy. 2010;98(2-3):114-120. doi:10.1016/j.healthpol.2010.05.010
  14. Van Malderen C, Van Oyen H, Speybroeck N. Contributing determinants of overall and wealth-related inequality in under-5 mortality in 13 African countries. J Epidemiol Community Health. 2013;67(8):667-676. doi:10.1136/jech-2012-202195
  15. Wagstaff A, van Doorslaer E, Watanabe N. On decomposing the causes of health sector inequalities with an application to malnutrition inequalities in Vietnam. J Econom. 2003;112(1):207-223. doi:10.1016/S0304-4076(02)00161-6
  16. Walsh B, Cullinan J. Decomposing Socio-economic  inequalities in childhood obesity: Evidence from Ireland. Econ Hum Biol. 2015;16:60-72. doi:10.1016/j.ehb.2014.01.003
  17. Harper S, Lynch J. Commentary: Using innovative inequality measures in epidemiology. Int J Epidemiol. 2007;36(4):926-928. doi:10.1093/ije/dym139
  18. Speybroeck N, Konings P, Lynch J, et al. Decomposing Socio-economic  health inequalities. Int J Public Health. 2010;55(4):347-351. doi:10.1007/s00038-009-0105-z
  19. O’Donnell O, van Doorslaer E, Wagstaff A, Lindelow M. Analyzing Health Equity Using Household Survey Data. Washington DC: The World Bank; 2008.
  20. Zare H, Trujillo AJ, Driessen J, Ghasemi M, Gallego G. Health inequalities and development plans in Iran; an analysis of the past three decades (1984–2010). Int J Equity Health. 2014;13(1):42. doi:10.1186/1475-9276-13-42
  21. World Health Organization (WHO). Levels and trend in child mortality, repor 2011. Geneva: World Health Organization; 2011.
  22. Income  distribution  between urban and rural region in Iran between 2001-2012. Statistical Center of Iran website. http://www.amar.org.ir. Updated June 15, 2014. Accessed February 23, 2016.
  23. Ministry of Health and Medical Education (MoHME). Population and health in the Islamic Republic of Iran. Iran demographic and health survey report. Tehran: MoHME; 2000.
  24. Rashidian A, Khosravi A, Khabiri R, et al. Islamic Republic of Iran's Multiple Indicator Demograpphic and Healh Survey(IrMIDHS) 2010. Tehran: Ministry of Health and Medical Education; 2012.
  25. Rashidian A, Khosravi A, Arab M, et al. Iran Multiple Indicator Demographic and Health Survey 2010: questionnaire, guides and protocols. Tehran: National Institute of Health Research and Ministry of Health and Medical Education; 2012.
  26. Stata Corporation. Statistical Software, Release 13. College Station, Texas, USA: StataCorp LP; 2013.
  27. Hosseinpoor AR, Mohammad K, Majdzadeh R, et al. Socio-economic  inequality in infant mortality in Iran and across its provinces. Bull World Health Organ. 2005;83:837-844. doi:10.1590/S0042-96862005001100013
  28. Anand S, Diderichsen F, Evans T, Shkolnikov VM, Wirth M. Measuring disparities in health: methods and indicators. Challenging inequities in health: from ethics to action. New York: Oxford University Press,2001:49-67.
  29. Mosley WH, Chen LC. An analythical framework for the study of child survival in developing countries. Popul Dev Rev. 1984;10:25-45. doi:10.2307/2807954
  30. Vyas S, Kumaranayake L. Constructing socio-economic status indices: how to use principal components analysis. Health Policy Plan. 2006;21(6):459-468. doi:10.1093/heapol/czl029
  31. Montgomery MR, Gragnolati M, Burke KA, Paredes E. Measuring living standards with proxy variables. Demography. 2000;37(2):155-174. doi:10.2307/2648118
  32. Tajik P, Majdzadeh R. Constructing pragmatic Socio-economic  status assessment tools to addresshealth equality challenges. Int J Prev Med. 2014;5(1):46-51.
  33. Combes JB, Gerdtham UG, Jarl J. Equalisation of alcohol participation among Socio-economic  groups over time: an analysis based on the total differential approach and longitudinal data from Sweden. Int J Equity Health. 2011;10:10. doi:10.1186/1475-9276-10-10
  34. Kakwani N, Wagstaff A, Van Doorslaer E. Socioeconomic  inequalities in health: measurement, computation, and statistical inference. J Econom. 1997;77(1):87-103.        doi:10.1016/S0304-4076(96)01807-6
  35. Wagstaff A. The bounds of the concentration index when the variable of interest is binary, with an application to immunization inequality. Health Econ. 2005;14(4):429-432. doi:10.1002/hec.953
  36. Erreygers, G. Correcting the concentration index. J Health Econ. 2009;28(2):504-515. doi:10.1016/j.jhealeco.2008.02.003
  37. Kjellsson G, Gerdtham UG. On correcting the concentration index for binary variables. J Health Econ. 2013;32(3):659-670.        doi:10.1016/j.jhealeco.2012.10.012
  38. Yiengprugsawan V, Lim LL, Carmichael GA, Dear KB, Sleigh AC. Decomposing Socio-economic  inequality for binary health outcomes: an improved estimation that does not vary by choice of reference group. BMC Res Notes. 2010;3(1):57. doi:10.1186/1756-0500-3-57
  39. De Brouwere V, Richard F, Witter S. Access to maternal and perinatal health services: lessons from successful and less successful examples of improving access to safe delivery and care of the newborn. Trop Med Int Health. 2010;15(8):901-909. doi:10.1111/j.1365-3156.2010.02558.x
  40. Sekabaraga C, Diop F, Soucat A. Can innovative health financing policies increase access to MDG-related services? Evidence from Rwanda. Health Policy Plan. 2011;26(suppl 2):ii52-ii62. doi:10.1093/heapol/czr070
  41. Malik K. Human development report 2014. Sustaining human progress: Reducing vulnerabilities and building resilience. New York: United Nations Development Programme; 2014.
  42. Household income and expenditure survey. Statistical Center of Iran website.  http://www.amar.org.ir. Updated May 5, 2014.  Accessed February 18, 2016.
  43. The labour force survey (2005-2014). Statistical Center of Iran website. http://www.amar.org.ir. Updated July 12, 2104.Accessed November  20, 2015.  
  44. Central Bank of Iran. Selective economic statistics: Economic Accounts of Iran. Iran: Central Bank of Iran;2015.
  45. Morasae E, Forouzan A, Majdzadeh R, Asadi-Lari M, Noorbala A, Hosseinpoor A. Understanding determinants of Socio-economic  inequality in mental health in Iran's capital, Tehran: a concentration index decomposition approach. Int J Equity Health. 2012;11(1):18. doi:10.1186/1475-9276-11-18
International Journal of Health Policy and Management
Volume 6, Issue 4
2017
Pages 219-228

  • Received Date 14 March 2016
  • Revised Date 14 September 2016
  • Accepted Date 17 September 2016
  • First Published Date 01 April 2017
  • Published Date 01 April 2017