IJE Advance Access originally published online on September 19, 2006
International Journal of Epidemiology 2006 35(5):1211-1219; doi:10.1093/ije/dyl164
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Decomposing socioeconomic inequality in infant mortality in Iran
1 Department of Equity, Poverty and Social Determinants of Health, Evidence and Information for Policy, World Health Organization, Geneva, Switzerland
2 Institute of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
3 Health Deputy, Ministry of Health and Medical Education, Tehran, Iran
4 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
* Corresponding author. Ahmad Reza Hosseinpoor, Department of Equity, Poverty and Social Determinants of Health, Evidence and Information for Policy, World Health Organization, 20 Avenue Appia, Geneva 27 CH1211, Switzerland. E-mail: hosseinpoora{at}who.int
Background Although measuring socioeconomic inequality in population health indicators like infant mortality is important, more interesting for policy purposes is to try to explain infant mortality inequality. The objective of this paper is to quantify for the first time the determinants' contributions of socioeconomic inequality in infant mortality in Iran.
Methods A nationally representative sample of 108 875 live births from October 1990 to September 1999 was selected. The data were taken from the Iranian Demographic and Health Survey (DHS) conducted in 2000. Households' socioeconomic status was measured using principal component analysis. The concentration index of infant mortality was used as our measure of socioeconomic inequality and decomposed into its determining factors.
Results The largest contributions to inequality in infant mortality were owing to household economic status (36.2%) and mother's education (20.9%). Residency in rural/urban areas (13.9%), birth interval (13.0%), and hygienic status of toilet (11.9%) also proved important contributors to the measured inequality.
Conclusions The findings indicate that socioeconomic inequality in infant mortality in Iran is determined not only by health system functions but also by factors beyond the scope of health authorities and care delivery system. This implies that in addition to reducing inequalities in wealth and education, investments in water and sanitation infrastructure and programmes (especially in rural areas) are necessary to realize improvements of inequality in infant mortality across society. These findings can be instrumental for the recent 5 year Economic, Social and Cultural Development Plan of Iran, which identified the reduction of inequalities in social determinants of health.
Accepted 4 July 2006
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