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Amini Rarani M, rashidian A, Khosravi A, Arab M, Abbasian E. Socio-Economic Inequality Changes in Under-Five Mortality in Iran: Two National Surveys Analysis. Hakim 2017; 20 (3) :131-141
URL: http://hakim.tums.ac.ir/article-1-1782-en.html

Mostafa Amini Rarani ¹ (MSc, PhD), Arash Rashidian ^{2, 3*} (MD, PhD), Ardeshir Khosravi ⁴ (PhD) Mohammad Arab ² (PhD), Ezatollah Abbasian ⁵ (PhD)

Abstract

Introduction: Iran’s trends indicate that substantial reductions have been made in under-five mortality rates. Whether this progress has been accompanied by an increasing or decreasing of the under-five mortality inequality between socioeconomic quintiles is unknown.

Methods: We performed a cross-sectional secondary data analysis of 2 demographic and health surveys (DHS) conducted in 2000 and 2010 in Iran. Under-f ive mortality rates (U5MR) were estimated directly from full birth history. Socioeconomic quintiles were constructed using principal component analysis. We measured change in inequality using the odds ratios, mortality rates and the concentration indices change between socioeconomic groups, as well as testing concentration curves dominance.

Results: Under-five mortality odds ratios in the poorest quintile compared with the richest declined from 1.98 (95 % CI = 1.64 - 2.3) in 2000 to 1.85 (95 % CI = 1.13 - 3) in 2010. While the U5MR had dropped to 38.6% in the poorest quintile, the highest reduction in U5MR (52.3 %) had occurred in the richest group. Concentration index (CI) of under-five mortality in 2000 was -0.17 (95% CI = -0.2 to -0.1), though in 2010 it had dropped to -0.14 (95 % CI = -0.22 to -0.05), a 17.6% reduction. The findings of concentration curves dominance test of under-five mortality showed that decreasing change in under-five mortality inequality between 2000 and 2010 is statistically significant.

Conclusions: Regardless of substantial reduction in under-five mortality rates, socioeconomic inequalities in under-five mortality disfavor the worse off groups still exist. Focusing on new pro-poor child health strategies alongside with pro-equity programs in other social and economic authorities may further decrease the underfive mortality across socioeconomic quintiles.

Keywords: Under-Five Mortality; Socioeconomic Inequality Change; Concentration Index; Odds Ratio; Iran

Amini Rarani M, Rashidian A, Khosravi A, Arab M, Abbasian E. Socio-Economic Inequality Changes in Under-Five Mortality in Iran: Two National Surveys Analysis. Hakim Health Sys Res 2017; 20(3): 131- 141.

*Corresponding Author: Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Poursina Ave, 1417613191 Tehran, Iran. Tel: +98-2188989128, Fax: +98-2188989129, E-mail: arashidian@tums.ac.ir