title: Decomposition of Health Inequality Determinants in Shiraz, South-west Iran.
abstract: BACKGROUND
  Despite the enhancement in health outcomes worldwide, health inequity and inequality is one of the most relevant topics both for health policy and public health. This research was designed to decompose the health inequality of people living in Shiraz, south-west Iran.
  
  
  METHODS
  Data were obtained from a multistage-sample survey conducted in Shiraz from April to May 2012, to find determinants of health related quality of life (HRQoL). General health (GH) and mental health (MH) were used as health status. As a measure of socioeconomic inequality, a concentration index of GH and MH was used and decomposed into its determinants.
  
  
  RESULTS
  The overall concentration indices of MH and GH in Shiraz were 0.023 (95% CI: 0.015, 0.031) and 0.016 (95% CI: 0.009, 0.022), respectively. Decomposition of the concentration indices indicated that income made the largest contribution (39.92% for GH and 39.82% for MH) to income-related health inequality. Education (about 25% for GH and 34% for MH), insurance (about 14% for GH and 11% for MH), and occupation (about 12% for GH and 11% for MH) also proved important contributors to the health inequality in Shiraz.
  
  
  CONCLUSIONS
  There exist MH and GH inequalities in Shiraz. Apart from insurance, most of the health inequalities in Shiraz can be explained through factors beyond the health sector. Hence, implementing redistributive policies and education expansion programs as well as providing an insurance scheme and secure career conditions could decrease these unethical health inequalities.
authors.affiliation: Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Vajihe
authors.initials: V
authors.lastname: Ramezani Doroh
authors.affiliation: Health Management and Economics Research Center, School of Management and Medical Information, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Sajad
authors.initials: S
authors.lastname: Vahedi
authors.affiliation: Department of Health Care Management, School of Public Health, Zabol University of Medical Sciences, Zabol, Iran. masoudarefnezhad@gmail.com.
authors.forename: Masoud
authors.initials: M
authors.lastname: Arefnezhad
authors.affiliation: Social Determinants of Health Research Center, School of Management and Medical Information, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Zahra
authors.initials: Z
authors.lastname: Kavosi
authors.affiliation: Department of Epidemiology and Biostatistics, School of Health, Qom University of Medical Sciences, Qom, Iran.
authors.forename: Abolfazl
authors.initials: A
authors.lastname: Mohammadbeigi
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006291:Health Policy; D054624:Health Status Disparities; D006306:Health Surveys; D006801:Humans; D007492:Iran; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012923:Social Class; D055815:Young Adult
keywords: Concentration index; Decomposition; Health inequality; Iran