Irritable bowel syndrome is concentrated in people with higher educations in Iran: an inequality analysis.
OBJECTIVE
Like any other health-related disorder, irritable bowel syndrome (IBS) has a differential distribution with respect to socioeconomic factors. This study aimed to estimate and decompose educational inequalities in the prevalence of IBS.


METHODS
Sampling was performed using a multi-stage random cluster sampling approach. The data of 1,850 residents of Kish Island aged 15 years or older were included, and the determinants of IBS were identified using a generalized estimating equation regression model. The concentration index of educational inequality in cases of IBS was estimated and decomposed as the specific inequality index.


RESULTS
The prevalence of IBS in this study was 21.57% (95% confidence interval [CI], 19.69 to 23.44%). The concentration index of IBS was 0.20 (95% CI, 0.14 to 0.26). A multivariable regression model revealed that age, sex, level of education, marital status, anxiety, and poor general health were significant determinants of IBS. In the decomposition analysis, level of education (89.91%), age (-11.99%), and marital status (9.11%) were the three main contributors to IBS inequality. Anxiety and poor general health were the next two contributors to IBS inequality, and were responsible for more than 12% of the total observed inequality.


CONCLUSIONS
The main contributors of IBS inequality were education level, age, and marital status. Given the high percentage of anxious individuals among highly educated, young, single, and divorced people, we can conclude that all contributors to IBS inequality may be partially influenced by psychological factors. Therefore, programs that promote the development of mental health to alleviate the abovementioned inequality in this population are highly warranted.
Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Asieh
0000-0002-8507-6738
A
Mansouri
Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Mostafa Amini
0000-0002-4809-2237
MA
Rarani
Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
Mosayeb
0000-0002-6036-3378
M
Fallahi
Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Iman
0000-0002-0032-1264
I
Alvandi
D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D006801:Humans; D007492:Iran / Q000453:epidemiology; D043183:Irritable Bowel Syndrome / Q000453:epidemiology*; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D015995:Prevalence; D012044:Regression Analysis; D012923:Social Class; D055815:Young Adult
Inequality; Iran; Irritable bowel syndrome; Mental health; Socioeconomic factors