Economic inequality in unmet refractive error need in deprived rural population of Iran
Abbasali Yekta1, Hassan Hashemi2, Reza Pakzad3, Mohamadreza Aghamirsalim4, Hadi Ostadimoghaddam5, Asgar Doostdar6, Fahimeh Khoshhal7, Mehdi Khabazkhoob8
1 Department of Optometry, Mashhad University of Medical Sciences, Mashhad, Iran
2 Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
3 Department of Epidemiology, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran
4 Eye Research Center, Tehran University of Medical Sciences, Tehran, Iran
5 Refractive Errors Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
6 Department of Optometry, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
7 Department of Pediatrics, Dezful University of Medical Sciences, Dezful, Iran
8 Department of Psychiatric Nursing and Management, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Department of Psychiatric Nursing and Management, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran
Source of Support: None, Conflict of Interest: None
Purpose: To determine economic inequality in unmet refractive error (RE) need and its determinants in deprived rural population of Iran.
Methods: In this population-based study, two villages were randomly selected from among underserved villages of Iran. After selecting the participants, optometric examinations, including uncorrected and corrected visual acuity and subjective and manifest refraction, were done for all the participants. Then, unmet need for glasses was determined. Concentration index (C) was used to assess inequality, and Oaxaca–Blinder decomposition method was applied to decompose the gap between the two groups based on the determinants.
Results: Of 3851 samples, 3314 participated in the study (response rate = 86.05%). The data of 3255 participants were used for analysis. The value of C and 95% confidence interval (CI) was −0.088 (−0.157 to −0.020), indicating a pro-poor inequality in unmet need. The prevalence (95% CI) of unmet need was 11.74% (9.25–14.22) in the poor and 6.51% (4.96–8.06) in the rich, with a gap of about 5% in favor of the rich (P < 0.001). A marked percentage of the gap was due to the explained portion (b = 5.73; P = 0.031). In the explained portion, the variable of economic status (b = 3.48; P = 0.004) and myopia (b = 0.88; P = 0.031) caused inequality in favor of the rich and against the poor, respectively. In the unexplained portion (b = −0.51; P = 0.372), the variables of education (P = 0.002) and place (P = 0.001) had statistically significant effects on inequality.
Conclusions: There is a significant pro-poor economic inequality in the prevalence of unmet need in rural areas of Iran. Although part of this inequality is related to variables such as education and myopia, a major portion (two thirds) of this inequality may be due to the direct effect of economic inequality.