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Why caesarean is more unequally concentrated among better-off people in Tehran? A concentration index decomposition approach
  1. Reza Omani-Samani1,
  2. Amir Almasi-Hashiani2,
  3. Saeid Safiri3,
  4. Mahroo Rezaeinejad4,
  5. Fatemeh Shokri5,
  6. Esmaeil Khedmati Morasae6,
  7. Saman Maroufizadeh7,
  8. Mahdi Sepidarkish8
  1. 1 Departmentof Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
  2. 2 Department of Epidemiology, School of Health, Arak University of Medical Sciences, Arak, Iran
  3. 3 Managerial Epidemiology Research Center, Department of Public Health, School of Nursing and Midwifery, Maragheh University of Medical Sciences, Maragheh, Iran
  4. 4 Department of Obstetrics and Gynecology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
  5. 5 Department of Health Education and Promotion, Iran University of Medical Sciences, Tehran, Iran
  6. 6 National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care, North West Coast (NIHR CLAHRC NWC), Institute of Psychology, Health and Society, Health Services Research Department, University of Liverpool, Liverpool, UK
  7. 7 Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
  8. 8 Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
  1. Correspondence to Dr Mahdi Sepidarkish, Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran; mahdi.sepidarkish{at}gmail.com

Abstract

Background Iran, as one of the low-income and middle-income countries, has experienced a remarkable increase in the caesarean section (CS) rate during the past three decades. Although several studies have been conducted on the prevalence and risk factors affecting CS, but few studies were done regarding socioeconomic factors influencing the CS rate. The aim of this study was to identify socioeconomic inequalities and its determinants in CS in Tehran, capital of Iran.

Methods A population-based cross-sectional study was conducted on 5170 pregnancies in Tehran, since 2015. Principal component analysis was applied to measure the asset-based economic status. Concentration index was used to measure socioeconomic inequality in CS and then decomposed in to its determinants.

Results The concentration index and its 95% CI for CS history was 0.102 (0.091 to 0.112). Decomposition of the concentration index showed that economic status had the largest contribution (49.2%) to socioeconomic inequality in CS. Mother’s education (14.9%), father’s occupation (13.3%) and father’s nationality (9.7%) had the next high positive contribution to measured inequality in CS, respectively.

Conclusions CS is mostly concentrated among women with high economic status. The identified contributing factors should be addressed to decrease the socioeconomic inequalities as possible.

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Footnotes

  • Contributors MS and RO-S designed the study and completed data collection and analyses. AA-H, SS, FS and MR provided input into the study design and data collection materials. EKM and SM provided technical guidance. All authors have given a final approval of the version to be published. All authors have read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Esmaeil Khedmati Morasae is part-funded by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care, North West Coast (NIHR CLAHRC NWC). The views expressed are those of the author and not necessary those of the NHS, NIHR or Department of Health.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Ethical Committee of Royan Institute (EC/92/1097).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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