Avoidable socioeconomic inequality in mental health distribution in Tehran: Concentration Index standardization approach

Widespread health inequalities are of grand challenges to health systems. In present study, researchers aimed to measure socioeconomic inequality in distribution of mental disorders in Tehran. Required data were obtained from Urban HEART (Urban Health Equity Assessment and Response Tool) survey conducted by Municipality of Tehran in 2007. Sample was consist of 22135 people (over 15 years old) selected by systematic cluster sampling method. The Concentration index (C) approach was applied to examine socioeconomic inequality in mental health in Tehran. Concentration index of mental health was demographically (age-sex-ethnicity) standardized in order to determine the level of avoidable inequality. In next step, to control for variables of education, occupation, marital status and economic status which might be related to mental health and demographic variables and prevent from inadvertent standardizing of these variables, these variables also were entered into model. Concentration index of mental health (-0.0673, 95% confidence interval =-0.070 ¬¬¬– -0.057) showed that, there is inequality unfavourable to poorer people in Tehran respecting mental disorders. When the distribution of mental disorders was standardized for demographic composition of the quintiles, the standardized C equalled -0.046 (95% confidence interval =-0.0522 ¬¬¬– -0.0398). This little drop suggests that demographic composition is not the main determinant of observed mental health inequality in Tehran. When they controlled for variables of employment and education, standardized C increased and equaled CI=-0.053 (95% confidence interval =-0.059 ¬¬¬– -0.047). Indeed, the last analysis led to more shrink in inequality attributable to demographics. Since much of the observed inequality in mental health is probably due to social factors and not to demographic ones, therefore the possibility of inequality correction and its avoidance will increase