Skip to main content

Advertisement

Measurement components of socioeconomic status in health-related studies in Iran

Article metrics

  • 1095 Accesses

Abstract

Objective

The socioeconomic status (SES) is as a symbol of social determinants of health which has a dominant influence on population health. The purpose of this study was collecting, weighing, and determining the most relevant SES measurement items in Iran.

Results

The SES health studies conducted in Iran was searched from 2007 to 2017. First, the SES items were categorized. Then, each item was weighed based on its reliability and generalizability. Finally, the necessity of items was determined, weighed, and ranked. This is the two-round Delphi technique. After weighing 57 SES items, 37 items were selected with ≥ 1 weight and classified in 7 categories. According to the Delphi evaluation, 15 items were identified ≥ 3.5 for measuring SES of Iranian households: household size, head of household education, head of household job, household monthly income, type of school that children attend, house ownership, local value of residence, number of rooms in the house, house area, personal computer/laptop, smart cell phone, 3D TV, dishwasher, microwave, and car ownership. The SES items for the present society are categorized in 7 domains. The items collected in this study have the most comprehension of all studies related to income, life facilities, and assets.

Introduction

Our understanding of health and its social determinants has been deepened and is comparable to past decades. Nowadays, social determinants are considered as the key factors of health quality and play an important role in the macro concept of health. These factors along with health services directly or indirectly can influence the health status of people in communities.

Each of the social determinants of health such as income, education, occupation, nutrition, and the social class have a much larger role than biological factors in human health.

The socioeconomic status (SES) is the most influential determinant of health [1, 2]. SES is a complex and multidimensional construct, which requires a standardized format of measurement for each community. That is a concept that is used not only to measure social components of health but also to measure socioeconomic inequalities of health [3]. Generally, SES is defined as the position of an individual or of a household within a society. It is a combination of occupation, education, income, wealth, and residence neighborhood [4, 5]. Given the above-mentioned issues, building of an appropriate tool for measuring SES can be a significant contribution for planning and policy-making in health system, both at micro & macro levels [6].

In developing countries, the SES survey is a challenging issue in data collection for assessing and monitoring health equity. Therefore, researchers have concluded that development of a structured format for each society is necessary for SES measurement [7]. Reviewing studies performed in Iran and additionally based upon a systematic review conducted by Mahdavian et al. [8], there is a tremendous discrepancies in measuring SES method.

Due to such diversities and given the important role of SES in health studies, there is a need for a unified tool to collect socioeconomic data for an each community based on its specific circumstances and its level of technology development. Plus, the SES measurement tools are dynamic, i.e. an item that can be a household SES indicator for a population at a period of time may not be applicable later on. In other word, ever-changing quality of life standards may discredit an SES indicator that was valid an earlier time.

This study has tried to collect and edit a set of most appropriate items that could well represent the SES criteria for the Iranian society. These items can be used for development of SES measurement as a tool applicable for related researches in different dimensions. Furthermore, it can provide a unified platform to compare the results of different studies. In addition, this study gathered, weighed, and determined the necessity of items for measuring the SES for Iranian society.

Main text

Materials and methods

The mixed method of review study and Delphi method was applied. A critical review was carried out to collect items used for measuring SES in Iran. The items were weighed based upon the validity and generalizability of the extracted item. The weighed items were ranked based upon the experts’ opinion.

Search review strategy

A literature review was performed in PubMed database covering during 2007–2017 using the following keywords: SES, socioeconomic factors, wealth, welfare, asset, tool, develop, instrument, measure, and Iran. Appropriate operatories (AND, OR, NOT) and appropriate filters were used to focus the search goals. A search for articles published in Farsi was performed using of the above-mentioned keywords in Google Search Engine.

Selection process

Full text of articles was reviewed in the health field that looked on SES items. Backward search was also considered for original questionnaire.

The extracted SES measurement was entered in a table and categorized in 7 socioeconomic domains, such as: (a) demographics, (b) purchasing ability, (c) employment status, (d) literacy/education, (e) housing and accommodation status, (f) home appliances, and (g) personal assets. By designing an Excel spreadsheet, the frequency of each SES item was presented for an individual paper.

The scoring method

Then, to develop the most valid list of SES items related to the community of Iran, articles were weighed based upon two criteria: (1) the validation of study method, and (2) generalizability of SES items at the nationwide scale. The scoring method was based upon the consensus of experts’ panel. Two review authors (SSh, ShY) independently assessed the scoring approach in the present study, with any disagreements resolved by discussion and consensus of the team. The scores allocated to each article for validation were determined arbitrarily by the research team prior to the assessment, according to the American Psychological Association (APA) guideline [9]. The scoring system was as follows:

  1. I.

    1 point: The strong statistical method of Principal Factor Analysis (PFA) or Principal Component Analysis (PCA) was used to validate the SES items.

  2. II.

    0.6 point: Validation of the SES items was evaluated using an experts’ panel.

  3. III.

    0.5 point: If the article cited another article with an appropriate validation method.

  4. IV.

    0.3 point: When only internal consistency of items was assessed.

  5. V.

    0.1 point: When the validation technique was not clear.

Based upon the experts’ consensus, the scoring system for generalizability of an article was as follows:

  1. I.

    the studies that were conducted in less than half of the provinces of Iran, scored as 0.25 point.

  2. II.

    the studies that were conducted in more than half of the provinces of Iran, scored as 1 point.

Determining the weight of each SES items

The weight of each study was calculated through multiplication of validation score by generalizability score. The weighed items were added to the excel table. Then, weighing of each item calculated by sum of the scores recorded for each article in the excel table. Next, the items that were weighed higher than score of one—assuming that there was at least one validated article about it—were selected to get experts opinion.

Determining the final SES items

In order to determine the final SES items, the two-round Delphi method was used to obtain structured experts’ opinions, based upon the five-point Likert scale. A comment section was also provided for further explanations. After receiving the first round of Delphi method, the percentage of Likert scale was calculated according to expert responses for each SES items. Afterward, the unique filled questionnaire which contained the percentage of experts responded to each Likert score with their comments were returned for the second round of evaluation. It is of statistically significance to provide each individual expert opinion visible for all other experts. This has the advantage that experts can freely revise their first round opinions in the second round of evaluation, as well, increasing the dependable face validity.

Selection of experts’ panel

Initially, 15 experts for Delphi method were selected using purposive and snowball sampling techniques based on their experience in the related subject. Finally, 11 experts accepted to participate in the study. The composition of the group was from a wide range of academic affiliations: 4 public health specialists, 2 health economists, 1 health policy specialist, 2 healthcare managers, and 2 socialists.

Results

After reviewing the titles, abstracts and full-text of the articles, 60 related articles were selected. It contained 45 English articles from PubMed database and 15 Farsi articles from the Google search engine. Items that were used to measure SES in selected articles are listed in Table 1.

Table 1 Items that were used to measure SES in selected articles

After removing duplications, 57 items were categorized in seven domains: (I) Demographic, (II) Purchasing ability, (III) Education, (IV) Employment, (V) Housing status, (VI) Home appliances, and (VII) Personal assets (Table 2). After weighing the mentioned items, the above items were decreased to 37, if they received one or more point weight (≥ 1).

Table 2 These present 37 items are product of the second step of the study that gained the score of ≥ 1

Among 37 items, the ones that gained the score higher than the median of 3.5 based upon the consensus within the experts’ panel opinions, were set as the basis of selection. That concluded with 15 items suitable for SES measurement. These items included: (1) household size, (2) head of household education, (3) head of household occupation, (4) household monthly income, (5) type of school that children attend (public/private), (6) House ownership, (7) Local value of residence, (8) Number of rooms in the house, (9) House area, (10) Personal computer/laptop, (11) Smart cell phone, (12) Three-dimensional television, (13) Dishwasher, (14) Microwave, and (15) Car ownership.

Discussion

The items of this study were related to indirect indicators and assessed beside the direct indicators of assets. While reviewing the literature, three studies were only found used a close approach to the present study method. Abubakri et al. [32] developed and validated a questionnaire for assessing SES in urban households for health studies. They chose SES items from international literature and used the expert panel’s opinions for adjustment. In their questionnaire, personal vehicle was the only item scaling the asset. However, the present study selected the SES items from national studies performed for Iranian community. Further, some indicators included in this investigation have a special emphasis on many other asset indicators.

Another study concluded that 6 items out of 33 items of the household cost-income questionnaire, established by the Center for National Statistics of Iran (CNSI), were sufficient for measuring the SES of Iranian households [42]. These items comprise of: kitchen, bathroom, vacuum cleaner, washing machine, freezer, and personal computer. In fact, this study considered asset items much limited to those of the CNSI’s questionnaire and no gold standard was used to compare the results of regression analysis.

In a questionnaire designed by Garmaroudy et al. [66] six items were used to identify SES items of householders in Tehran, including: head of households and his spouse education, area and price of house, personal vehicle, and computer set. Of these items, only two items were directly related to assets, and two-thirds of the total weight of measurement tool was allocated to education. Needless to mention that education has less quantification value for SES evaluation.

In the above-mentioned studies, with the exception of one study [42], the SES measurement tools have been developed and validated by focusing on either a specific subgroup of population or an international community, not for a nationwide model. Therefore, their results cannot be generalized to all Iranian households. On the contrary, this study has pointed out the comprehensive items that not only structured for this public but also can be applied to nationwide Iranian households.

It is of significance to mention that SES is composed of different dimensions and domains that may change or lose their validity over time. However, this fluctuation is not similar for all defined items. In other word, there are items that are more dependent to technology and are consequently subjected to change their creditability, accordingly. For example, based upon a study that conducted at one time cell phone was a luxury device and in a later time becomes a standard life accessory. Another example is the internet accessibility which is rapidly expanded for public use during the past decade. This is socially recognized as technology acquisition and technology advancement [70] (Fig. 1). This highlights the need for renewing the SES measurement tools, including the combination of items used in the tool, at appropriate time intervals. This issue is applicable to the findings of this study in the future, as well.

Fig. 1
figure1

Technology cycle time comprises of: Technology Awareness, Technology Acquisition, Technology Adaptation, Technology Advancement, Technology Abandonment. This would define the internal and external environment

To develop a more precise measurement tool, there are a few points that should be taken into consideration. First, the items about area of the house, household income or the number of rooms in the house should be adjusted based on the number of household members. Second, due to the nature of some jobs in the community, such as day-labor or farmer, it is preferable to refer the annual income rather than monthly income. Also, the number of jobs that people may be occupied with should not be neglected. Third, the concept of residence should not be limited to a rental home since the ownership of other residentials, commercial unit, or a vacational residence. Fourth, the regional-value of residential location should be concomitantly considered with the house area. Therefore, the house price and rent can be one of the functions of the economic value of the residence area. Fifth, assets such as: vehicles, laptop, smartphone, 3D TV, dishwasher and microwave fall into different price categories due to their various features and brands. As such, the price of a selected utensil may place from a very low to very high range of a price. Thus, structuring an inclusive SES questionnaire requires more in depth queries.

Conclusions

This study comprehended fifteen items were collected in this study in 7 domains for SES criteria as a dependable measurement tool for Iranian households. Obviously, as the technology changes over time, the SES measurement tools are required to be revised. The methodology used in this study provides an on-going basis for updating the SES tools.

Limitation of the study

The present study faced with some limitations for implementation. First, there was limited number of articles structured with a well-designed study for SES evaluation. Second, the limited number of publications in our national level did restrict the authors for designing a solid study.

References

  1. 1.

    Wilkinson RG, Marmot M. Social determinants of health: the solid facts. Geneva: World Health Organization; 2003.

  2. 2.

    Shavers VL. Measurement of socioeconomic status in health disparities research. J Natl Med Assoc. 2007;99(9):1013.

  3. 3.

    Boles DB. Socioeconomic status, a forgotten variable in lateralization development. Brain Cogn. 2011;76(1):52–7.

  4. 4.

    Bell SD. Socioeconomic status and study abroad: participation, academic performance, and graduation. Norfolk: Old Dominion University; 2015.

  5. 5.

    Marmot M, Friel S, Bell R, Houweling TA, Taylor S, Health CoSDo. Closing the gap in a generation: health equity through action on the social determinants of health. Lancet. 2008;372(9650):1661–9.

  6. 6.

    Haghdoost AA. Complexity of the socioeconomic status and its disparity as a determinant of health. Int J Prev Med. 2012;3(2):75.

  7. 7.

    Psaki SR, Seidman JC, Miller M, Gottlieb M, Bhutta ZA, Ahmed T, et al. Measuring socioeconomic status in multicountry studies: results from the eight-country MAL-ED study. Popul Health Metr. 2014;12(1):8.

  8. 8.

    Mahdavian M, Safizadeh H. Measurement of socioeconomic status in Iran: a systematic review. Asian J Agric Ext Econ Sociol ISSN. 2015;6(1):2320–7027.

  9. 9.

    Cizek GJ, Bowen D, Church K. Sources of validity evidence for educational and psychological tests: a follow-up study. Educ Psychol Meas. 2010;70(5):732–43.

  10. 10.

    Rezazadeh A, Omidvar N, Eini-Zinab H, Ghazi-Tabatabaie M, Majdzadeh R, Ghavamzadeh S, et al. Food insecurity, socio-economic factors and weight status in two Iranian ethnic groups. Ethn Health. 2016;21(3):233–50.

  11. 11.

    Doulabi MA, Sajedi F, Vameghi R, Mazaheri MA, Baghban AA. Socioeconomic status index to interpret inequalities in child development. Iran J Child Neurol. 2017;11(2):13.

  12. 12.

    Mirmoghtadaee P, Heshmat R, Djalalinia S, Motamed-Gorji N, Motlagh ME, Ardalan G, et al. The association of socioeconomic status of family and living region with self-rated health and life satisfaction in children and adolescents: the CASPIAN-IV study. Med J Islamic Repub Iran. 2016;30:423.

  13. 13.

    Khajavi A, Pishgar F, Dehghani M, Naderimagham S. Socioeconomic inequalities in neonatal and postneonatal mortality: evidence from rural Iran, 1998–2013. Int J Equity Health. 2017;16(1):83.

  14. 14.

    Almasi-Hashiani A, Sepidarkish M, Safiri S, Morasae EK, Shadi Y, Omani-Samani R. Understanding determinants of unequal distribution of stillbirth in Tehran, Iran: a concentration index decomposition approach. BMJ Open. 2017;7(5):e013644.

  15. 15.

    Kelishadi R, Qorbani M, Djalalinia S, Sheidaei A, Rezaei F, Arefirad T, et al. Physical inactivity and associated factors in Iranian children and adolescents: the Weight Disorders Survey of the CASPIAN-IV study. J Cardiovasc Thorac Res. 2017;9(1):41.

  16. 16.

    Kia AA, Rezapour A, Khosravi A, Abarghouei VA. Socioeconomic inequality in malnutrition in under-5 children in Iran: evidence from the multiple indicator demographic and health survey, 2010. J Prev Med Public Health. 2017;50(3):201.

  17. 17.

    Mosallanezhad Z, Sotoudeh GR, Jutengren G, Salavati M, Harms-Ringdahl K, Wikmar LN, et al. A structural equation model of the relation between socioeconomic status, physical activity level, independence and health status in older Iranian people. Arch Gerontol Geriatr. 2017;70:123–9.

  18. 18.

    Maharlouei N, Akbari M, Akbari M, Lankarani KB. Socioeconomic status and satisfaction with public healthcare system in Iran. Int J Community Based Nurs Midwifery. 2017;5(1):22.

  19. 19.

    Ayubi E, Sani M, Safiri S, Khedmati Morasae E, Almasi-Hashiani A, Nazarzadeh M. Socioeconomic determinants of inequality in smoking stages: a distributive analysis on a sample of male high school students. Am J Men’s Health. 2017;11(4):1162–8.

  20. 20.

    Tajik F, Ferdosi M, Rejaliyan F. Determining the socio-economic inequalities in health services utilization among ischemic heart disease patients, case of Falavarjan City. Health Res. 2016;2(1):9–16.

  21. 21.

    Kavehfirouz Z, Zare B, Shamsedini H. The effect of life style dimension on attitudes towards childbearing among married women in Tehran City. Women Dev Politics. 2016;14(2):217–34.

  22. 22.

    Mostafavi N, Kelishadi R, Kazemi E, Ataei B, Yaran M, Motlagh ME, et al. Comparison of the prevalence and risk factors of hepatitis A in 10 to 18-year-old adolescents of sixteen Iranian provinces: the CASPIAN-III study. Hepat Mon. 2016;16(9):e36437.

  23. 23.

    Safiri S, Kelishadi R, Heshmat R, Rahimi A, Djalalinia S, Ghasemian A, et al. Socioeconomic inequality in oral health behavior in Iranian children and adolescents by the Oaxaca-Blinder decomposition method: the CASPIAN-IV study. Int J Equity Health. 2016;15(1):143.

  24. 24.

    Ahmadi B, Alimohammadian M, Yaseri M, Majidi A, Boreiri M, Islami F, et al. Multimorbidity: epidemiology and risk factors in the Golestan cohort study, Iran: a cross-sectional analysis. Medicine. 2016;95(7):e2756.

  25. 25.

    Alhossaini MR, Hassanzadeh A, Feizi A, Sarrafzadegan N. Transition in public knowledge of risk factors of cardiovascular disease in an Iranian general population: a latent transition analysis (LTA) on a longitudinal large community-based educational prevention program. ARYA Atheroscler. 2016;12(4):185.

  26. 26.

    Heshmat R, Salehi F, Qorbani M, Rostami M, Shafiee G, Ahadi Z, et al. Economic inequality in nutritional knowledge, attitude and practice of Iranian households: the NUTRI-KAP study. Med J Islam Repub Iran. 2016;30:426.

  27. 27.

    Tavakoli S, Dorosty-motlagh AR, Hoshiar-Rad A, Eshraghian MR, Sotoudeh G, Azadbakht L, et al. Is dietary diversity a proxy measurement of nutrient adequacy in Iranian elderly women? Appetite. 2016;105:468–76.

  28. 28.

    Pasdar Y, Darbandi M, Niazi P. Alghasi S, Roshanpour F. The Prevalence and the affecting factors of obesity in women of Kermanshah. jorjani. 2015;3(1):82–97.

  29. 29.

    Keshtkar A, Ranjbaran M, Soori H, Etemad K, Khashayar P, Dini M, et al. Is the relationship between individual-and family-levels socioeconomic status with disease different? Analyzing third stage data of IMOS. Koomesh. 2015;17(1):27–36.

  30. 30.

    Naghibi SA, Moosazadeh M, Shojaee J. Epidemiological features of under 5 year children mortality in Mazandaran. J Health Res Community. 2015;1(1):11–9.

  31. 31.

    Roudsari AH, Vedadhir A, Kalantari N, Amiri P, Omidvar N, Eini-Zinab H, et al. Concordance between self-reported body mass index with weight perception, self-rated health and appearance satisfaction in people living in Tehran. J Diabetes Metab Disord. 2015;15(1):22.

  32. 32.

    Abobakri O, Sadeghi-Bazargani H, Asghari-Jafarabadi M, Aghdam MBA, Imani A, Tabrizi J, et al. Development and psychometric evaluation of a socioeconomic status questionnaire for urban households (SESIran): the preliminary version. Health Promot Perspect. 2015;5(4):250.

  33. 33.

    Bahramian H, Mohebbi SZ, Khami MR, Asadi-Lari M, Shamshiri AR, Hessari H. Psychosocial determinants of dental service utilization among adults: results from a population-based survey (Urban HEART-2) in Tehran, Iran. Eur J Dent. 2015;9(4):542.

  34. 34.

    Ramezani Doroh V, Vahedi S, Arefnezhad M, Kavosi Z, Mohammadbeigi A. Decomposition of health inequality determinants in Shiraz, South-West Iran. J Res Health Sci. 2015;15(3):152–8.

  35. 35.

    Ghorbani Z, Ahmady AE, Ghasemi E, Zwi A. Socioeconomic inequalities in oral health among adults in Tehran, Iran. Community Dent Health. 2015;32(1):26–31.

  36. 36.

    Baygi F, Heshmat R, Kelishadi R, Mohammadi F, Motlagh ME, Ardalan G, Asayesh H, Larijani B, Qorbani M. Regional disparities in sedentary behaviors and meal frequency in iranian adolescents: The CASPIAN-III Study. Iran J Pediatr. 2015;25(2).

  37. 37.

    Morowatisharifabad MA, Karimi M, Ghorbanzadeh F. Watching television by kids: How much and why?. J Edu Health Promot. 2015;4:36.

  38. 38.

    Mashayekhi-Ghoyonlo V, Kiafar B, Rohani M, Esmaeili H, Erfanian-Taghvaee MR. Correlation between socioeconomic status and clinical course in patients with cutaneous leishmaniasis. J Cutan Med Surg. 2015;19(1):40–4.

  39. 39.

    Najafianzadeh M, Mobarak-Abadi A, Ranjbaran M, Nakhaei M. Relationship between the prevalence of food insecurity and some socioeconomic and demographic factors in the rural households of Arak, 2014. Iran J Nutr Sci Food Technol. 2015;9(4):35–44.

  40. 40.

    Shishehgar S, Dolatian M, Majd HA, Bakhtiary M. Socioeconomic status and stress rate during pregnancy in Iran. Glob J Health Sci. 2014;6(4):254.

  41. 41.

    Cheraghian B, Asadi-Lari M, Mansournia MA, Majdzadeh R, Mohammad K, Nedjat S, et al. Prevalence and associated factors of self-reported hypertension among Tehran adults in 2011: a population-based study (Urban HEART-2). Med J Islam Repub Iran. 2014;28:105.

  42. 42.

    Tajik P, Majdzadeh R. Constructing pragmatic socioeconomic status assessment tools to address health equality challenges. Int J Prev Med. 2014;5(1):46.

  43. 43.

    Mokhayeri Y, Mahmoudi M, Haghdoost AA, Amini H, Asadi-Lari M, Naieni KH. How within-city socioeconomic disparities affect life expectancy? Results of urban HEART in Tehran, Iran. Med J Islam Repub Iran. 2014;28:80.

  44. 44.

    Eslami B, Macassa G, Sundin Ö, Khankeh HR, Soares JJ. Style of coping and its determinants in adults with congenital heart disease in a developing country. Congenit Heart Dis. 2014;9(4):349–60.

  45. 45.

    Kavosi Z, Zare F, Jafari A, Fattahi MR. Economic burden of hepatitis B virus infection in different stages of disease; a report from southern iran. Middle East J Dig Dis. 2014;6(3):156.

  46. 46.

    Mohebbi SZ, Sheikhzadeh S, Batebi A, Bassir SH. Oral Impacts on Daily Performance in 20-to 50-year-olds Demanding Dental Care in Tehran, Iran: Association with Clinical Findings and Self-reported Health. Oral Health Prev Dent. 2014;12(1):29–36.

  47. 47.

    Heydari A, Teymoori A, Nasiri H. Development of suicidality within socioeconomic context: mediation effect of parental control and anomie. OMEGA J Death Dying. 2014;68(1):63–76.

  48. 48.

    Eslami A, Mahmoudi A, Khabiri M, Najafiyan SM. The role of socioeconomic conditions in the citizens’ motivation for participating in public sports. 2014.

  49. 49.

    Pasdar Y, Rezaei M, Darbandi M, Niazi P, Faramani RS. Consumption pattern of lipids and the factors affecting their selection among families in Kermanshah (2011). J Kermanshah Univ Med Sci. 2014;18(1):44–52.

  50. 50.

    Ghodratnama A, Heidarinejad S, Davoodi I. The relationship between socio-economic status and the rate of physical activity in Shahid Chamran University students of Ahwaz. J Sport Manag. 2013;5(16):5–20.

  51. 51.

    Nejhad ZH, Vardanjani HM, Abolhasani F, Hadipour M, Sheikhzadeh K. Relative effect of socio-economic status on the health-related quality of life in type 2 diabetic patients in Iran. Diabetes Metab Syndr. 2013;7(4):187–90.

  52. 52.

    Naghibi Sistani MM, Yazdani R, Virtanen J, Pakdaman A, Murtomaa H. Determinants of oral health: does oral health literacy matter?. ISRN Dent. 2013;2013:249591.

  53. 53.

    Nazari SSH, Mahmoodi M, Mansournia M-A, Naieni KH. Association of residential segregation and disability: a multilevel study using Iranian census data. J Urban Health. 2013;90(1):67–82.

  54. 54.

    Khayatzadeh MM, Rostami HR, Amirsalari S, Karimloo M. Investigation of quality of life in mothers of children with cerebral palsy in Iran: association with socio-economic status, marital satisfaction and fatigue. Disabil Rehabil. 2013;35(10):803–8.

  55. 55.

    Asefzadeh S, Alikhani S, Javadi H. Socio-economic status and mortality from cardiovascular diseases in Qazvin (2009). 2013.

  56. 56.

    Nedjat S, Hosseinpoor AR, Forouzanfar MH, Golestan B, Majdzadeh R. Decomposing socioeconomic inequality in self-rated health in Tehran. J Epidemiol Community Health. 2012;66(6):495–500.

  57. 57.

    Fakhri M, Hamzehgardeshi Z, Golchin NAH, Komili A. Promoting menstrual health among Persian adolescent girls from low socioeconomic backgrounds: a quasi-experimental study. BMC Public Health. 2012;12(1):193.

  58. 58.

    Morasae EK, Forouzan AS, Majdzadeh R, Asadi-Lari M, Noorbala AA, Hosseinpoor AR. Understanding determinants of socioeconomic inequality in mental health in Iran’s capital, Tehran: a concentration index decomposition approach. Int J Equity Health. 2012;11(1):18.

  59. 59.

    Zolala F, Heidari F, Afshar N, Haghdoost AA. Exploring maternal mortality in relation to socioeconomic factors in Iran. Singapore Med J. 2012;53(10):684.

  60. 60.

    Rohani-Rasaf M, Moradi-Lakeh M, Ramezani R, Asadi-Lari M. Measuring socioeconomic disparities in cancer incidence in Tehran, 2008. Asian Pac J Cancer Prev. 2012;13(6):2955–60.

  61. 61.

    Payab M, Dorosty Motlagh A, Eshraghian M, Siassi F. The association between food insecurity, socio-economic factors and dietary intake in mothers having primary school children living in Ray 2010. Iran J Nutr Sci Food Technol. 2012;7(1):56.

  62. 62.

    Yaghoubi DM, Enayat H. Sociological factors of domestic violence towards adolescent female children (case study: high schools in Ahwaz). 2012.

  63. 63.

    Donyavi T, Naieni KH, Nedjat S, Vahdaninia M, Najafi M, Montazeri A. Socioeconomic status and mortality after acute myocardial infarction: a study from Iran. Int J Equity Health. 2011;10(1):9.

  64. 64.

    Fazeli B. Buerger’s disease as an indicator of socioeconomic development in different societies, a cross-sectional descriptive study in the North-East of Iran. Arch Med Sci AMS. 2010;6(3):343.

  65. 65.

    Sheykhmounesi F, Shahsavari M, Jafarzadeh A, Khademlo M. Creativity and intelligence quotient in bipolar disorder patients and their offspring: a case-control study. J Mazandaran Univ Med Sci. 2010;20(76):55–60.

  66. 66.

    Garmaroudi G, Moradi A. Designing a measurement tool for SES in Tehran. Q J Med Sci Res Inst. 2010;9(2):137–44.

  67. 67.

    Montazeri A, Goshtasebi A, Vahdaninia M. Educational inequalities in self-reported health in a general Iranian population. BMC Res Notes. 2008;1(1):50.

  68. 68.

    Ansari H, Bahrami L, Akbar ZL, Bakhshani N. Assessment of general health and some related factors among students of Zahedan University of Medical Sciences in 2007. 2008.

  69. 69.

    Hosseinpoor AR, Van Doorslaer E, Speybroeck N, Naghavi M, Mohammad K, Majdzadeh R, et al. Decomposing socioeconomic inequality in infant mortality in Iran. Int J Epidemiol. 2007;35(5):1211–9.

  70. 70.

    Kayal AA, Waters RC. An empirical evaluation of the technology cycle time indicator as a measure of the pace of technological progress in superconductor technology. IEEE Trans Eng Manag. 1999;46(2):127–31.

Download references

Authors’ contributions

SS was the main operator of the study was the manuscript preparator; SY designed the study and monitored all steps of the study; MJ was the co-designer of the study; AHZ designed and monitored all steps of the study, and prepared, edited, and finalized the manuscript. All authors read and approved the manuscript.

Acknowledgements

This manuscript is submitted as a partial fulfillment of the requirement for PhD degree in Community Oral Health. This article is originated from a part of dissertation registered under #643 at the office of Academic Affairs of Shahid Beheshti University of Medical Sciences School of Dentistry.

Competing interests

The authors declare that they have no competing interests.

Availability of data and materials

The authors confirm that the data and material is available for any further interpretation, replication and building upon the findings reported in the article.

Consent to publish

Not applicable.

Ethics approval and consent to participate

IR.SBMU.RIDS.REC.1396.447 [Based upon the regulations, to obtain the above registration number, each research project, regardless of the structural design (literature review, human study, or an animal study) should be submitted to the office of Research Affairs for approval. If approved, the office of Academic Affairs after an official process (operators’ evaluations, etc.) assigns a registration number, as above. Thus, the Ethical Approval is part of the preliminary approval, as well].

Funding

The authors state that there is no funding for this study and publication of the article.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Author information

Correspondence to A. Hamid Zafarmand.

Rights and permissions

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Keywords

  • Social determinant of health (SDH)
  • Socioeconomic factors
  • Socioeconomic status (SES)
  • Family characteristics
  • Household head
  • Household equipment
  • Iran