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Public health
Research
Understanding determinants of unequal distribution of stillbirth in Tehran, Iran: a concentration index decomposition approach
  1. Amir Almasi-Hashiani1,
  2. Mahdi Sepidarkish1,
  3. Saeid Safiri2,
  4. Esmaeil Khedmati Morasae3,
  5. Yahya Shadi4,
  6. Reza Omani-Samani1
  1. 1 Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Centre, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, The Islamic Republic of Iran
  2. 2 Managerial Epidemiology Research Center, Department of Public Health, School of Nursing and Midwifery, Maragheh University of Medical Sciences, Maragheh, The Islamic Republic of Iran
  3. 3 Centre for Systems Studies, Hull University Business School(HUBS), Hull York Medical School(HYMS), University of Hull, Hull, UK
  4. 4 Department of Public Health, School of Public Health, Zanjan University of Medical Sciences, Zanjan, The Islamic Republic of Iran
  1. Correspondence to Dr Reza Omani-Samani; r.samani{at}gmail.com

Abstract

Objective The present inquiry set to determine the economic inequality in history of stillbirth and understanding determinants of unequal distribution of stillbirth in Tehran, Iran.

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

Results The concentration index and its 95% CI for stillbirth was −0.121 (−0.235 to −0.002). Decomposition of the concentration index showed that mother’s education (50%), mother’s occupation (30%), economic status (26%) and father’s age (12%) had the highest positive contributions to measured inequality in stillbirth history in Tehran. Mother’s age (17%) had the highest negative contribution to inequality.

Conclusions Stillbirth is unequally distributed among Iranian women and is mostly concentrated among low economic status people. Mother-related factors had the highest positive and negative contributions to inequality, highlighting specific interventions for mothers to redress inequality.

  • stillbirth
  • socioeconomic inequality
  • concentration index
  • decomposition
  • Tehran

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2016-013644

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    Footnotes

    • Acknowledgements This nationwide survey was conducted in Iran with the cooperation of the Royan Institute.

    • Contributors AAH, MS and ROS designed the study and were involved in data collection. SS, AAH, YS and MS participated in statistical analysis and drafted the manuscript. Critical revision was done by AAH, MS, SS, YS and ROS.

    • Competing interests None declared.

    • Ethics approval Ethical Committee of Royan Institute.

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

    • Data sharing statement No additional data are available.