Decomposing Socioeconomic Inequality in Health Literacy in Iran: A Concentration Index Approach

Amir Almasi‑Hashiani, Mahmoud Abbasi, Mohammad Tavakol, Vali Baigi, Mehri Mohammadi, Javad Nazari, Esmaeil Khedmati Morasae, Yahya Shadi, Majid Taheri


Background: Health literacy is a major factor for health promotion and well‑being. In spite of
several researches on health literacy, information on the subject of the status of health literacy in
Asian countries such as Iran is inadequate. Therefore, this study aimed to assess the inequality of
health literacy in an Iranian population and its influencing factors.

Methods: In this cross‑sectional
study, 736 families were selected by cluster random sampling. A validated questionnaire was used to
measure the health literacy of participants. Socioeconomic status (SES) was calculated by asset‑based
approach, and principal component analysis (PCA) was performed to estimate the families’ SES.
Concentration index and curve were used to measure SES inequality in health literacy, and after that
decomposed into its determinants. The data were analyzed by Stata software.

Results: The mean
age of the participants was 34.81 years (standard deviation = 5.98 years). The value of concentration
index for health literacy equals 0.2292 (95% confidence interval = 0.168–0.283), and this value
indicates that there is inequality in distribution of health literacy in Iran and the inequality disfavors
the poor.

Conclusions: The results of this study revealed that there is inequality in distribution of
health literacy in Iran, and people of higher economic status in Iran enjoy from better health literacy

Keywords: Healthcare disparities, health literacy, health status disparities, socioeconomic factors

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