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      The Assessment of Inequality on Geographical Distribution of Non-Cardiac Intensive Care Beds in Iran

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          Abstract

          Background:

          The purpose of the present study was to evaluate the inequality of geographical distribution of non-cardiac intensive care beds in Iran using the Gini coefficient.

          Methods:

          The population information of Iran’s provinces in 2006 was obtained from The Statistical Center of Iran and the number of non-cardiac intensive care beds (including ICU, PostICU and NICU beds) in all provinces was taken from published information of Ministry of Health and Medical Education of Iran in the current year. The number of beds per 100,000 populations of each province and the Gini coefficients for each bed were calculated.

          Results:

          Iran’s population was 70,495,782. The total number of ICU, PostICU and NICU beds were 3720, 291 and 1129, respectively. Tehran had the highest percentage of each bed among all provinces. The number of each bed was 5.3, 0.4 and 1.6 per 100,000 populations of country, respectively. The calculated Gini coefficients for each bed were 0.17, 0.15 and 0.23, respectively.

          Conclusion:

          The findings of this study showed that, according to the Gini coefficients, non-cardiac intensive care beds have an almost equal geographical distribution throughout the country. However, the numbers of beds per population are less than other countries. Since such studies can be used as a base for health systems planning about correction of inequality of health services distribution, similar studies in other health care services are recommended which can be conducted at the national or provincial level.

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          Most cited references37

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          Widening socioeconomic inequalities in mortality in six Western European countries.

          During the past decades a widening of the relative gap in death rates between upper and lower socioeconomic groups has been reported for several European countries. Although differential mortality decline for cardiovascular diseases has been suggested as an important contributory factor, it is not known what its quantitative contribution was, and to what extent other causes of death have contributed to the widening gap in total mortality. We collected data on mortality by educational level and occupational class among men and women from national longitudinal studies in Finland, Sweden, Norway, Denmark, England/Wales, and Italy (Turin), and analysed age-standardized death rates in two recent time periods (1981-1985 and 1991-1995), both total mortality and by cause of death. For simplicity, we report on inequalities in mortality between two broad socioeconomic groups (high and low educational level, non-manual and manual occupations). Relative inequalities in total mortality have increased in all six countries, but absolute differences in total mortality were fairly stable, with the exception of Finland where an increase occurred. In most countries, mortality from cardiovascular diseases declined proportionally faster in the upper socioeconomic groups. The exception is Italy (Turin) where the reverse occurred. In all countries with the exception of Italy (Turin), changes in cardiovascular disease mortality contributed about half of the widening relative gap for total mortality. Other causes also made important contributions to the widening gap in total mortality. For these causes, widening inequalities were sometimes due to increasing mortality rates in the lower socioeconomic groups. We found rising rates of mortality from lung cancer, breast cancer, respiratory disease, gastrointestinal disease, and injuries among men and/or women in lower socioeconomic groups in several countries. Reducing socioeconomic inequalities in mortality in Western Europe critically depends upon speeding up mortality declines from cardiovascular diseases in lower socioeconomic groups, and countering mortality increases from several other causes of death in lower socioeconomic groups.
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            Psychosocial and material pathways in the relation between income and health: a response to Lynch et al.

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              Effects of residence and race on burden of travel for care: cross sectional analysis of the 2001 US National Household Travel Survey

              Background Travel burden is a key element in conceptualizing geographic access to health care. Prior research has shown that both rural and minority populations bear disproportionate travel burdens. However, many studies are limited to specific types of patient or specific locales. The purpose of our study was to quantify geographic and race-based differences in distance traveled and time spent in travel for medical/dental care using representative national data. Methods Data were drawn from 2001 National Household Travel Survey (NHTS), a nationally representative, cross-sectional household survey conducted by the US Department of Transportation. Participants recorded all travel on a designated day; the overall response rate was 41%. Analyses were restricted to households reporting at least one trip for medical and/or dental care; 3,914 trips made by 2,432 households. Dependent variables in the analysis were road miles traveled, minutes spent traveling, and high travel burden, defined as more than 30 miles or 30 minutes per trip. Independent variables of interest were rural residence and race. Characteristics of the individual, the trip, and the community were controlled in multivariate analyses. Results The average trip for care in the US in 2001 entailed 10.2 road miles (16.4 kilometers) and 22.0 minutes of travel. Rural residents traveled further than urban residents in unadjusted analysis (17.5 versus 8.3 miles; 28.2 versus 13.4 km). Rural trips took 31.4% longer than urban trips (27.2 versus 20.7 minutes). Distance traveled did not vary by race. African Americans spent more time in travel than whites (29.1 versus 20.6 minutes); other minorities did not differ. In adjusted analyses, rural residence (odds ratio, OR, 2.67, 95% confidence interval, CI 1.39 5.1.5) was associated with a trip of 30 road miles or more; rural residence (OR, 1.80, CI 1.09 2.99) and African American race/ethnicity (OR 3.04. 95% CI 2.0 4.62) were associated with a trip lasting 30 minutes or longer. Conclusion Rural residents and African Americans experience higher travel burdens than urban residents or whites when seeking medical/dental care.
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                Author and article information

                Journal
                Iran J Public Health
                Iran. J. Public Health
                IJPH
                Iranian Journal of Public Health
                Tehran University of Medical Sciences
                2251-6085
                2251-6093
                30 June 2011
                2011
                : 40
                : 2
                : 25-33
                Affiliations
                [1 ]Dept. of Management of Health Care, School of Public Health, Baqiyatallah University of Medical Sciences, Tehran, Iran
                [2 ]Dept. of Economic Health, Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
                [3 ]Research Center, Medicine Faculty, Shahed University, Tehran, Iran
                [4 ]Baqiyatallah University of Medical Sciences, Tehran, Iran
                Author notes
                [* ]Corresponding author: Tel: +98 21 88057022, E-mail: shr_tofighi@ 123456yahoo.com
                Article
                ijph-40-25
                3481771
                23113070
                6038f25c-72e7-413c-9a5d-dfd5af99fc20
                Copyright © Iranian Public Health Association & Tehran University of Medical Sciences

                This is an open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0), which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.

                History
                : 28 September 2010
                : 15 March 2011
                Categories
                Original Article

                Public health
                gini coefficient,intensive care beds,iran,inequity,geographical distribution
                Public health
                gini coefficient, intensive care beds, iran, inequity, geographical distribution

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