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      Socioeconomic Inequalities in Gastroesophageal Reflux Disorder: Results from an Iranian Cohort Study

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          Despite progress in the health indexes in recent years, health inequalities remain as a global challenge within and between regions and countries. This study is the first to quantify the socioeconomic inequity in gastroesophageal reflux disease (GERD) using the concentration index.


          In this cross-sectional study, we used baseline data (7012 subjects) from the Fasa Cohort Study (the Southern Iran). The principal component analysis was used to construct socioeconomic status of the participants. The concentration index and concentration curve were used to measure socioeconomic-related inequality in GERD. Decomposition of concentration index was also done to identify the contribution of each explanatory variable to the wealth-related inequality in GERD prevalence.


          The prevalence of GERD was 16.9% (95% CI: 15.9-17.7%). The overall concentration index for GERD was 0.093 (95% CI: 0.062-0.166]. Correspondingly, this figure for men and women were 0.116 (95% CI: 0.062-0.171%) and 0.091 (95% CI: 0.044-0.137%), respectively. The main contributors of socioeconomic-related inequality in GERD prevalence were socioeconomic status (64.4%), alcohol drinking (29%), and age (8.4%).


          GERD is significantly more concentrated among richest people. There was significant socioeconomic inequality in GERD according to some individual factors. These inequalities need to be addressed by policy makers to identify the vulnerable subgroups and to reduce the disease burden in the community.

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          Most cited references 48

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          The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus.

          A globally acceptable definition and classification of gastroesophageal reflux disease (GERD) is desirable for research and clinical practice. The aim of this initiative was to develop a consensus definition and classification that would be useful for patients, physicians, and regulatory agencies. A modified Delphi process was employed to reach consensus using repeated iterative voting. A series of statements was developed by a working group of five experts after a systematic review of the literature in three databases (Embase, Cochrane trials register, Medline). Over a period of 2 yr, the statements were developed, modified, and approved through four rounds of voting. The voting group consisted of 44 experts from 18 countries. The final vote was conducted on a 6-point scale and consensus was defined a priori as agreement by two-thirds of the participants. The level of agreement strengthened throughout the process with two-thirds of the participants agreeing with 86%, 88%, 94%, and 100% of statements at each vote, respectively. At the final vote, 94% of the final 51 statements were approved by 90% of the Consensus Group, and 90% of statements were accepted with strong agreement or minor reservation. GERD was defined as a condition that develops when the reflux of stomach contents causes troublesome symptoms and/or complications. The disease was subclassified into esophageal and extraesophageal syndromes. Novel aspects of the new definition include a patient-centered approach that is independent of endoscopic findings, subclassification of the disease into discrete syndromes, and the recognition of laryngitis, cough, asthma, and dental erosions as possible GERD syndromes. It also proposes a new definition for suspected and proven Barrett's esophagus. Evidence-based global consensus definitions are possible despite differences in terminology and language, prevalence, and manifestations of the disease in different countries. A global consensus definition for GERD may simplify disease management, allow collaborative research, and make studies more generalizable, assisting patients, physicians, and regulatory agencies.
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            On the measurement of inequalities in health

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              On decomposing the causes of health sector inequalities with an application to malnutrition inequalities in Vietnam


                Author and article information

                Middle East J Dig Dis
                Middle East J Dig Dis
                Middle East Journal of Digestive Diseases
                Iranian Association of Gastroerterology and Hepatology
                July 2018
                10 June 2018
                : 10
                : 3
                : 180-187
                1 Non-Communicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
                2 Center for Diseases Control and Prevention, Deputy of Health Services, Fasa University of Medical Sciences, Fasa, Iran
                3 Research Centre for Health Sciences, Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
                4 Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
                Author notes
                [* ] Corresponding Author: Shahab Rezaeian, PhD Department of Epidemiology, School of Health, Kermanshah University of Medical Sciences, Isar Sq, Kermanshah 6719851351, Iran Telefax: + 98 83 38262005 Email: shahab.rezayan@
                © 2018 The Author(s)

                This work is published by Middle East Journal of Digestive Diseaes as an open access article distributed under the terms of the Creative Commons Attribution License ( Non-commercial uses of the work are permitted, provided the original work is properly cited.

                Figures: 1, Tables: 3, References: 48, Pages: 8
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