تحلیل ارتباط نهاده‌های بهداشتی بر مرگ و میر کودکان براساس ضریب جینی و منحنی لورنز
محورهای موضوعی : -مدارک پزشکی
فاطمه کریم نژاد رمی
1
(کارشنا‌سی‌ارشد مدیریت خدمات بهداشتی و درمانی، واحد ساری، دانشگاه آزاد اسلامی، ساری، ایران)
قهرمان محمودی
2
(دانشیار، گروه مدیریت خدمات بهداشتی و درمانی، واحد ساری، دانشگاه آزاد اسلامی، ساری، ایران)
محمدعلی جهانی
3
(دانشیار، مرکز تحقیقات عوامل اجتماعی موثر بر سلامت، دانشکده پزشکی، دانشگاه علوم پزشکی بابل، بابل، ایران)
کلید واژه: مرگ و میر نوزادان, مرگ و میر کودکان, نابرابری,
چکیده مقاله :
مقدمه:مرگ و میر کودکان یکی از مهم ترین شاخص های بهداشتی، فرهنگی و اقتصادی در ارزیابی سلامت جامعه می‌باشد. هدف از این پژوهش تحلیل ارتباط نهاده‌های بهداشتی بر مرگ و میر کودکان براساس ضریب جینی و منحنی لورنز بوده است. روش پژوهش: مطالعه حاضر توصیفی از نوع اکولوژیک بوده که به برابری یا نابرابری توزیع امکانات بهداشتی در سطح شهرستان‌های استان مازندران براساس شاخص‌های جمعیتی سال 1395 پرداخته است. جامعه پژوهش شامل مراکز بهداشتی و درمانی، پایگاه‌های بهداشتی، خانه‌های بهداشتی، کارکنان بهداشتی، پایگاه‌های اورژانس وتعداد کارکنان این مراکز بوده است، پس از جمع‌آوری داده‌ها از معاونت بهداشتی دانشگاه‌های علوم پزشکی استان مازندران و بابل تحلیل داده‌ها توسط نرم‌افزارهای Dasp2.1 ،STATA وSPSS19 انجام شد. یافته‌ها: ضریب جینی توزیع مراکز بهداشتی روستایی برحسب جمعیت 0.32 در مراکز بهداشتی و درمانی شهری 0.28 بود. ضریب جینی توزیع پایگاه‌های بهداشتی، خانه‌های بهداشت و کارکنان بخش بهداشتی بالای 0.3 بوده است. بین نسبت مراکز بهداشتی روستایی به جمعیت با مرگ و میر نوزادان (0.895- = r، 0.03= p-value ) وکودکان زیر پنج سال(0.901- = r، 0.01= p-value ) و بین نسبت خانه‌های بهداشتی به جمعیت با مرگ و میر نوزادان (0.367- = r، 0.03= p-value ) وکودکان زیر پنج سال(0.489- = r ، 0.03= p-value ) ارتباط معنی‌داری وجود داشت. نتیجه‌گیری: نابرابری درتوزیع برخی نهاده‌های بهداشتی وجود داشت که با توجه به ارتباط بین نهاده‌های بهداشتی با مرگ و میر کودکان و نوزادان،پیشنهاد می‌گردد توجه به درجه توسعه‌یافتگی شهرستان‌ها و میزان برخورداری از این شاخص‌ها در اولویت قرار گیرد.
Introduction: Child mortality is one of the most important cultural, economic and health indicators in evaluating the health status of the community. This study aimed to analyze the relationship between health centers with the child mortality based on the Gini coefficient and Lorenz curve. Methods: This ecological descriptive study was conducted in 2016 to examine the equality or inequality in the distribution of health facilities in the cities of Mazandaran province based on demographic indicators. The research population consisted of health centers, health personnel, emergency centers and the number of employees in these centers. After collecting data from the Ministry of Health of Mazandaran and babol University of Medical Sciences, the obtained data was analyzed using Dasp2.1, STATA and SPSS19 software. Results: Gini coefficient for the distribution of rural health centers was 0.28 and 0.32 for urban health centers, based on population. The Gini coefficient for distribution of health centers and health personnel was higher than 0.3. There was a significant relationship between the ratio of rural health centers to the population and child mortality (r = -0.853, p-value = 0.03) of children under five years old (r = -0.901, p-value = 0.01), and between the ratio of health centers to population and child mortality (r = -0.367; p-value = 0.03) of children under five years old (r = 0.489, p-value = 0.03). Conclusion: Since a significant level of inequality was found in the distribution of some health centers, considering the relationship between health centers and child mortality.
1- De Harlez Y, Malagueño R. Examining the joint effects of strategic priorities, use of management control systems, and personal background on hospital performance. Management Accounting Research. 2016;30:2-17. doi: 0.1016/j.mar.2015.07.001.
2- WHO. Development of indicators for monitoring progress towards health for all by the year 2000. World Health Organization. Geneva: 1981. Available from: http://apps.who.int/iris/handle/10665/40672.
3- Silva R. Child mortality estimation: consistency of under-five mortality rate estimates using full birth histories and summary birth histories. PLoS Medicine. 2012;9(8):1-14. doi: 0.1371/journal.pmed.1001296.
4- Wilmoth J, Zureick S, Canudas-Romo V, Inoue M, Sawyer C. A flexible two-dimensional mortality model for use in indirect estimation. Population studies, 2012; 66(1): 1-28. doi: 10.1080/00324728.2011.611411.
5- Yadava R, Tiwari A. An indirect technique for estimations of infant and child mortality: Data analysis from India and Bangladesh. Health and Population Perspectives and Issues, 2003; 26(2): 67-73.
6- Mehdizadeh H, Jahani M, Mahmoudi G. Frequency of Referrals of Cancer Patients Referred to Hospitals Affiliated to the Babol University of Medical Sciences according to the International Classification of Diseases. Journal of Babol University Of Medical Sciences, 2017; 19(12): 55-62. [In Persian]
7- World Health Statistics 2014. Geneva, World Health Organization, 2014(Available from://www.who.int/gho/pablications/world_health_statistics/2014/en/, accessed 29 June 2014.
8- Hallowell M. Safety risk perception in construction companies in the Pacific Northwest of the USA. Construction management and economics, 2010; 28(4): 403-13.
9- Zyaambo C, Siziya S, Fylkesnes K. Health status and socio-economic factors associated with health facility utilization in rural and urban areas in Zambia. BMC health services research, 2012; 12(1): 1.
10- Palència L, Espelt A, Rodríguez-Sanz M, Rocha KB, Pasarín MI, Borrell C. Trends in social class inequalities in the use of health care services within the Spanish National Health System, 1993–2006. The European Journal of Health Economics, 2013; 14(2): 211-9.
11- Dahlgren G, Whitehead M. A framework for assessing health systems from the public's perspective: the ALPS approach. International Journal of Health Services, 2007; 37(2): 363-78.
12- Song H-J, Han H-R, Lee J-E, Kim J-Y, Kim KB, Ryu JP, et al. Does access to care still affect health care utilization by immigrants? Testing of an empirical explanatory model of health care utilization by Korean American immigrants with high blood pressure. Journal of immigrant and Minority Health, 2010; 12(4): 513-9.
13- Shin H, Song H, Kim J, Probst JC. Insurance, acculturation, and health service utilization among Korean-Americans. Journal of immigrant health, 2005; 7(2): 65-74.
14- Lai D, Huang J, Risser JM, Kapadia AS. Statistical properties of generalized Gini coefficient with application to health inequality measurement. Social Indicators Research, 2008; 87(2): 249-58.
15- Miao C-x, Zhuo L, Gu Y-m, Qin Z-h. Study of large medical equipment allocation in Xuzhou. Journal of Zhejiang University SCIENCE B, 2007; 8(12): 881-4.
16- Nasiripour AA, Raeissi P, Asgari AA. Analysis of the spatial distribution of health care centers of Shahrekord by geographical information system. Journal of Shahrekord University of Medical Sciences, 2015; 16(6): 19-27. [In Persian]
17- Abbasi M, Hasoumi M, Mohamadi E, Asadi H. Analysis of the relationship between distributions of health sector inputs and health outcomes in Iran; using Gini coefficient. Bioethics Journal (Quarterly), 2016; 4(12): 65-79. [In Persian]
18- Roshanaei G, Safari M, Faradmal J, Karami m, Kouselo Z. Ranking and clustering Iranian provinces based on important health indicators of vital horoscope in rural areas by using multivariate methods. koomesh Journal, 2016; 17(2): 277-87. [In Persian]
19- Seperdoust H, Ebrahiminasab S. Human development index and under five years children mortality rate in iran. Journal of the Iranian Institute for Health Sciences Research, 2015; 4(2): 137-44. [In Persian]
20- Feng XL, Guo S, Yang Q, Xu L, Zhu J, Guo Y. Regional disparities in child mortality within China 1996–2004: epidemiological profile and health care coverage. Environmental health and preventive medicine, 2012; 16(4): 209-16. doi: 10.1007/s12199-010-0187-5.
21- Adedini SA, Odimegwu C, Imasiku EN, Ononokpono DN, Ibisomi L. Regional variations in infant and child mortality in Nigeria: a multilevel analysis. Journal of biosocial science, 2015; 47(2): 165-87.
22- Quentin W, Abosede O, Aka J, Akweongo P, Dinard K, Ezeh A, et al. Inequalities in child mortality in ten major African cities. BMC medicine, 2014; 12(1): 1-11. doi: 0.1186/741-7015-12-95.
23- Choe SA, Cho S-I. Causes of Child Mortality (1 to 4 Years of Age) From 1983 to 2012 in the Republic of Korea: National Vital Data. Journal of Preventive Medicine and Public Health, 2014; 47(6): 336-42. doi: 10.3961/jpmph.14.024.
24- Rozbhan, M.Economic Development, Taban public, Tehran; 2009.
25- Brown MC. Using Gini-style indices to evaluate the spatial patterns of health practitioners: theoretical considerations and an application based on Alberta data. Social science & medicine, 1994; 38(9): 1243-56.
26- Lorenz MO. Methods of measuring the concentration of wealth. Publications of the American statistical association, 1905; 9(70): 209-19.
27- Mirkatoli J, Kanani M. Evaluation of Regional Development and Inequality Levels, Using Multi- Criteria Decision Making Models. Gheographical Planing, 2011; 1(2): 17-36. [In Persian]
28- Afrakhte H, Riyahi V, Jalalian h. Evaluation the Spatial Justice in Distribution of Rural Services in The Counties of Isfahan Province. Amayesh Sarzamin, 2016; 8(1): 57-81. [In Persian]
29- Zarrabi A, Tabrizi N. Factors analysis approach and determination of development level of mazandran province. Amayesh Mohit, 2011; 4(12): 63-77. [In Persian]
30- Reshadat S, Saedi S, Zangeneh A, Amooie MR, Karbasi A. Equity in Access to Health Care Using Geographic Information System: a Kermanshah Case Study. J Mazandaran Univ Med Sci, 2014; 24(115): 134-40. [In Persian]
31- Taghvai M, Shahyvandy A. Dispersion of health services in the Iranian citys. Journal Social Welfare 2011;10(39):33-54. [In Persian].
32- Zandiyan h, ghiasvand h, nasimi dr. Measuring inequality of distribution of health resources: A case study. Payesh, 2012; 11(6): 799-805. [In Persian]
33- Kiadaliri AA, Najafi B, Haghparast-Bidgoli H. Geographic distribution of need and access to health care in rural population: an ecological study in Iran. International journal for equity in health, 2011; 10(1): 1. [In Persian]
34- Rezaei S, Nouri B. Evaluation of inequalities in the distribution of health resources by Gini coefficient and Lorenz curve: a case study in Kurdistan province from 2006 to 2013. Scientific Journal of Kurdistan University of Medical Sciences, 2016; 20(6): 1-11. [In Persian]
35- Sadoughi F, Hataminejad H, Zarei J, Parvan M. Geographical Accessibility of Rural Communities to Rural Health Houses using Geographical Information System: A Case Study in Khozestan Province, IRAN. Journal of Health System Research, 2016; 12(2): 1-8. [In Persian]
36- Rezaei S, KaramiMatin B, Akbari Sari A. Inequality in the geographic distribution of health workers in the public health sector in Iran. Hakim Health Systems Research Journal, 2015; 18(3): 194-200. [In Persian]
37- Isabel C, Paula V. Geographic distribution of physicians in Portugal. The European Journal of Health Economics, 2010; 11(4): 383-93. doi: 10.1007/s10198-009-0208-8. Epub 2009 Dec 11.
38- Panahi H, Aleemran Sa. The relationship between mortality of infant under one year and poverty, urbanization and GDP per capita in Iran. Journal of the Iranian Institute for Health Sciences Research, 2015; 4(4): 399-410. [In Persian]
39- Siddiqi A, Jones MK, Erwin PC. Does higher income inequality adversely influence infant mortality rates? Reconciling descriptive patterns and recent research findings. Social Science & Medicine, 2015; 131(1): 82-8. doi: doi: 10.1016/j.socscimed.2015.03.010.
_||_1- De Harlez Y, Malagueño R. Examining the joint effects of strategic priorities, use of management control systems, and personal background on hospital performance. Management Accounting Research. 2016;30:2-17. doi: 0.1016/j.mar.2015.07.001.
2- WHO. Development of indicators for monitoring progress towards health for all by the year 2000. World Health Organization. Geneva: 1981. Available from: http://apps.who.int/iris/handle/10665/40672.
3- Silva R. Child mortality estimation: consistency of under-five mortality rate estimates using full birth histories and summary birth histories. PLoS Medicine. 2012;9(8):1-14. doi: 0.1371/journal.pmed.1001296.
4- Wilmoth J, Zureick S, Canudas-Romo V, Inoue M, Sawyer C. A flexible two-dimensional mortality model for use in indirect estimation. Population studies, 2012; 66(1): 1-28. doi: 10.1080/00324728.2011.611411.
5- Yadava R, Tiwari A. An indirect technique for estimations of infant and child mortality: Data analysis from India and Bangladesh. Health and Population Perspectives and Issues, 2003; 26(2): 67-73.
6- Mehdizadeh H, Jahani M, Mahmoudi G. Frequency of Referrals of Cancer Patients Referred to Hospitals Affiliated to the Babol University of Medical Sciences according to the International Classification of Diseases. Journal of Babol University Of Medical Sciences, 2017; 19(12): 55-62. [In Persian]
7- World Health Statistics 2014. Geneva, World Health Organization, 2014(Available from://www.who.int/gho/pablications/world_health_statistics/2014/en/, accessed 29 June 2014.
8- Hallowell M. Safety risk perception in construction companies in the Pacific Northwest of the USA. Construction management and economics, 2010; 28(4): 403-13.
9- Zyaambo C, Siziya S, Fylkesnes K. Health status and socio-economic factors associated with health facility utilization in rural and urban areas in Zambia. BMC health services research, 2012; 12(1): 1.
10- Palència L, Espelt A, Rodríguez-Sanz M, Rocha KB, Pasarín MI, Borrell C. Trends in social class inequalities in the use of health care services within the Spanish National Health System, 1993–2006. The European Journal of Health Economics, 2013; 14(2): 211-9.
11- Dahlgren G, Whitehead M. A framework for assessing health systems from the public's perspective: the ALPS approach. International Journal of Health Services, 2007; 37(2): 363-78.
12- Song H-J, Han H-R, Lee J-E, Kim J-Y, Kim KB, Ryu JP, et al. Does access to care still affect health care utilization by immigrants? Testing of an empirical explanatory model of health care utilization by Korean American immigrants with high blood pressure. Journal of immigrant and Minority Health, 2010; 12(4): 513-9.
13- Shin H, Song H, Kim J, Probst JC. Insurance, acculturation, and health service utilization among Korean-Americans. Journal of immigrant health, 2005; 7(2): 65-74.
14- Lai D, Huang J, Risser JM, Kapadia AS. Statistical properties of generalized Gini coefficient with application to health inequality measurement. Social Indicators Research, 2008; 87(2): 249-58.
15- Miao C-x, Zhuo L, Gu Y-m, Qin Z-h. Study of large medical equipment allocation in Xuzhou. Journal of Zhejiang University SCIENCE B, 2007; 8(12): 881-4.
16- Nasiripour AA, Raeissi P, Asgari AA. Analysis of the spatial distribution of health care centers of Shahrekord by geographical information system. Journal of Shahrekord University of Medical Sciences, 2015; 16(6): 19-27. [In Persian]
17- Abbasi M, Hasoumi M, Mohamadi E, Asadi H. Analysis of the relationship between distributions of health sector inputs and health outcomes in Iran; using Gini coefficient. Bioethics Journal (Quarterly), 2016; 4(12): 65-79. [In Persian]
18- Roshanaei G, Safari M, Faradmal J, Karami m, Kouselo Z. Ranking and clustering Iranian provinces based on important health indicators of vital horoscope in rural areas by using multivariate methods. koomesh Journal, 2016; 17(2): 277-87. [In Persian]
19- Seperdoust H, Ebrahiminasab S. Human development index and under five years children mortality rate in iran. Journal of the Iranian Institute for Health Sciences Research, 2015; 4(2): 137-44. [In Persian]
20- Feng XL, Guo S, Yang Q, Xu L, Zhu J, Guo Y. Regional disparities in child mortality within China 1996–2004: epidemiological profile and health care coverage. Environmental health and preventive medicine, 2012; 16(4): 209-16. doi: 10.1007/s12199-010-0187-5.
21- Adedini SA, Odimegwu C, Imasiku EN, Ononokpono DN, Ibisomi L. Regional variations in infant and child mortality in Nigeria: a multilevel analysis. Journal of biosocial science, 2015; 47(2): 165-87.
22- Quentin W, Abosede O, Aka J, Akweongo P, Dinard K, Ezeh A, et al. Inequalities in child mortality in ten major African cities. BMC medicine, 2014; 12(1): 1-11. doi: 0.1186/741-7015-12-95.
23- Choe SA, Cho S-I. Causes of Child Mortality (1 to 4 Years of Age) From 1983 to 2012 in the Republic of Korea: National Vital Data. Journal of Preventive Medicine and Public Health, 2014; 47(6): 336-42. doi: 10.3961/jpmph.14.024.
24- Rozbhan, M.Economic Development, Taban public, Tehran; 2009.
25- Brown MC. Using Gini-style indices to evaluate the spatial patterns of health practitioners: theoretical considerations and an application based on Alberta data. Social science & medicine, 1994; 38(9): 1243-56.
26- Lorenz MO. Methods of measuring the concentration of wealth. Publications of the American statistical association, 1905; 9(70): 209-19.
27- Mirkatoli J, Kanani M. Evaluation of Regional Development and Inequality Levels, Using Multi- Criteria Decision Making Models. Gheographical Planing, 2011; 1(2): 17-36. [In Persian]
28- Afrakhte H, Riyahi V, Jalalian h. Evaluation the Spatial Justice in Distribution of Rural Services in The Counties of Isfahan Province. Amayesh Sarzamin, 2016; 8(1): 57-81. [In Persian]
29- Zarrabi A, Tabrizi N. Factors analysis approach and determination of development level of mazandran province. Amayesh Mohit, 2011; 4(12): 63-77. [In Persian]
30- Reshadat S, Saedi S, Zangeneh A, Amooie MR, Karbasi A. Equity in Access to Health Care Using Geographic Information System: a Kermanshah Case Study. J Mazandaran Univ Med Sci, 2014; 24(115): 134-40. [In Persian]
31- Taghvai M, Shahyvandy A. Dispersion of health services in the Iranian citys. Journal Social Welfare 2011;10(39):33-54. [In Persian].
32- Zandiyan h, ghiasvand h, nasimi dr. Measuring inequality of distribution of health resources: A case study. Payesh, 2012; 11(6): 799-805. [In Persian]
33- Kiadaliri AA, Najafi B, Haghparast-Bidgoli H. Geographic distribution of need and access to health care in rural population: an ecological study in Iran. International journal for equity in health, 2011; 10(1): 1. [In Persian]
34- Rezaei S, Nouri B. Evaluation of inequalities in the distribution of health resources by Gini coefficient and Lorenz curve: a case study in Kurdistan province from 2006 to 2013. Scientific Journal of Kurdistan University of Medical Sciences, 2016; 20(6): 1-11. [In Persian]
35- Sadoughi F, Hataminejad H, Zarei J, Parvan M. Geographical Accessibility of Rural Communities to Rural Health Houses using Geographical Information System: A Case Study in Khozestan Province, IRAN. Journal of Health System Research, 2016; 12(2): 1-8. [In Persian]
36- Rezaei S, KaramiMatin B, Akbari Sari A. Inequality in the geographic distribution of health workers in the public health sector in Iran. Hakim Health Systems Research Journal, 2015; 18(3): 194-200. [In Persian]
37- Isabel C, Paula V. Geographic distribution of physicians in Portugal. The European Journal of Health Economics, 2010; 11(4): 383-93. doi: 10.1007/s10198-009-0208-8. Epub 2009 Dec 11.
38- Panahi H, Aleemran Sa. The relationship between mortality of infant under one year and poverty, urbanization and GDP per capita in Iran. Journal of the Iranian Institute for Health Sciences Research, 2015; 4(4): 399-410. [In Persian]
39- Siddiqi A, Jones MK, Erwin PC. Does higher income inequality adversely influence infant mortality rates? Reconciling descriptive patterns and recent research findings. Social Science & Medicine, 2015; 131(1): 82-8. doi: doi: 10.1016/j.socscimed.2015.03.010.