Atopic dermatitis (AD) is a relapsing chronic pruritic inflammatory disease of skin for which no ... more Atopic dermatitis (AD) is a relapsing chronic pruritic inflammatory disease of skin for which no monogenic cause has been identified so far. Meanwhile, the filaggrin (FLG) gene is considered as the most important gene associated with predisposition to the disease. One hundred and six patients with AD and 105 healthy individuals were enrolled in this study. Real time polymerase chain reaction was performed to determine frequencies of alleles and genotype in six variants of the FLG gene. The frequencies of allele A in variants of rs3126065, rs2786680, and rs1933063 as well as allele C in variant rs3814300 were 100%. There was no significant difference between allele frequencies in variants rs2485518 and rs3814299. The only genotypes in variants of rs3814299 and rs2485518 were GG and CC, respectively, with no significant difference between the patients and controls. This study demonstrated that there was no significant association between polymorphisms of FLG gene variants and AD.
Aim: To determine the prevalence of refractive errors among schoolchildren in urban and rural are... more Aim: To determine the prevalence of refractive errors among schoolchildren in urban and rural areas of Dezful County, Iran. Methods: In a cross-sectional study, using random cluster sampling, 5721 Dezful schoolchildren were selected from 39 clusters. The participants in the study totalled 5544; 3673 elementary and middle school students and 1871 high school students. For the former group, cycloplegic refraction and for the latter, noncycloplegic refraction was tested. In all participants, uncorrected visual acuity and best corrected visual acuity were determined, and those with a visual acuity of 20/40 or worse, underwent a complete ophthalmic examination to determine the cause of visual impairment. A spherical equivalent of 20.5 diopter (D) or worse was defined as myopia, +2.0 D or more was defined as hyperopia, and a cylinder refraction greater than 0.75 D was considered astigmatism. Results: The uncorrected visual acuity was 20/40 or worse in the better eye of 224 schoolchildren (3.8% of participants). This figure (percentage) was 14 (0.03%) based on their best corrected visual acuity and 96 (1.7%) with their presenting vision. According to results of cycloplegic refraction, 3.4% (95% confidence interval (CI), 2.5 to 4.4) of the primary and middle school students were myopic and 16.6% (95% CI, 13.6 to 19.7) were hyperopic. For high school students, these rates were 2.1% (95% CI, 0.7 to 3.5) and 33.0% (95% CI, 24.9 to 41.1), respectively, with non-cycloplegic refraction. In the multivariate logistic regression for primary and middle school students, myopia was correlated with age (p = 0.030), and hyperopia was correlated with age (p,0.001) and area of residence (p = 0.007). In high school students, hyperopia again showed a correlation with their area of residence (p = 0.029). Conclusion: The present study reveals the considerable prevalence rates of refractive errors among schoolchildren in Dezful County and the high rate of an unmet need for their correction. Although myopia is not very prevalent, the high rate of hyperopia in the studied population emphasises its need for attention.
To determine the prevalence of myopia and hyperopia and the associated risk factors in the presby... more To determine the prevalence of myopia and hyperopia and the associated risk factors in the presbyopic age group of the population in Shahroud, Iran. Through a multistage random cluster sampling approach, 6311 people of the 40- to 64-year-old population residing in Shahroud were invited to this study. The prevalence of a cycloplegic spherical equivalent (SE) ≥-0.5 diopter (D) and hyperopia >+0.50 D was determined by age and gender. Of the invitees, 5190 (82.2%) participated in the study and data from 4864 people was used in the analyses. On the basis of cycloplegic refraction, the prevalence of myopia and hyperopia was 30.2% [95% confidence interval (CI): 28.9 to 31.5] and 35.6 (95% CI: 34.1 to 37.1), respectively. In the multiple logistic regression model, the odds of myopia significantly increased with higher education [odds ratio (OR) = 1.02, p < 0.001] and nuclear cataract (OR = 3.23, p < 0.001). After the age of 54 years, the odds of hyperopia significantly increased compared with the 40- to 44-year age group, whereas higher education and nuclear cataract had negative association with hyperopia. The prevalence of high myopia (SE >-6.0 D) and high hyperopia (SE > 4.0 D) was 1.9% (95% CI: 1.5 to 2.3) and 1.1% (95% CI: 0.8 to 1.4), respectively. Nuclear cataract significantly correlated with high myopia (OR = 6.44) and older age significantly correlated with high hyperopia (OR = 1.12). The prevalence of myopia was unexpectedly higher than that found in other parts of the Middle East. The prevalence of hyperopia was lower than that previously reported in Iran. Education correlated directly with myopia and inversely with hyperopia; however, nuclear cataract was the most important risk factor for myopia. Adjusted for other variables, the prevalence of hyperopia still increased with age.
Background: There is limited information regarding the prevalence of presbyopia in different part... more Background: There is limited information regarding the prevalence of presbyopia in different parts of the world. The add power and the prevalence of presbyopia by age and gender in general population of Shahroud, north of Iran, were studied.
To determine the normal corneal curvature, power, and eccentricity in an Iranian population and t... more To determine the normal corneal curvature, power, and eccentricity in an Iranian population and their determinants. This report is part of a population-based study conducted in 2009. Of the 5190 participants of the study, Pentacam data from 8532 eyes of 4266 people who met the inclusion criteria for this analysis were used. For each eye, we extracted minimum and maximum keratometry readings, the average of the 2 readings (mean-K), the difference between these 2 parameters (keratometric astigmatism), and corneal eccentricity. The average mean-K, keratometric astigmatism, and eccentricity were 43.73 ± 2.47, 0.90 ± 0.93, and 0.27 ± 0.63 diopter, respectively. Mean-K was directly correlated with age; inversely correlated with body mass index, axial length, white-to-white corneal diameter, and anterior chamber depth; increased at higher amounts of myopia; and was higher in women compared with men. Keratometric astigmatism was significantly higher in women, increased at higher amount of refractive error, but showed no association with other variables. Eccentricity was correlated indirectly with age and white-to-white corneal diameter, and directly with axial length. It increased with myopia. Compared with other studies, the mean corneal power and eccentricity values were lower in this Iranian population sample. Our findings may have implications for clinical interventions, especially refractive surgery. Further studies can identify the causes of such differences in the shape and size of the cornea, which may also be attributable to the choice of the measuring device.
To determine the prevalence of visual impairment by age and gender in Shahroud. Using random clus... more To determine the prevalence of visual impairment by age and gender in Shahroud. Using random cluster sampling, 6311 Shahroud inhabitants who were between 40 and 64 years old were invited for ophthalmological examinations. Visual acuity worse than 0.5 LogMAR (20/60) and 1.3 LogMAR (20/400) in the better eye was regarded as low vision and blindness, respectively. The cause of blindness was determined by an ophthalmologist and in a person with more than one cause, the most correctable cause was regarded as the main cause. This study was conducted on 5190 participants (response rate: 82.2%). On the basis of presenting visual acuity, the prevalence of low vision and blindness was found to be 1.8% (95% confidence interval (CI): 1.4-2.10) and 0.5% (95% CI: 0.3-0.7), respectively. Based on corrected vision, these values were 0.5% (95% CI: 0.3-0.7) and 0.3% (95% CI: 0.1-0.4), respectively. Visual impairment increased with age in women (P<0.001). Uncorrected refractive errors (63.9%), cataract (20.2%), and amblyopia (5.9%) were the most common causes of visual impairment based on presenting vision. Based on corrected vision, however, cataract (42.5%), amblyopia (12.5%), and retinitis pigmentosa (7.5%) were the most common causes of visual impairment. Although the prevalence of visual impairment in the city of Shahroud was determined to be lower than two previous studies in the country, correction of refractive errors and cataract could minimize the rate of visual impairment in this population as they were shown to comprise 85% of the causes of visual impairment. The elderly women need to receive more attention.
To determine the distribution of central and peripheral corneal thickness values and its determin... more To determine the distribution of central and peripheral corneal thickness values and its determinants in an Iranian population.
To determine the normal range of contrast sensitivity and its determinants through a population-b... more To determine the normal range of contrast sensitivity and its determinants through a population-based study in Shahroud, in northern Iran.
Background: The prevalence of astigmatism, its axis and determinants were determined in the 40-to... more Background: The prevalence of astigmatism, its axis and determinants were determined in the 40-to 64-year-old population of Shahroud, Iran.
Uncorrected refractive error plays a significant role in poor vision and blindness, and its corre... more Uncorrected refractive error plays a significant role in poor vision and blindness, and its correction is the most cost-effective intervention in eye care. In this study, we report the status of the unmet refractive need and the role of economic inequality in determining the level of this need in Shahroud, Iran. This cross-sectional nested case–control study was performed on 5,190 individuals aged 40–64 years. Cases and controls were individuals with uncorrected visual acuity worse than 0.3 LogMAR in the better eye who showed at least 0.2 LogMAR improvement after correction. Cases were individuals whose presenting vision was worse than 0.3 in the better eye but improved by at least 0.2 LogMAR after correction. Controls were individuals in whom the difference between the presenting and corrected vision was less than 0.2 LogMAR. The prevalence of the unmet need was 5.7 % and it was more prevalent in women (6.5 %) than in men (4.6 %) (p = 0.003). There was a gap of 19.6 % between the two groups of high and low economic status. The Oaxaca–Blinder decomposition method revealed that differences in the education level of the two groups accounted for half of this gap. Spectacle usage is better in Iran than in some other developing countries; however, in this study, about 40 % of those who required spectacles did not have them.
Objective Malnutrition is one of the most important health problems, especially in developing cou... more Objective Malnutrition is one of the most important health problems, especially in developing countries. The present study aimed to describe the socio-economic inequality in stunting and its determinants in Iran for the first time.Design Cross-sectional, population-based survey, carried out in 2009. Using randomized cluster sampling, weight and height of children were measured and anthropometric indices were calculated based on child growth standards given by the WHO. Socio-economic status of families was determined using principal component analysis on household assets and social specifications of families. The concentration index was used to calculate socio-economic inequality in stunting and its determinants were measured by decomposition of this index. Factors affecting the gap between socio-economic groups were recognized by using the Oaxaca–Blinder decomposition method.Setting Shahroud District in north-eastern Iran.Subjects Children (n 1395) aged <6 years.Results The concentration index for socio-economic inequality in stunting was −0·1913. Mother's education contributed 70 % in decomposition of this index. Mean height-for-age Z-score was −0·544 and −0·335 for low and high socio-economic groups, respectively. Mother's education was the factor contributing most to the gap between these two groups.Conclusions There was a significant socio-economic inequality in the studied children. If mother's education is distributed equally in all the different groups of Iranian society, one can expect to eliminate 70 % of the socio-economic inequalities. Even in high socio-economic groups, the mean height-for-age Z-score was lower than the international standards. These issues emphasize the necessity of applying new interventions especially for the improvement of maternal education.(Received January 11 2013)(Revised July 07 2013)(Accepted July 25 2013)
High Blood Pressure & Cardiovascular Prevention, 2013
To determine the prevalence of hypertension and pre-hypertension and its determinants in the 40-6... more To determine the prevalence of hypertension and pre-hypertension and its determinants in the 40-64 year old population of Shahroud in the north of Iran. The blood pressure of 5,190 of the 40-64 year old people participating in the first phase of Shahroud Eye Cohort Study was measured using the standard method. Sampling was done in 2009 using a random cluster approach. The prevalence of hypertension and pre-hypertension was determined by age and sex, and we used a multi-nominal logistic regression model to calculate the odds ratio (OR). The prevalence of pre-hypertension was 37.2 % in men and 30.9 % in women, and the prevalence of hypertension was respectively 37.1 % and 39.0 %. In both sexes, there was an increase in the prevalence of hypertension and a decrease in the prevalence of pre-hypertension with age. Older age, male sex, higher body mass index, blood glucose higher than 140 mg/dl were found associated with hypertension and pre-hypertension. Also, diabetes increases the odds of hypertension (OR = 1.4) and a history of smoking was correlated with a decreased odds of having hypertension and pre-hypertension. According to the criteria of Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure, the prevalence of hypertension and pre-hypertension was high in the studied population, and considering the epidemiologic transition of diseases in Iran, it can be concluded that a high percentage of the population are at risk of cardiovascular diseases.
Abstract: While pterygium is considered a common eye disorder, the etiology and pathogenesis is s... more Abstract: While pterygium is considered a common eye disorder, the etiology and pathogenesis is still not known. The aim of this study was to describe the prevalence of pterygium and pinguecula in the over 40 population of Shahroud and assess associated factors. The present study is part of the phase one of the Shahroud Eye Cohort Study conducted in 2009, in which the target population was people between 40 and 64 years of age.
Abstract The Shahroud Eye Cohort Study was set up to determine the prevalence and incidence of vi... more Abstract The Shahroud Eye Cohort Study was set up to determine the prevalence and incidence of visual impairment and major eye conditions in the 40–64-year-old population of Shahroud as a Middle Eastern population. The first phase of the study was conducted in 2009–10. Using random cluster sampling, 6311 Shahroud inhabitants were invited for ophthalmologic examinations; of these, 5190 participants completed phase 1 (participation rate of 82.2%).
The aim of this study was to determine the prevalence of color vision defects in the middle-age p... more The aim of this study was to determine the prevalence of color vision defects in the middle-age population of Shahroud, Iran. We selected 6,311 people from the 40- to 64-year-old population through random cluster sampling. Color vision testing was performed with the Farnsworth D-15. Cases with similar and symmetric results in both eyes were classified as hereditary, and those with asymmetric results were considered acquired. Cases that did not conform to standard patterns were classified as unknown category. Of 5,190 respondents (response rate 82.2 %), 5,102 participants underwent the color vision test. Of these, 14.7 % (95 % confidence interval 13.7-15.6) had some type of color vision deficiency. Of the 2,157 male participants, 6.2 % were hereditary and 10.2 % were acquired and of the 2,945 female participants, 3.1 % were hereditary and 10 % were acquired. Hereditary color deficiencies were mostly of the deutan form (63.8 %), and acquired deficiencies were mostly tritan (66.1 %). The prevalence of hereditary and acquired color vision deficiency, as well as different types of red-green and blue-yellow color vision defects significantly increased with age (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). In conclusion, the pattern of color vision defects among the middle-aged population of Shahroud was significantly different from that seen in the younger population. This could be due to changes associated with age, gender, medical and ocular conditions, and differences in race and environment. Thus, results of previous examinations and the overall health status should be considered before making any judgment about the status of color vision in middle-aged people.
Clinical & experimental optometry : journal of the Australian Optometrical Association, 2013
BackgroundThe aim of this study was to evaluate the prevalence of anisometropia in an urban adult... more BackgroundThe aim of this study was to evaluate the prevalence of anisometropia in an urban adult population in the north of Iran.The aim of this study was to evaluate the prevalence of anisometropia in an urban adult population in the north of Iran.MethodsThis cross-sectional study was conducted among the 40–64-year-old population in Shahroud, Iran. Random cluster sampling was applied to select 6,311 people. Following an interview, optometric and ophthalmologic examinations, including objective non-cycloplegic refractions, were carried out. The prevalence of anisometropia was reported according to non-cycloplegic refraction and with cut-off points of 0.50, 1.00, 2.00 and 3.00 D.This cross-sectional study was conducted among the 40–64-year-old population in Shahroud, Iran. Random cluster sampling was applied to select 6,311 people. Following an interview, optometric and ophthalmologic examinations, including objective non-cycloplegic refractions, were carried out. The prevalence of anisometropia was reported according to non-cycloplegic refraction and with cut-off points of 0.50, 1.00, 2.00 and 3.00 D.ResultsOf the sampled people, 5,190 (82.2 per cent) took part in the study. After considering exclusion criteria, data from 4,918 participants were included in the final analysis. Most participants were female (57.6 per cent) and the average age (with standard deviation) was 50.7 ± 6.2 years. The prevalence of anisometropia with cut-off points of 0.50, 1.00 and 2.00 D were 23.1 (95%CI: 22.0–24.3), 7.7 (95%CI: 7.0–8.4) and 3.2 per cent (95%CI: 2.7–3.7), respectively. The prevalence of severe anisometropia (3.00 D or more) was 1.9 per cent (95%CI: 1.5–2.3). The odds ratio (OR) of anisometropia was 1.06 times higher for every year of increasing age. The OR of anisometropia in participants with cataract was 2.78 times more than in those without (p < 0.001). Anisometropia was more frequent among participants with unilateral cataract (21.7 per cent) compared to those with bilateral cataract (13.4 per cent). Anisometropia of 1.00 D or more was significantly more prevalent among myopic participants compared to hyperopic participants (13.8 versus 12.7 per cent, p < 0.001) and there was a stronger association between anisometropia and myopia (OR = 2.93) than hyperopia (OR = 2.23). With increasing educational level, the prevalence of anisometropia decreased significantly (p < 0.001). The prevalence of aniso-astigmatism of 1.00 D or more was 11.1 per cent (95%CI: 10.2–11.9).Of the sampled people, 5,190 (82.2 per cent) took part in the study. After considering exclusion criteria, data from 4,918 participants were included in the final analysis. Most participants were female (57.6 per cent) and the average age (with standard deviation) was 50.7 ± 6.2 years. The prevalence of anisometropia with cut-off points of 0.50, 1.00 and 2.00 D were 23.1 (95%CI: 22.0–24.3), 7.7 (95%CI: 7.0–8.4) and 3.2 per cent (95%CI: 2.7–3.7), respectively. The prevalence of severe anisometropia (3.00 D or more) was 1.9 per cent (95%CI: 1.5–2.3). The odds ratio (OR) of anisometropia was 1.06 times higher for every year of increasing age. The OR of anisometropia in participants with cataract was 2.78 times more than in those without (p < 0.001). Anisometropia was more frequent among participants with unilateral cataract (21.7 per cent) compared to those with bilateral cataract (13.4 per cent). Anisometropia of 1.00 D or more was significantly more prevalent among myopic participants compared to hyperopic participants (13.8 versus 12.7 per cent, p < 0.001) and there was a stronger association between anisometropia and myopia (OR = 2.93) than hyperopia (OR = 2.23). With increasing educational level, the prevalence of anisometropia decreased significantly (p < 0.001). The prevalence of aniso-astigmatism of 1.00 D or more was 11.1 per cent (95%CI: 10.2–11.9).ConclusionIn the present study, the prevalence of anisometropia in Iran was not negligible; however, it is less than in Eastern Asia. Myopia, cataract, age and educational level were associated with anisometropia.In the present study, the prevalence of anisometropia in Iran was not negligible; however, it is less than in Eastern Asia. Myopia, cataract, age and educational level were associated with anisometropia.
To determine the prevalence of keratoconus in the 40- to 64-year-old population of Shahroud, Iran... more To determine the prevalence of keratoconus in the 40- to 64-year-old population of Shahroud, Iran. This study was done cross sectionally based on the data from the first phase of the Shahroud Eye Cohort Study. In this study, 6311 patients were selected using random cluster sampling, and 5190 patients (response rate = 82.2%) participated in the study. Here, the analysis was done on data pertaining to those whose topographic map (with Pentacam) had no errors. These patients were categorized as keratoconus, forme fruste keratoconus, and non-keratoconus. After applying the exclusion criteria, data from 4592 patients with a mean age of 50.83 ± 0.12 years were analyzed. Of these, 35 patients (0.76%) were diagnosed with keratoconus in at least 1 eye, and 47 patients (1.02%) were identified as having forme fruste keratoconus. The prevalence of keratoconus was 0.72% (95% confidence interval, 0.35-1.09) in men, and 0.79% (95% confidence interval, 0.43-1.15) in women (P = 0.793). The mean age of the keratoconic patients was 47.6, which was significantly lower than 50.9 of normal individuals (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). The mean maximum keratometry and central corneal thickness in patients with keratoconus were 48.67 ± 3.6 diopters and 470 ± 29 μm, respectively. Keratoconus was associated with an 8.1 greater odds of visual impairment (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). The prevalence of keratoconus in the Shahroud population is far higher than in western populations. Because of the high odds of visual impairment in this population, it can be a serious warning for the need to assess the prevalence and causes of keratoconus in the Middle Eastern region.
Mohammad Hassan Emamian, Mansooreh Fateh, Neman Gorgani, Akbar Fotouhi
Objective Malnutrition is one of the most important health problems, especially in developing cou... more Objective Malnutrition is one of the most important health problems, especially in developing countries. The present study aimed to describe the socio-economic inequality in stunting and its determinants in Iran for the first time.
Design Cross-sectional, population-based survey, carried out in 2009. Using randomized cluster sampling, weight and height of children were measured and anthropometric indices were calculated based on child growth standards given by the WHO. Socio-economic status of families was determined using principal component analysis on household assets and social specifications of families. The concentration index was used to calculate socio-economic inequality in stunting and its determinants were measured by decomposition of this index. Factors affecting the gap between socio-economic groups were recognized by using the Oaxaca–Blinder decomposition method.
Setting Shahroud District in north-eastern Iran.
Subjects Children (n 1395) aged <6 years.
Results The concentration index for socio-economic inequality in stunting was −0·1913. Mother's education contributed 70 % in decomposition of this index. Mean height-for-age Z-score was −0·544 and −0·335 for low and high socio-economic groups, respectively. Mother's education was the factor contributing most to the gap between these two groups.
Conclusions There was a significant socio-economic inequality in the studied children. If mother's education is distributed equally in all the different groups of Iranian society, one can expect to eliminate 70 % of the socio-economic inequalities. Even in high socio-economic groups, the mean height-for-age Z-score was lower than the international standards. These issues emphasize the necessity of applying new interventions especially for the improvement of maternal education.
International Journal of Health Policy and Management, 2014
The current study aimed to determine eye care utilization, to assess the role of economic inequal... more The current study aimed to determine eye care utilization, to assess the role of economic inequality in the utilization of eye care services, and to identify its determinants in Shahroud, North of Iran. Of the 6,311 invited people, 5,190 (82.24%) individuals aged 40 to 64 years old participated in the study. A history of a visit by an ophthalmologist or optometrist was considered as eye care utilization. The gap between low- and high-economic groups was decomposed into its determinants using the Oaxaca decomposition method. Among the participants, 16.32% [95% Confidence Intervals (CI)= 15.31-17.33%] had never been examined by an ophthalmologist or optometrist, and 30.94% (95% CI= 29.69-32.20%) had not undergone an eye examination in the past 5 years. This negative history was significantly higher among female subjects [Odds Ratio (OR)= 1.79, 95% CI= 1.51-2.14], the low-economic group (OR= 2.33, 95% CI= 1.90-2.87), the visually impaired (OR= 1.41, 95% CI= 1.05-1.90), and the uninsured (OR= 1.93, 95% CI= 1.45-2.58). The negative history of eye examination decreased with increasing in age (OR= 0.94, 95% CI= 0.93-0.96) and education (OR= 0.94, 95% CI= 0.92-0.96). In this study, 24.72% (95% CI= 22.30-27.14) of the low-economic group and 9.94% (95% CI= 8.75-11.14) of the high-economic group had no history of eye examination. Decomposition of the gap between the two economic groups showed that education and gender were the most important determinants of inequality. A considerable percentage of adults, even those with visual impairment, do not receive appropriate eye care. There is a definite economic inequality in the community for which poverty per se could be the major cause.
Atopic dermatitis (AD) is a relapsing chronic pruritic inflammatory disease of skin for which no ... more Atopic dermatitis (AD) is a relapsing chronic pruritic inflammatory disease of skin for which no monogenic cause has been identified so far. Meanwhile, the filaggrin (FLG) gene is considered as the most important gene associated with predisposition to the disease. One hundred and six patients with AD and 105 healthy individuals were enrolled in this study. Real time polymerase chain reaction was performed to determine frequencies of alleles and genotype in six variants of the FLG gene. The frequencies of allele A in variants of rs3126065, rs2786680, and rs1933063 as well as allele C in variant rs3814300 were 100%. There was no significant difference between allele frequencies in variants rs2485518 and rs3814299. The only genotypes in variants of rs3814299 and rs2485518 were GG and CC, respectively, with no significant difference between the patients and controls. This study demonstrated that there was no significant association between polymorphisms of FLG gene variants and AD.
Aim: To determine the prevalence of refractive errors among schoolchildren in urban and rural are... more Aim: To determine the prevalence of refractive errors among schoolchildren in urban and rural areas of Dezful County, Iran. Methods: In a cross-sectional study, using random cluster sampling, 5721 Dezful schoolchildren were selected from 39 clusters. The participants in the study totalled 5544; 3673 elementary and middle school students and 1871 high school students. For the former group, cycloplegic refraction and for the latter, noncycloplegic refraction was tested. In all participants, uncorrected visual acuity and best corrected visual acuity were determined, and those with a visual acuity of 20/40 or worse, underwent a complete ophthalmic examination to determine the cause of visual impairment. A spherical equivalent of 20.5 diopter (D) or worse was defined as myopia, +2.0 D or more was defined as hyperopia, and a cylinder refraction greater than 0.75 D was considered astigmatism. Results: The uncorrected visual acuity was 20/40 or worse in the better eye of 224 schoolchildren (3.8% of participants). This figure (percentage) was 14 (0.03%) based on their best corrected visual acuity and 96 (1.7%) with their presenting vision. According to results of cycloplegic refraction, 3.4% (95% confidence interval (CI), 2.5 to 4.4) of the primary and middle school students were myopic and 16.6% (95% CI, 13.6 to 19.7) were hyperopic. For high school students, these rates were 2.1% (95% CI, 0.7 to 3.5) and 33.0% (95% CI, 24.9 to 41.1), respectively, with non-cycloplegic refraction. In the multivariate logistic regression for primary and middle school students, myopia was correlated with age (p = 0.030), and hyperopia was correlated with age (p,0.001) and area of residence (p = 0.007). In high school students, hyperopia again showed a correlation with their area of residence (p = 0.029). Conclusion: The present study reveals the considerable prevalence rates of refractive errors among schoolchildren in Dezful County and the high rate of an unmet need for their correction. Although myopia is not very prevalent, the high rate of hyperopia in the studied population emphasises its need for attention.
To determine the prevalence of myopia and hyperopia and the associated risk factors in the presby... more To determine the prevalence of myopia and hyperopia and the associated risk factors in the presbyopic age group of the population in Shahroud, Iran. Through a multistage random cluster sampling approach, 6311 people of the 40- to 64-year-old population residing in Shahroud were invited to this study. The prevalence of a cycloplegic spherical equivalent (SE) ≥-0.5 diopter (D) and hyperopia &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;+0.50 D was determined by age and gender. Of the invitees, 5190 (82.2%) participated in the study and data from 4864 people was used in the analyses. On the basis of cycloplegic refraction, the prevalence of myopia and hyperopia was 30.2% [95% confidence interval (CI): 28.9 to 31.5] and 35.6 (95% CI: 34.1 to 37.1), respectively. In the multiple logistic regression model, the odds of myopia significantly increased with higher education [odds ratio (OR) = 1.02, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001] and nuclear cataract (OR = 3.23, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). After the age of 54 years, the odds of hyperopia significantly increased compared with the 40- to 44-year age group, whereas higher education and nuclear cataract had negative association with hyperopia. The prevalence of high myopia (SE &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;-6.0 D) and high hyperopia (SE &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 4.0 D) was 1.9% (95% CI: 1.5 to 2.3) and 1.1% (95% CI: 0.8 to 1.4), respectively. Nuclear cataract significantly correlated with high myopia (OR = 6.44) and older age significantly correlated with high hyperopia (OR = 1.12). The prevalence of myopia was unexpectedly higher than that found in other parts of the Middle East. The prevalence of hyperopia was lower than that previously reported in Iran. Education correlated directly with myopia and inversely with hyperopia; however, nuclear cataract was the most important risk factor for myopia. Adjusted for other variables, the prevalence of hyperopia still increased with age.
Background: There is limited information regarding the prevalence of presbyopia in different part... more Background: There is limited information regarding the prevalence of presbyopia in different parts of the world. The add power and the prevalence of presbyopia by age and gender in general population of Shahroud, north of Iran, were studied.
To determine the normal corneal curvature, power, and eccentricity in an Iranian population and t... more To determine the normal corneal curvature, power, and eccentricity in an Iranian population and their determinants. This report is part of a population-based study conducted in 2009. Of the 5190 participants of the study, Pentacam data from 8532 eyes of 4266 people who met the inclusion criteria for this analysis were used. For each eye, we extracted minimum and maximum keratometry readings, the average of the 2 readings (mean-K), the difference between these 2 parameters (keratometric astigmatism), and corneal eccentricity. The average mean-K, keratometric astigmatism, and eccentricity were 43.73 ± 2.47, 0.90 ± 0.93, and 0.27 ± 0.63 diopter, respectively. Mean-K was directly correlated with age; inversely correlated with body mass index, axial length, white-to-white corneal diameter, and anterior chamber depth; increased at higher amounts of myopia; and was higher in women compared with men. Keratometric astigmatism was significantly higher in women, increased at higher amount of refractive error, but showed no association with other variables. Eccentricity was correlated indirectly with age and white-to-white corneal diameter, and directly with axial length. It increased with myopia. Compared with other studies, the mean corneal power and eccentricity values were lower in this Iranian population sample. Our findings may have implications for clinical interventions, especially refractive surgery. Further studies can identify the causes of such differences in the shape and size of the cornea, which may also be attributable to the choice of the measuring device.
To determine the prevalence of visual impairment by age and gender in Shahroud. Using random clus... more To determine the prevalence of visual impairment by age and gender in Shahroud. Using random cluster sampling, 6311 Shahroud inhabitants who were between 40 and 64 years old were invited for ophthalmological examinations. Visual acuity worse than 0.5 LogMAR (20/60) and 1.3 LogMAR (20/400) in the better eye was regarded as low vision and blindness, respectively. The cause of blindness was determined by an ophthalmologist and in a person with more than one cause, the most correctable cause was regarded as the main cause. This study was conducted on 5190 participants (response rate: 82.2%). On the basis of presenting visual acuity, the prevalence of low vision and blindness was found to be 1.8% (95% confidence interval (CI): 1.4-2.10) and 0.5% (95% CI: 0.3-0.7), respectively. Based on corrected vision, these values were 0.5% (95% CI: 0.3-0.7) and 0.3% (95% CI: 0.1-0.4), respectively. Visual impairment increased with age in women (P&lt;0.001). Uncorrected refractive errors (63.9%), cataract (20.2%), and amblyopia (5.9%) were the most common causes of visual impairment based on presenting vision. Based on corrected vision, however, cataract (42.5%), amblyopia (12.5%), and retinitis pigmentosa (7.5%) were the most common causes of visual impairment. Although the prevalence of visual impairment in the city of Shahroud was determined to be lower than two previous studies in the country, correction of refractive errors and cataract could minimize the rate of visual impairment in this population as they were shown to comprise 85% of the causes of visual impairment. The elderly women need to receive more attention.
To determine the distribution of central and peripheral corneal thickness values and its determin... more To determine the distribution of central and peripheral corneal thickness values and its determinants in an Iranian population.
To determine the normal range of contrast sensitivity and its determinants through a population-b... more To determine the normal range of contrast sensitivity and its determinants through a population-based study in Shahroud, in northern Iran.
Background: The prevalence of astigmatism, its axis and determinants were determined in the 40-to... more Background: The prevalence of astigmatism, its axis and determinants were determined in the 40-to 64-year-old population of Shahroud, Iran.
Uncorrected refractive error plays a significant role in poor vision and blindness, and its corre... more Uncorrected refractive error plays a significant role in poor vision and blindness, and its correction is the most cost-effective intervention in eye care. In this study, we report the status of the unmet refractive need and the role of economic inequality in determining the level of this need in Shahroud, Iran. This cross-sectional nested case–control study was performed on 5,190 individuals aged 40–64 years. Cases and controls were individuals with uncorrected visual acuity worse than 0.3 LogMAR in the better eye who showed at least 0.2 LogMAR improvement after correction. Cases were individuals whose presenting vision was worse than 0.3 in the better eye but improved by at least 0.2 LogMAR after correction. Controls were individuals in whom the difference between the presenting and corrected vision was less than 0.2 LogMAR. The prevalence of the unmet need was 5.7 % and it was more prevalent in women (6.5 %) than in men (4.6 %) (p = 0.003). There was a gap of 19.6 % between the two groups of high and low economic status. The Oaxaca–Blinder decomposition method revealed that differences in the education level of the two groups accounted for half of this gap. Spectacle usage is better in Iran than in some other developing countries; however, in this study, about 40 % of those who required spectacles did not have them.
Objective Malnutrition is one of the most important health problems, especially in developing cou... more Objective Malnutrition is one of the most important health problems, especially in developing countries. The present study aimed to describe the socio-economic inequality in stunting and its determinants in Iran for the first time.Design Cross-sectional, population-based survey, carried out in 2009. Using randomized cluster sampling, weight and height of children were measured and anthropometric indices were calculated based on child growth standards given by the WHO. Socio-economic status of families was determined using principal component analysis on household assets and social specifications of families. The concentration index was used to calculate socio-economic inequality in stunting and its determinants were measured by decomposition of this index. Factors affecting the gap between socio-economic groups were recognized by using the Oaxaca–Blinder decomposition method.Setting Shahroud District in north-eastern Iran.Subjects Children (n 1395) aged <6 years.Results The concentration index for socio-economic inequality in stunting was −0·1913. Mother's education contributed 70 % in decomposition of this index. Mean height-for-age Z-score was −0·544 and −0·335 for low and high socio-economic groups, respectively. Mother's education was the factor contributing most to the gap between these two groups.Conclusions There was a significant socio-economic inequality in the studied children. If mother's education is distributed equally in all the different groups of Iranian society, one can expect to eliminate 70 % of the socio-economic inequalities. Even in high socio-economic groups, the mean height-for-age Z-score was lower than the international standards. These issues emphasize the necessity of applying new interventions especially for the improvement of maternal education.(Received January 11 2013)(Revised July 07 2013)(Accepted July 25 2013)
High Blood Pressure & Cardiovascular Prevention, 2013
To determine the prevalence of hypertension and pre-hypertension and its determinants in the 40-6... more To determine the prevalence of hypertension and pre-hypertension and its determinants in the 40-64 year old population of Shahroud in the north of Iran. The blood pressure of 5,190 of the 40-64 year old people participating in the first phase of Shahroud Eye Cohort Study was measured using the standard method. Sampling was done in 2009 using a random cluster approach. The prevalence of hypertension and pre-hypertension was determined by age and sex, and we used a multi-nominal logistic regression model to calculate the odds ratio (OR). The prevalence of pre-hypertension was 37.2 % in men and 30.9 % in women, and the prevalence of hypertension was respectively 37.1 % and 39.0 %. In both sexes, there was an increase in the prevalence of hypertension and a decrease in the prevalence of pre-hypertension with age. Older age, male sex, higher body mass index, blood glucose higher than 140 mg/dl were found associated with hypertension and pre-hypertension. Also, diabetes increases the odds of hypertension (OR = 1.4) and a history of smoking was correlated with a decreased odds of having hypertension and pre-hypertension. According to the criteria of Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure, the prevalence of hypertension and pre-hypertension was high in the studied population, and considering the epidemiologic transition of diseases in Iran, it can be concluded that a high percentage of the population are at risk of cardiovascular diseases.
Abstract: While pterygium is considered a common eye disorder, the etiology and pathogenesis is s... more Abstract: While pterygium is considered a common eye disorder, the etiology and pathogenesis is still not known. The aim of this study was to describe the prevalence of pterygium and pinguecula in the over 40 population of Shahroud and assess associated factors. The present study is part of the phase one of the Shahroud Eye Cohort Study conducted in 2009, in which the target population was people between 40 and 64 years of age.
Abstract The Shahroud Eye Cohort Study was set up to determine the prevalence and incidence of vi... more Abstract The Shahroud Eye Cohort Study was set up to determine the prevalence and incidence of visual impairment and major eye conditions in the 40–64-year-old population of Shahroud as a Middle Eastern population. The first phase of the study was conducted in 2009–10. Using random cluster sampling, 6311 Shahroud inhabitants were invited for ophthalmologic examinations; of these, 5190 participants completed phase 1 (participation rate of 82.2%).
The aim of this study was to determine the prevalence of color vision defects in the middle-age p... more The aim of this study was to determine the prevalence of color vision defects in the middle-age population of Shahroud, Iran. We selected 6,311 people from the 40- to 64-year-old population through random cluster sampling. Color vision testing was performed with the Farnsworth D-15. Cases with similar and symmetric results in both eyes were classified as hereditary, and those with asymmetric results were considered acquired. Cases that did not conform to standard patterns were classified as unknown category. Of 5,190 respondents (response rate 82.2 %), 5,102 participants underwent the color vision test. Of these, 14.7 % (95 % confidence interval 13.7-15.6) had some type of color vision deficiency. Of the 2,157 male participants, 6.2 % were hereditary and 10.2 % were acquired and of the 2,945 female participants, 3.1 % were hereditary and 10 % were acquired. Hereditary color deficiencies were mostly of the deutan form (63.8 %), and acquired deficiencies were mostly tritan (66.1 %). The prevalence of hereditary and acquired color vision deficiency, as well as different types of red-green and blue-yellow color vision defects significantly increased with age (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). In conclusion, the pattern of color vision defects among the middle-aged population of Shahroud was significantly different from that seen in the younger population. This could be due to changes associated with age, gender, medical and ocular conditions, and differences in race and environment. Thus, results of previous examinations and the overall health status should be considered before making any judgment about the status of color vision in middle-aged people.
Clinical & experimental optometry : journal of the Australian Optometrical Association, 2013
BackgroundThe aim of this study was to evaluate the prevalence of anisometropia in an urban adult... more BackgroundThe aim of this study was to evaluate the prevalence of anisometropia in an urban adult population in the north of Iran.The aim of this study was to evaluate the prevalence of anisometropia in an urban adult population in the north of Iran.MethodsThis cross-sectional study was conducted among the 40–64-year-old population in Shahroud, Iran. Random cluster sampling was applied to select 6,311 people. Following an interview, optometric and ophthalmologic examinations, including objective non-cycloplegic refractions, were carried out. The prevalence of anisometropia was reported according to non-cycloplegic refraction and with cut-off points of 0.50, 1.00, 2.00 and 3.00 D.This cross-sectional study was conducted among the 40–64-year-old population in Shahroud, Iran. Random cluster sampling was applied to select 6,311 people. Following an interview, optometric and ophthalmologic examinations, including objective non-cycloplegic refractions, were carried out. The prevalence of anisometropia was reported according to non-cycloplegic refraction and with cut-off points of 0.50, 1.00, 2.00 and 3.00 D.ResultsOf the sampled people, 5,190 (82.2 per cent) took part in the study. After considering exclusion criteria, data from 4,918 participants were included in the final analysis. Most participants were female (57.6 per cent) and the average age (with standard deviation) was 50.7 ± 6.2 years. The prevalence of anisometropia with cut-off points of 0.50, 1.00 and 2.00 D were 23.1 (95%CI: 22.0–24.3), 7.7 (95%CI: 7.0–8.4) and 3.2 per cent (95%CI: 2.7–3.7), respectively. The prevalence of severe anisometropia (3.00 D or more) was 1.9 per cent (95%CI: 1.5–2.3). The odds ratio (OR) of anisometropia was 1.06 times higher for every year of increasing age. The OR of anisometropia in participants with cataract was 2.78 times more than in those without (p < 0.001). Anisometropia was more frequent among participants with unilateral cataract (21.7 per cent) compared to those with bilateral cataract (13.4 per cent). Anisometropia of 1.00 D or more was significantly more prevalent among myopic participants compared to hyperopic participants (13.8 versus 12.7 per cent, p < 0.001) and there was a stronger association between anisometropia and myopia (OR = 2.93) than hyperopia (OR = 2.23). With increasing educational level, the prevalence of anisometropia decreased significantly (p < 0.001). The prevalence of aniso-astigmatism of 1.00 D or more was 11.1 per cent (95%CI: 10.2–11.9).Of the sampled people, 5,190 (82.2 per cent) took part in the study. After considering exclusion criteria, data from 4,918 participants were included in the final analysis. Most participants were female (57.6 per cent) and the average age (with standard deviation) was 50.7 ± 6.2 years. The prevalence of anisometropia with cut-off points of 0.50, 1.00 and 2.00 D were 23.1 (95%CI: 22.0–24.3), 7.7 (95%CI: 7.0–8.4) and 3.2 per cent (95%CI: 2.7–3.7), respectively. The prevalence of severe anisometropia (3.00 D or more) was 1.9 per cent (95%CI: 1.5–2.3). The odds ratio (OR) of anisometropia was 1.06 times higher for every year of increasing age. The OR of anisometropia in participants with cataract was 2.78 times more than in those without (p < 0.001). Anisometropia was more frequent among participants with unilateral cataract (21.7 per cent) compared to those with bilateral cataract (13.4 per cent). Anisometropia of 1.00 D or more was significantly more prevalent among myopic participants compared to hyperopic participants (13.8 versus 12.7 per cent, p < 0.001) and there was a stronger association between anisometropia and myopia (OR = 2.93) than hyperopia (OR = 2.23). With increasing educational level, the prevalence of anisometropia decreased significantly (p < 0.001). The prevalence of aniso-astigmatism of 1.00 D or more was 11.1 per cent (95%CI: 10.2–11.9).ConclusionIn the present study, the prevalence of anisometropia in Iran was not negligible; however, it is less than in Eastern Asia. Myopia, cataract, age and educational level were associated with anisometropia.In the present study, the prevalence of anisometropia in Iran was not negligible; however, it is less than in Eastern Asia. Myopia, cataract, age and educational level were associated with anisometropia.
To determine the prevalence of keratoconus in the 40- to 64-year-old population of Shahroud, Iran... more To determine the prevalence of keratoconus in the 40- to 64-year-old population of Shahroud, Iran. This study was done cross sectionally based on the data from the first phase of the Shahroud Eye Cohort Study. In this study, 6311 patients were selected using random cluster sampling, and 5190 patients (response rate = 82.2%) participated in the study. Here, the analysis was done on data pertaining to those whose topographic map (with Pentacam) had no errors. These patients were categorized as keratoconus, forme fruste keratoconus, and non-keratoconus. After applying the exclusion criteria, data from 4592 patients with a mean age of 50.83 ± 0.12 years were analyzed. Of these, 35 patients (0.76%) were diagnosed with keratoconus in at least 1 eye, and 47 patients (1.02%) were identified as having forme fruste keratoconus. The prevalence of keratoconus was 0.72% (95% confidence interval, 0.35-1.09) in men, and 0.79% (95% confidence interval, 0.43-1.15) in women (P = 0.793). The mean age of the keratoconic patients was 47.6, which was significantly lower than 50.9 of normal individuals (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). The mean maximum keratometry and central corneal thickness in patients with keratoconus were 48.67 ± 3.6 diopters and 470 ± 29 μm, respectively. Keratoconus was associated with an 8.1 greater odds of visual impairment (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). The prevalence of keratoconus in the Shahroud population is far higher than in western populations. Because of the high odds of visual impairment in this population, it can be a serious warning for the need to assess the prevalence and causes of keratoconus in the Middle Eastern region.
Mohammad Hassan Emamian, Mansooreh Fateh, Neman Gorgani, Akbar Fotouhi
Objective Malnutrition is one of the most important health problems, especially in developing cou... more Objective Malnutrition is one of the most important health problems, especially in developing countries. The present study aimed to describe the socio-economic inequality in stunting and its determinants in Iran for the first time.
Design Cross-sectional, population-based survey, carried out in 2009. Using randomized cluster sampling, weight and height of children were measured and anthropometric indices were calculated based on child growth standards given by the WHO. Socio-economic status of families was determined using principal component analysis on household assets and social specifications of families. The concentration index was used to calculate socio-economic inequality in stunting and its determinants were measured by decomposition of this index. Factors affecting the gap between socio-economic groups were recognized by using the Oaxaca–Blinder decomposition method.
Setting Shahroud District in north-eastern Iran.
Subjects Children (n 1395) aged <6 years.
Results The concentration index for socio-economic inequality in stunting was −0·1913. Mother's education contributed 70 % in decomposition of this index. Mean height-for-age Z-score was −0·544 and −0·335 for low and high socio-economic groups, respectively. Mother's education was the factor contributing most to the gap between these two groups.
Conclusions There was a significant socio-economic inequality in the studied children. If mother's education is distributed equally in all the different groups of Iranian society, one can expect to eliminate 70 % of the socio-economic inequalities. Even in high socio-economic groups, the mean height-for-age Z-score was lower than the international standards. These issues emphasize the necessity of applying new interventions especially for the improvement of maternal education.
International Journal of Health Policy and Management, 2014
The current study aimed to determine eye care utilization, to assess the role of economic inequal... more The current study aimed to determine eye care utilization, to assess the role of economic inequality in the utilization of eye care services, and to identify its determinants in Shahroud, North of Iran. Of the 6,311 invited people, 5,190 (82.24%) individuals aged 40 to 64 years old participated in the study. A history of a visit by an ophthalmologist or optometrist was considered as eye care utilization. The gap between low- and high-economic groups was decomposed into its determinants using the Oaxaca decomposition method. Among the participants, 16.32% [95% Confidence Intervals (CI)= 15.31-17.33%] had never been examined by an ophthalmologist or optometrist, and 30.94% (95% CI= 29.69-32.20%) had not undergone an eye examination in the past 5 years. This negative history was significantly higher among female subjects [Odds Ratio (OR)= 1.79, 95% CI= 1.51-2.14], the low-economic group (OR= 2.33, 95% CI= 1.90-2.87), the visually impaired (OR= 1.41, 95% CI= 1.05-1.90), and the uninsured (OR= 1.93, 95% CI= 1.45-2.58). The negative history of eye examination decreased with increasing in age (OR= 0.94, 95% CI= 0.93-0.96) and education (OR= 0.94, 95% CI= 0.92-0.96). In this study, 24.72% (95% CI= 22.30-27.14) of the low-economic group and 9.94% (95% CI= 8.75-11.14) of the high-economic group had no history of eye examination. Decomposition of the gap between the two economic groups showed that education and gender were the most important determinants of inequality. A considerable percentage of adults, even those with visual impairment, do not receive appropriate eye care. There is a definite economic inequality in the community for which poverty per se could be the major cause.
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Papers by Akbar Fotouhi
Design Cross-sectional, population-based survey, carried out in 2009. Using randomized cluster sampling, weight and height of children were measured and anthropometric indices were calculated based on child growth standards given by the WHO. Socio-economic status of families was determined using principal component analysis on household assets and social specifications of families. The concentration index was used to calculate socio-economic inequality in stunting and its determinants were measured by decomposition of this index. Factors affecting the gap between socio-economic groups were recognized by using the Oaxaca–Blinder decomposition method.
Setting Shahroud District in north-eastern Iran.
Subjects Children (n 1395) aged <6 years.
Results The concentration index for socio-economic inequality in stunting was −0·1913. Mother's education contributed 70 % in decomposition of this index. Mean height-for-age Z-score was −0·544 and −0·335 for low and high socio-economic groups, respectively. Mother's education was the factor contributing most to the gap between these two groups.
Conclusions There was a significant socio-economic inequality in the studied children. If mother's education is distributed equally in all the different groups of Iranian society, one can expect to eliminate 70 % of the socio-economic inequalities. Even in high socio-economic groups, the mean height-for-age Z-score was lower than the international standards. These issues emphasize the necessity of applying new interventions especially for the improvement of maternal education.
Design Cross-sectional, population-based survey, carried out in 2009. Using randomized cluster sampling, weight and height of children were measured and anthropometric indices were calculated based on child growth standards given by the WHO. Socio-economic status of families was determined using principal component analysis on household assets and social specifications of families. The concentration index was used to calculate socio-economic inequality in stunting and its determinants were measured by decomposition of this index. Factors affecting the gap between socio-economic groups were recognized by using the Oaxaca–Blinder decomposition method.
Setting Shahroud District in north-eastern Iran.
Subjects Children (n 1395) aged <6 years.
Results The concentration index for socio-economic inequality in stunting was −0·1913. Mother's education contributed 70 % in decomposition of this index. Mean height-for-age Z-score was −0·544 and −0·335 for low and high socio-economic groups, respectively. Mother's education was the factor contributing most to the gap between these two groups.
Conclusions There was a significant socio-economic inequality in the studied children. If mother's education is distributed equally in all the different groups of Iranian society, one can expect to eliminate 70 % of the socio-economic inequalities. Even in high socio-economic groups, the mean height-for-age Z-score was lower than the international standards. These issues emphasize the necessity of applying new interventions especially for the improvement of maternal education.