Geographical inequality in cataract surgery among Iranians between 2006 and 2011

Cataract surgery is a highly cost-effective intervention for sight restoration but inequalities exist in its use which health care systems should aim to reduce.

This study aimed to measure the level of inequality in cataract surgery use and the changes in inequality between 2006 and 2011 in the Islamic Republic of Iran.

A number of metrics, including ranges and indexes based on Lorenz curves (Gini, concentration and dissimilarity indexes), were used to measure the inequality in cataract surgery use among Iranians in 2006 and 2011. Cataract surgical numbers and socioeconomic data were obtained from a province-based survey and the national census database.

Significant inter-provincial and inter-regional differences were found in cataract surgical proportions. South Khorasan province had the lowest cataract surgical rate in 2006 and 2011, while Tehran province had the highest rate in both years. Inequality in the distribution of cataract surgery services decreased between 2006 and 2011: the Gini, concentration and dissimilarity indexes decreased by 0.028, 0.03 and 0.037, respectively. However, cataract surgery delivery remained in favour of the better-off provinces.

To reduce this inequality, policy-makers should improve financial and physical access to cataract surgery, especially in the relatively deprived provinces, and tackle physician-induced demand.