assessment of horizontal inequity in eye careutilization in the iranian middle‑aged population

Purpose: the present study was designed to determine the extent that horizontal inequity was realized regarding eye care utilization in a middle‑aged population as well as factors affecting this equity. methods: data were obtained from a population‑based study (shahroud eye cohort study) in 2009 that included 5190 participants from 40 to 64 years of age. horizontal inequity was determined based on the following variables: (i) economic status, (ii) eye care service needs, (iii) non‑need variables, and (iv) eye care utilization (visiting an ophthalmologist or optometrist). decomposition analysis of the concentration index based on a nonlinear model and indirect standardization was used to ascertain the contribution of each factor in inequity of eye care utilization. results: after adjusting for need variables, the results of our study demonstrated that horizontal inequity in eye care utilization in a middle‑aged iranian population remained positive and significant (horizontal inequity: 0.19; 95% confidence interval: 0.17–0.23) indicating that use of services was focused among participants with a better financial situation. furthermore, decomposition analysis demonstrated that educational level and economic status had the greatest contribution (54.1% and 41.1%, respectively) in comparison to other variables. conclusion: this study demonstrated that horizontal inequity exists in eye care utilization among the middle‑aged iranian population.