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Table 1 The data extraction and quality of the studies (population level)

From: Determinants of catastrophic health expenditures in Iran: a systematic review and meta-analysis

Study quality

CHE (%)

Data collection method

Sample size

Population

Years of study

Publication type—language

Study design

Author (year)

N

1

Nekoei-Moghadam et al. (2012)

Descriptive–analytical study

Article—English

2008

Iranian households

39,008

Secondary data

2.8%

Good

Determinants of exposure to CHE: use of outpatient service, drug addiction cessation services, Inpatient service—household size (3 ≤ x < 6) (+)—economic status—pharmaceutical expenses—health insurance

2

Ghiasvand et al. (2015)

Descriptive study

Article—English

2013–2014

Iranian households

Total: 38,318

19,437 (rural) 18,888(urban)

Secondary data

Rural: 11.7% Urban: 11.45%

Good

Determinants of exposure to CHE

3

Karami et al. (2009)

Descriptive study

Article—English

2008

Kermanshah

189

questionnaire

22.2%

Medium

Determinants of exposure to CHE

4

Daneshkohan et al. (2011)

Descriptive study

Article—English

2008

Kermanshah

189

Questionnaire

22.2%

Good

Determinants of exposure to CHE

5

Ghoddoosinejad et al. (2014)

Cross-sectional descriptive study

Article—English

2013

Ferdows

100

Questionnaire

24%

Medium

Determinants of exposure to CHE: use of dentistry services

6

Kavosi et al. (2012)

Longitudinal study

Article—English

2003 and 2008

South-west Tehran

579 (2003)

592 (2008)

Questionnaire

12.6% (2003), 11.8% (2008)

Good

Determinants of exposure to CHE: economic status—member over 65 years (+)—disabled members—health insurance- use of dentistry services, outpatient service, inpatient service

7

Saber-Mahani et al. (2014)

Cross-sectional study

Article—Persian

2011

Tehran

34,700

Secondary data

11.3%

Medium

Determinants of exposure to CHE: number of members under 5 years (+)—number of members over 65 years (+)—employed head—education status of household head (−)—chronic disease members—health insurance—age of household head (+)—equivalent household size (−)—income deciles (+)—per capita household expenditure (−)—number of the employed persons in household

8

Amery et al. (2013)

Cross-sectional study

Article—Persian

2011

Yazd

386

Questionnaire

8.3%

Medium

Determinants of exposure to CHE: use of inpatient services—household size (> 7) (+)—members under 5 years (−)—use of medical services and diagnosis

9

Soofi et al. (2013)

Cross-sectional study

Article—Persian

2001

Iranian households

10,300

Secondary data

15.31%

Medium

Determinants of exposure to CHE: living in the urban (−)—household size (+)—member with chronic illness—member in need of care—economic status—health insurance—use of outpatient service

10

Kavosi et al. (2009)

Longitudinal study

Article—Persian

2003–2008

Tehran

579 (2003), 592 (2008)

Questionnaire

12.6% (2003), 11.8% (2008)

Medium

Determinants of exposure to CHE: use of inpatient service, dentistry services—member over 65 years (+)—member in need of care—number of use of outpatient services—economic status

11

Amery et al. (2012)

Cross-sectional study

Article—Persian

2012

Mashhad

384

Questionnaire

6.77%

Medium

Determinants of exposure to CHE: household size (> 7) (+)—health insurance—use of inpatient service, dentistry services, medicinal and diagnostic services—member over 65 years (+)—pharmaceutical expenses—members under 5 years (−)

12

Rezapour et al. (2013)

Cross-sectional study

Article—English

2013

Tehran

2200

Interviews, and Questionnaire

6.45%

Good

Determinants of exposure to CHE: number of use of outpatient services—education status of household head (+)—household size (+)—preschool children living in household (−)—member with chronic illness

13

Aeenparast et al. (2016)

Review literature on studies

Article—Persian

Not reported

Iranian households

19 papers

–

2.5% to 72.5%

Weak

Determinants of exposure to CHE

14

Asefzadeh et al. (2013)

Cross-sectional–descriptive–analytical study

Article—Persian

2011

Qazvin

100

Questionnaire

24%

Medium

Determinants of exposure to CHE: use of dentistry servicesDeterminants of exposure to CHE: use of dentistry services

15

Raghfar et al. (2013)

Longitudinal study

Article—Persian

1984 to 2010

Iranian households

30,000 households in each year

Secondary data

6.78% to 5.76% (rural)

3.9% to 5.76% (urban)

Weak

Determinants of exposure to CHE

16

Fazaeli et al. (2015)

Cross-sectional–descriptive–analytical study

Article—English

2010

Iranian households

28,997

Secondary data

2.1%

Medium

Determinants of exposure to CHE: living in the urban (−)—number of members over 65 years (+)—education status of household head (+)—employment situation of household head—number of the employed persons in household—expenditure deciles (+)—equivalent household size (+)

17

Masaeli et al. (2015)

Descriptive–analytical study

Article—Persian

2011

Iranian households

38,437

Secondary data

1.56%

Medium

Determinants of exposure to CHE

18

Mehrara et al. (2010)

Longitudinal study–descriptive–analytical study

Article—Persian

2003–2007

Iranian households

31,283 (2007)

2003–2004-2005-2006 (not reported)

Secondary data

2.3% (2003)

1.9% (2004)

2.4% (2005)

2.3% (2006)

2.5% (2007)

weak

Determinants of exposure to CHE: living in the urban (−)—number of members over 60 years (+)—number of members under 12 years (+)—health insurance—employment situation of household head—number of members employed in the household (+)—marital status (single head) (+)—per capita infrastructure residential area of the household, wealth index (−)—equivalent household size (+)—expenditure deciles (+)—equivalent per capita household expenditure (+)

19

Fazaeli (2007)

Longitudinal study

Thesis—Persian

2003–2006

Iranian households

23,134 (2003)

24,534 (2004)

26,895 (2005)

30,910 (2006)

Secondary data

2.28% (2003)

1.9% (2004)

2.36% (2005)

2.26% (2006)

Medium

Determinants of exposure to CHE: age of household head (−)—number of members employed in the household (−)—health insurance—members over 60 years (+)—living in the urban (−)—education status of household head (−)—employment situation of household head—per capita household expenditure— (+)per capita infrastructure residential area of the household, wealth index (−)

20

Kavosi et al. (2014)

Cross-sectional study

Article—English

2012

Shiraz

761

Questionnaire

14.2%

Good

Determinants of exposure to CHE: Economic status (−)—use of dentistry services, inpatient services, physician visits—frequency of use of outpatient services—health insurance—supplementary insurance status of household head—member in chronic need of medical care- living in the urban (−)

21

Nekoei-moghadam et al. (2014)

Descriptive–analytical retrospective

Article—Persian

2008

Kerman

1477

Secondary data

4.1%

Good

Determinants of exposure to CHE: living in the urban (+)—use of inpatient services, outpatient services, dental care services

22

Fazaeli et al. (2015)

Longitudinal study

Article—English

2003 to 2010

Iranian households

23,134 to 38,170 for each year

Secondary data

2.28% (2003)

1.91% (2004)

2.37% (2005)

2.27% (2006)

2.49% (2007)

2.46% (2008)

2.82% (2009)

3.06% (2010)

Medium

Determinants of exposure to CHE

23

Yousefi et al. (2015)

Cross sectional–descriptive study

Article—Persian

2011

Iranian households

36,071

Secondary data

3.38%

Medium

Determinants of exposure to CHE

24

BagheriFaradonbeh et al. (2016)

Cross-sectional study

Article—Persian

2013

Tehran

625

Interview and observation using a Questionnaire

3.8%

Medium

Determinants of exposure to CHE: use of inpatient services- education status of household head (−)—number of use of health services—informal payment (+)—member over 65 years (+)

25

Piroozi et al. (2016)

Cross-sectional, descriptive–analytical study

Article—English

2015

Sanandaj

646

Face-to-Face Interviews—Questionnaire

4.8%

Good

Determinants of exposure to CHE: supplementary health insurance—gender of the head of household (female)(+)—economic status—members over 65 years(+)—disabled member and in need of care—use of inpatient services, dental care services, rehabilitation services

26

Hanjani et al. (2006)

Cross-sectional study

Article—Persian

2002

Iranian households

32,152

Secondary data

3.94%

weak

Determinants of exposure to CHE: age of household head (+)- living in the urban (−)—health insurance—education status of household head (−)—employment situation of household head—marital status (married) (+)—gender of the head of household (male) (+)—household size (−)

27

Ghiasi (2016)

Cross-sectional, descriptive–analytical study

Article—Persian

2013–2014

Zabol

393

Questionnaire

20.6%

Good

Determinants of exposure to CHE: education status of household head (−)—pharmaceutical expenses

28

Rezapour et al. (2016)

Cross-sectional study

Article—Persian

2013

Tehran

625

Questionnaire

–

Medium

Determinants of exposure to CHE: education status of household head (−)—health insurance—members over 60 years (+)—inpatient service—informal payment (+)—number of use of health services

  

29

Fattahi et al. (2015)

Cross-sectional study–case study

Article—Persian

2012–2013

Hossein Abad district of Uremia

300

Questionnaire

–

Medium

Determinants of exposure to CHE: wealth index(−)—gender of household head (male) (−)—household size (+)—members under 12 years (+)—employment situation of household head—number of use of inpatient services—health insurance—supplemental insurance

  

30

Nouraei-Motlagh S (2017)

Descriptive-analytical–retrospective study

Article—Persian

2012

Deprived states of Iran

22,057

Secondary data

6.25%

Medium

Determinants of exposure to CHE: expenditure deciles (+)—use of dentistry services, inpatient service—member over 65 years (+)—employment situation of household head—education status of household head (−)—health insurance—equivalent household size (−)—gender of the head of household (female) (+)—living in the urban (−)

31

Abolhallaje et al. (2013)

Analytical study

Article—English

2002–2005–2008

Iran

–

Secondary data

–

Medium

Determinants of exposure to CHE: employment situation of the head of household—education of the head—gender of the head of household—age of the head—number of the members of household—number of the members over 60—number of kids below 12—number of the employed persons in household—health insurance—large/small housing

32

Davari et al. (2015)

Retrospective cross sectional study

Article—English

2004 and 2011

Chaharmahal and Bakhtiary

715 (2004)

1001(2011)

Secondary data

2004

3.4% (rural)

1.7% (urban)

2011

0% (rural)

1.7% (urban)

Medium

Determinants of exposure to CHE

 

33

Homaie-Rad et al. (2017)

Before-and-after analysis

Article - English

2013 [before the reform] and 2015 [after the reform]

Guilan

1217 (2013)

1205 (2015)

Secondary data

5.75% (2013)

3.82% (2015)

Good

Determinants of exposure to CHE

34

Homaie-Rad et al. (2016)

Cross -sectional study

Article—English

2012

Iran retirees

6307

Secondary data

0.6%

Medium

Determinants of exposure to CHE

35

Khadivi et al. (2016)

Descriptive-analytical study

Article—Persian

2013

Construction workers in Isfahan

400

Questionnaire

4.75%

Medium

Determinants of exposure to CHE

36

Yazdi-Feyzabadi et al. (2017)

Retrospective study

Article—Persian

2008–2014

Iranian provinces

Not reported

Secondary data

2.7%

weak

Determinants of exposure to CHE

37

Ghafoori et al. (2014)

Descriptive–analytic study

Article—English

2012

22 districts of Tehran

784

Questionnaire

7.2%

Medium

Determinants of exposure to CHE

38

Ahmadnezhad et al. (2019)

Cross-sectional survey

Article—English

2013–2016

Iranian households

Not report

Secondary data

3.76% (2013) 3.82% (2016)

Good

Determinants of exposure to CHE: health transformation plan

39

Yazdi-Feyzabadi et al. (2019)

Cross-sectional survey

Article—English

2011–2017

Iranian households

Total: 76,300

38,434 (2011) 37,866 (2017)

Secondary data

1.99% (2011) 3.46% (2017)

Good

Determinants of exposure to CHE: health transformation plan had no considerable success in financial protection, requiring a review in actions to support pro-poor adaptation strategies

40

Yazdi-Feyzabadi et al. (2018)

Descriptive study

Article—English

2008–2015

Iranian households

Total: 77,156

39,008 (2008) 38,148 (2015)

Questionnaire

2.57% (2008) 3.25% (2015)

Good

Determinants of exposure to CHE: health insurance