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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