Gender-based Inequalities in Health literacy among an Iranian Kurd Population: Results of a Community Survey

Gender-based Inequalities in Health literacy among an Iranian Kurd Population: Results of a Community Survey | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Gender-based Inequalities in Health literacy among an Iranian Kurd Population: Results of a Community Survey Hassan Mahmoodi, Rahmatollah Moradzadeh, Abedin Iranpour, Fatemeh Shahi, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-60909/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Health literacy, as a social determinant of health, has a decisive role in providing different populations with healthcare services in an equal manner. Our aim in this study was to investigate the contribution of socio-demographic factors to functional health literacy (FHL) in a population of Iranian adults and identify differences in the contribution of these factors across genders. Methods This community-based cross-sectional study was conducted in 2015 to 2016 in Sanandaj, Iran. Multistage cluster sampling was employed to recruit 1000 people older than 18 (response rate = 89.2%) from 35 urban and 10 rural health care centers. Test of functional health literacy in adults (TOFHLA) was used to assess FHL. In order to measure inequality in FHL, concentration index decomposition was used. Results In total, 869 respondents (response rate: 86.9%) with a mean age (standard deviation; SD) of 33.68 (13.0) completed TOFHLA questionnaire. More than half of participants were women (57.5%). Participants demonstrated an average TOFHLA score of 51.9. Women demonstrated slightly higher TOFHLA scores (52.2 [SD: 0.46]) compared to men (50.7 [SD: 0.4]). However, the concentration index for gender was 10.9% suggesting gender contributed only moderately to TOFHLA scores. Comparatively, 54.3% of TOFHLA differences were attributed to geographic location. Among women, place of residence, monthly income, age, education level and being head of household contributed to 43%, 32%, 13%, 11.5% and 11% of FHL inequality, respectively. Among men, however, place of residence (45.2%), size of household (15.1%) and monthly income (13.5%) contributed most to inequality in FHL. Conclusions Although gender was not the strongest contributing factor for FHL inequalities, poor FHL was mostly concentrated among men. Different factors were attributed to FHL inequality by gender, as discussed inside. Understanding these differences may assist in identifying and targeting interventions towards men and women with low levels of FHL. Our findings shed light the critical role of social determinants of health (SDH) in promoting the health literacy of populations, particularly in developing countries like Iran. Health Policy Health Economics & Outcomes Research Health literacy Gender inequality concentration index Figures Figure 1 Background Health literacy (HL) is defined as the personal characteristics and social resources needed for individuals and communities to access, understand, appraise and take decisions in everyday life concerning healthcare, disease prevention and health promotion to maintain or improve quality of life during the life course [ 1 , 2 ]. HL has been considered as a determinant of health in clinical settings, public health, and contemporary society [ 2 ]. Addressing HL barriers has been highlighted as a population level strategy for health promotion [ 3 , 4 ]. Low HL among individuals, patients and the wider community is contributed to poor health outcomes [ 5 , 6 ]. However, addressing HL barriers in the delivery of health information and services has the potential to improve health outcomes for those with poorer HL abilities [ 7 ]. HL is a multidimensional concept that consists of seven dimensions of functional health literacy (FHL), factual and procedural knowledge, awareness, attitude and critical and affective dimensions [ 8 ]. Abilities related to reading, writing and numeracy are essential parts of FHL for effective daily function [ 9 ]. FHL is made up of two parts. The first is ‘numeracy skills’, the ability to understand and act on numerical directions given by the healthcare provider. The second is ‘comprehension’ referring to the ability to read and understand the printed medical information, for example, patient rights and responsibilities written on the insurance or informed consent forms [ 1 ]. In the literature, low HL and health disparities are considered as two significantly intertwined public health challenges [ 10 , 11 ], in a way that a significant overlap is reported in socio-demographic characteristics of those who are at risk for low HL and health disparities [ 10 ]. HL disparities have also been observed between men and women[ 12 , 13 ]. Some population groups demonstrate lower FHL, including older adults, individuals with lower education levels, those living in rural communities and economically disadvantaged individuals [ 13 , 14 ]. In terms of gender, women have demonstrated a higher level of HL than men in understanding medical forms, directions on medication bottles, and written information offered by healthcare providers [ 13 ], and also engagement in preventive health behaviors [ 15 ]. Therefore, gender may be associated with HL [ 16 ]. Previous research suggests higher education level, adequate income and having a consistent place to receive care with significant positive effects on HL among women [ 13 ]. Although in the Middle East and North African (MENA) region countries a number of studies have been carried out to investigate HL measures [ 17 – 20 ], among older adults and patients with chronic diseases [ 18 ], as well as the determination of HL [ 21 ], few studies have previously investigated the contribution of different socio-demographic factors to HL, and the associations between gender and HL in the region. Also, a majority of previous studies has only investigated the associations between socio-demographic characteristics and HL. So, there is lack of efforts in quantifying the differences in HL by the factors like gender, age and place of residence. From 2015 to 2016, a community survey was conducted to investigate the level of FHL and its associated factors in Sanandaj, Iran. In a previously published paper, urban-rural differences in the FHL and its determinants was reported [ 21 ]. Analyzing the data for that paper, a question arose for us that “were there gender inequalities in the FHL in this population?” In this manuscript, we tried to answer to this question through quantifying the disparities within HL by the factors (education, gender, income, age, and place of residence) that are indicative of health disparities. The following questions guided our study: 1) what socio-demographic factors may be contributed to FHL in the population of Sanandaj, Iran? 2) What differences may be in the contribution of these factors across genders? Methods Design and setting As mentioned above, this study was part of a cross sectional study investigating urban–rural differences in HL and its determinants in Iran. A detailed description of the research can be found in the project report [ 21 ]. The study was conducted from September 2015 to March 2016 in healthcare centers (HCCs) in Sanandaj, the center of Kurdistan province, western Iran. Although about 97% of inhabitants are from the Kurd ethnic group- an ancient Iranian ethnicity- with Kurdish language, a majority of the population in the County can understand and speak fluent Persian, the official language of the country. The population under study was the people older than 18 covered by the healthcare system in urban and rural areas of the County. According to the structure of primary healthcare system in Iran, there are health houses in each village and rural health centers which cover 1200 and 7000 inhabitants, respectively. HCCs provide primary and secondary healthcare services in Iran. Similar to the rural health-houses and health centers, the health posts and health centers in urban areas provide their populations with primary healthcare services [ 22 ]. Participants and sampling Multistage cluster sampling was employed to recruit 1000 people older than 18 years from 35 urban and 10 rural HCCs. Assuming a rate of 55% for adequate FHL [ 23 ], and 0.95 confidence level, the sample size was calculated using the formula n = Z 2 PQ/d 2 [ 24 ], where (the prevalence of FHL = 0.55), Q = 0.45 and d = 0.04. In order to consider the design effect variance inflation factor, the sample size was multiplied by 1.5 (n = 892). Finally, anticipating a non-response rate of 10% (Final sample size= Effective sample size / (1- non response rate anticipated), the final sample size was set to ~992 which was rounded to 1000. Based on the health records of population in the HCCs, twenty-three individuals were randomly selected from each center and were then contacted by the healthcare providers of the HCCs via phone call and invited to participate in the study (the response rate = 89.2%). In the case of accepting the invitation, the participants were set an appointment in locales convenient to them. Data collection At the time of appointments, the trained interviewers referred to the locales, and collected data applying TOFHLA (Test of Functional Health Literacy in Adults) questionnaire. Data were collected through face-to-face interviews ensuring participants who may experience difficulties in reading health information and completing questionnaires were still able to participate. This data collection method helped us to ensure participants with diverse HL needs to not be inadvertently excluded. At the beginning of the interview sessions, the interviewers explained to the participants the purpose of the study and their rights as participants, and all those participated in the study signed an informed consent form. Measurements Data were collected applying the following instruments: Socio-demographic Characteristics Form. Participants were asked to report their age, marital status (married/single), educational status, current occupation, the number of family members living in the home, whether they (parent in the household) were the head of household (the main income earner) (Yes/No), having one or more hospitalization in the previous 10 years (Yes/No), having one or more chronic diseases (Yes/No) and monthly household income. TOFHLA We used the Persian version [ 23 ] of the full-length TOFHLA questionnaire to assess the FHL of participants. The TOFHLA consists of two parts; (i) reading comprehension (50-item) in which some questions are asked about preparation for an upper gastrointestinal series, the patient rights and responsibilities section of a medical application form, prescription container labels and discharge instructions, and (ii) numerical ability (17-item) in using actual hospital forms and labeled prescription vials. It tests a patient's ability to comprehend directions for taking medicines, monitoring blood glucose, keeping clinic appointments, and obtaining financial assistance. Patients are presented with cue cards or labeled prescription bottles and asked to respond to oral questions regarding information about the cards or bottles [ 25 ]. Scores for the TOFHLA range from 0 to 100 and are categorized as; 0 to 59 inadequate, 60 to 74 marginal and 75 to 100 adequate FHL [ 26 ]. Data analysis Analyses of descriptive characteristics (mean, standard deviation and frequency) were undertaken by gender. Independent t-tests and chi-square tests were used to identify gender differences in sociodemographic characteristics. Splitting data by gender and adjusting for sociodemographic factors, stepwise backward regression was used to estimate the relationships between socio-demographic variables (as explanatory variables) and TOFHLA scores (as outcome variables). In the regression analysis, we used collinearity diagnostics test to test for multicollinearity, which represented the variance inflation factor (VIF)[ 27 ]. In both the tests for FHL among men and women, the VIF factors were from 1 to 5. We found some multicollinearities, but as the factors did not exceed 10, so we consider them to be acceptable for our further analysis. Concentration index decomposition There are a number of methods used to measure socioeconomic inequalities in health. A common approach, namely the Concentration Index Decomposition (CID), involves comparing two different groups (in this case, men and women) on the basis of an outcome measure (in this case, FHL). Interpretation is based on the rate ratio or the rate difference of the outcome variable between the two groups. When percentiles are used, the ratio or difference often refers to quintiles. Although relatively easy to construct and interpret, the rate ratio and rate difference methods mask the extent of the inequality between the two groups. Alternatively, it is possible to use concentration indices to measure inequality in one variable over the distribution of another [ 28 ]. CID has previously been used to measure socioeconomic-related health inequality in different populations [ 28 , 29 ]. In the present study, a concentration index (CI) was used to assess the inequalities in FHL (as outcome variable) between different socio-demographic groups (age, marital status, educational status, occupation, number of family members, being the head of the household, having a history of hospitalization for at least one time in the previous 10 years, experience of suffering from a chronic disease and monthly income). CI is a way to quantify the socioeconomic inequality of health by taking into account every individual’s level of health and every individual’s rank in the socioeconomic domain [ 30 ]. All analyses were performed using Stata v. 13 (Stata Corp, Texas, USA). Results The data on 869 respondents were included into statistical analysis. Participant characteristics are shown in Table 1 .The mean (± SD) age of participants was 33.68 (± 13.0), ranging from 18 to 98 years. More than half of participants were men (57.3%), and 84.8% of participants had adequate FHL. Nearly two-thirds were married (62%) and 68.6% reported an education level of high school or greater. Table 1 Socio-economic and underlying characteristics of the respondents Variable n (%)/mean (SD) n = 869 Male n (%)/mean (SD) n = 369 Female n (%)/mean (SD) n = 500 p-value Age, yrs. * 33.68 (± 13.0) 33.92(± 13.3) 33.44(± 12.5) 0.60 Size of household * 4.27 (± 2.0) 4.34(± 2.0) 4.18(± 2.0) 0.29 Education level * No formal education 141(16.2) 64(12.9) 76(20.8) < 0.001 Elementary 125(14.3) 80(16.2) 45(12.3) High school 97(11.1) 59(11.9) 36(9.8) Pre-university/diploma 210(24.1) 143(28.9) 67(18.3) University degree 292(33.4) 149(30.1) 142(8.8) Marital Status * Married 528(62.0) 299(61.3) 229 (63.1) 0.59 Unmarried 323(38.0) 189(38.7) 134(36.9) Head of Household * Yes 342(39.6) 305(61.7) 37(10.0) < 0.001 No 521(60.4) 189(38.3) 332(90.0) History of Hospitalization * Yes 209(24.2) 111(22.4) 98(26.8) 0.14 No 653(75.8) 385(77.6) 268(73.2) With chronic disease * Yes 72(8.3) 35(7.1) 37(0.3) 0.11 No 791(91.7) 461(92.9) 330(89.9) Geographic location Rural 489(56.3) 300(60.0) 189(51.2) 0.010 Urban 380(43.7) 200(40.0) 180(48.8) Monthly household income * < 300,000 196(26.3) 93(21.3) 103(33.4) < 0.001 300,000 to 500,000 264(35.5) 147(33.7) 117(38.0) ≥ 500,000 284(38.2) 196(45.0) 88(28.6) TOFHLA score 51.9 (0.43) 50.7 (0.4) 52.23 (0.46) < 0.001 Significant p-values shown in bold, determined by chi-square or t-test as appropriate; *Indicates missing data Using chi-square and t-tests, differences between male and female participants were observed in education level, likelihood of being the ‘head of household’, geographic location and income. Compared to men (mean = 50.7 ± 0.4), women (mean = 52.23 ± 0.46) demonstrated a greater level of TOFHLA score (p < 0.001). All sociodemographic variables displayed in Table 1 were included in a regression model to determine associations with TOFHLA scores. Using a Backward Stepwise Regression approach, variables demonstrating a p-value > 0.2 were removed, leaving the final model displayed in Table 2. As presented in Table 2, older age (β -0.17 [95%CI (-0.21- -0.13]), being the head of household (β 3.62 [95%CI (3.44 - 3.89]), rural location (β 1.80 [95%CI 1.67-1.93]) and lower monthly income (β 2.11 [95%CI 1.99-2.23]) were associated with lower levels of FHL in women. Similarly, rural location (β 2.21 [95%CI 2.12-2.34]) and lower monthly income (β 2.22 [95%CI 2.13-2.34]) were also associated with lower FHL in men. Greater size of household (β -0.93 [95%CI -0.99- -0.86]) and having ≥1 chronic condition (β -3.56 [95%CI -3.71- -3.45]) were associated with lower TOFHLA score in men, but not women. Table 2: Factors associated with TOFHLA score among male and female participants Female * Male ** Variable Name β Coefficient (95% Confidence Interval) P-value β Coefficient (95% Confidence Interval) P-value Age -0.17 (-0.21- - 0.13) <0.001 -0.07 (-0.11-0.03) 0.12 Size of household - - -0.93 ( -0.99- -0.86 ) <0.001 Marital Status - - 2.20 (2.03-2.41) 0.10 Head of Household 3.62 (3.44 - 3.89) 0.04 - - Previous hospitalization - - 1.84 (1.67-1.99) 0.08 ≥1 chronic condition - - -3.56 ( -3.71- -3.45 ) 0.04 Geographic location 1.80 ( 1.67-1.93 ) <0.001 2.21 ( 2.12-2.34 ) <0.001 Monthly income 2.11 ( 1.99-2.23 ) <0.001 2.22 ( 2.13-2.34 ) 0.2 and were not included in the final regression model. As illustrated in Figure 1, part A (x-axis shows cumulative percentage of FHL and y-axis shows the cumulative population proportion), the majority of higher scores for FHL is placed under the line of equality, showing that the higher levels of HL are more prevalent among women. The decomposition of inequality in HL is presented in Table 3. In the total population, 54.3% of FHL inequality was attributed to geographic location. The contribution of gender, age, size of household, and being head of household were 10.9%, 11%, 12.5%, and 16.7%, respectively. Table 3: Decomposing Inequalities in Health literacy among an Iranian Kurd Population Variable Name Elasticity Concentration Index Contribution Contribution (%) Age -.21415972 -.0193148 .00413645 11 Gender .02251563 .17169435 .00386581 10.9 Size of household -.18215007 -.02432816 .00443138 12.5 Education level .06474684 .0306539 .00198474 5.6 Marital Status .06279967 .00194113 .0001219 .003 Head of Household .07288442 .08115433 .00591489 16.7 History of Hospitalization .066603 .00122529 .00008161 .02 With chronic disease -.24917026 -.00112544 .00028043 .07 Geographic location .22309934 .08626815 .01924637 54.3 Monthly household income .2686311 -.01285406 -.003453 -9.7 The gender-based differences in the decomposition of FHL inequality are shown in Table 4. Among women, age, education level, head of household, place of residence and monthly income contributed to 32%, 11.5%, 11%, 43% and 13% of FHL inequality, respectively. Also, the greatest contributing factors to the inequality were age and place of residence. Among men, however, size of household (15.1%), place of residence (45.2%) and monthly income (13.5%) were attributable to FHL inequality, and the greatest inequality was attributed to place of residence. Table 4: Decomposing Inequalities in Functional Health literacy by gender among an Iranian Kurd Population Female Male Variable Name Elasticity Concentration Index Contribution Contribution (%) Elasticity Concentration Index Contribution Contribution (%) Age -.32365022 -.05985552 .01937225 32.8 -.15835058 -.01549298 .00245332 03.6 Size of household -.09323548 -.00618405 .00057657 00.97 -.2338878 -.04313318 .01008832 15.1 Education level .07010873 .09677956 .00678509 11.5 .04968551 .05083235 .00252563 03.7 Marital Status .00213926 .0359609 .00007693 00.13 .36652046 -.00389641 -.00142812 -02.1 Head of Household .37896595 .01724928 .00653689 11 -.22164007 -.0049915 .00110632 01.6 History of Hospitalization .01893105 .0042644 .00008073 00.13 .19502218 .0091931 .00179286 02.6 With chronic disease -.06145641 .01359243 -.00083534 -01.41 -.4246012 .00092304 -.00039192 -0.005 Geographic location .20995173 .12307978 .02584081 43.8 .23915177 .12575373 .03007423 45.2 Monthly income .24672997 .03245904 .00800862 13.5 .29861645 .03680047 .01098923 16.5 Figure 1, parts B and C illustrate gender inequality in FHL among urban and rural participants, respectively. As figure 1 shows, the majority of higher scores for FHL is placed under the line of equality, showing that among both urban and rural participants the higher levels of FHL are more prevalent among women. As 54% of inequality in FHL were attributed to the place of geographic location, we chose to perform a further analysis to investigate the decomposition of inequality in FHL by this variable. Table 5 shows the decomposition of FHL by geographic location. For residents of urban areas, a majority of the FHL inequality was attributable to gender (26.9%), marital status (17.7%), head of household (-16.9%) and monthly income (-41.8%). Among rural inhabitants, in contrast, size of household (20.4%), head of household (40.5%) and monthly income (-16.5%) were the greatest contributing factors to FHL inequality. Also, monthly income (in all respondents) and head of household (in rural participants only) contributed to FHL, inversely. Table 5: Decomposing Inequalities in Functional Health literacy by place of residence among an Iranian Kurd Population Urban Rural Variable Name Elasticity Concentration Index Contribution Contribution (%) Elasticity Concentration Index Contribution Contribution (%) Age .14162154 -.02803752 -.00397072 -14.77 -.2780881 -.00575269 .00159975 4.32 Sex .42768268 .1696193 .07254324 26.98 -.01911816 .17136951 -.00327627 - 8.91 Size of household -.05429083 .01142551 -.0006203 -02.31 -.20325079 -.03675944 .00747139 20.45 Education level .2793313 .01345078 .00375722 13.91 .06169862 -.00931566 -.00057476 - 1.51 Marital Status .34785649 .01373948 .00477937 17.72 .01795015 -.02166294 -.00038885 - 1.06 Head of Household -.54058015 .08452889 -.04569464 -16.97 .20350718 .07293269 .01484233 40.52 History of Hospitalization .84622306 .00362503 .00306759 11.46 .04221882 .00041671 .00001759 0.04 With chronic disease -.07650152 -.00212005 .00016219 00.62 -.36227497 -.00655104 .00237328 6.48 Monthly income .81703175 -.01376995 -.01125049 -41.81 .27480418 -.0215846 -.00593154 -16.19 Discussion The aim of this study was to investigate the contribution of sociodemographic characteristics to FHL scores across gender in an Iranian Kurd population. Women in our study demonstrated a higher average in FHL scores than men. However, our results showed that the concentration index for gender (contribution: 10.9%) did not explain the highest variance for inequalities in HL, and instead, geographic location (rural/urban) played the greatest role in contributing to inequality in FHL. Our results showed that to successfully remove disparities in HL, there is a need to improve the HL of men and rural inhabitants by about 11% and 54%, respectively. Among women, place of residence, age, monthly income, education level, and head of household were the factors affecting the FHL inequality. In contrast, among men, place of residence, sizes of household and monthly income were attributable factors to FHL inequality. We, also, found that various sociodemographic factors were contributed differently to FHL depending on geographic location. In accordance with the present results, previous studies have demonstrated greater levels of FHL in women, compared to men [ 12 , 13 ]. However, some studies find either no [ 31 ] or partial [ 10 ] differences in HL by gender. A study of HL in Korean adults suggested that the higher HL in women was associated with a higher level of education and having a consistent place to receive care [ 13 ], which is similar to those found in our study. Although we found geographic location, age and monthly income with greater contribution to FHL, compared to gender, our findings still confirms those reported by Lee et al., who suggested gender differences in HL as an international phenomenon [ 13 ]. Fleary et al., in a previous study emphasized that one general HL intervention for all groups in a society may not take effect [ 10 ]. Therefore, while designing gender-specific HL promotion intervention programs, healthcare providers and health promotion specialists should take into account the most disparate groups within the factors with high contribution to disparities in HL [ 10 ]. In other words, in such gender-specific interventions, there should be a great focus on clear communication criteria particularly for those who inhabited in rural areas, are the head of household, and with lower monthly income and education level. Our study indicated that lower income was associated with poorer FHL. These results are consistent with previous research which established a relationship between low HL and income inequalities [ 3 , 32 ]. Previous studies have also shown that lower income may negatively affect HL and thus increase the risk of poor health outcomes [ 5 ]. Research has demonstrated that disadvantaged social and socioeconomic conditions may not only be contributed to low HL, but HL may also mediate the relationship between social disadvantage and poor health outcomes [ 33 ]. Previous studies showed consistently lower levels of HL among minor ethnicities, compared to other people with the same educational attainment, income, gender and age [ 34 ]. Furthermore, low income and low educational attainment are intertwined [ 35 ]. A lower income can limit educational opportunities and a lower level of education may similarly limit economic opportunities; therefore both are associated with inequality of HL and difficulties in understanding health information. People with lower levels of education/income are more likely to have stressors that make practicing HL difficult [ 36 ]. Thus, health policymakers and stakeholders are suggested to plan for improving health outcomes in disadvantaged groups within the population through clear communication of health information in ways that meet the needs of those with inadequate FHL. Such planning needs deliberate and consistent efforts to weave the best practices of communication into the culture of the community. In the planning process, the policymakers should take into account the continual evaluation of HL promotion practices in terms of effectiveness and efficacy through community surveys. Literature shows associations between lower HL and poorer health outcomes and lower use of healthcare services [ 37 ], as well as misunderstanding discharge instructions or unintentional medication discrepancies [ 38 ]. So, they should also hold the health practitioners and healthcare providers across the healthcare system accountable for the providers’ role in advancing health communication excellence. In the present study, geographic location played the most critical role in contributing to inequality in FHL. For rural inhabitants, head of household and size of household were contributed to the inequality in FHL, and among urban residents, monthly income and gender were mostly attributable to FHL inequality. In the initial paper derived from the project reporting the urban–rural differences in HL and its determinants [ 21 ], we concluded that the differences found in FHL by geographic location may originate from the disparities in the number of family members, educational status, monthly income, and history of contact with the healthcare system between urban and rural areas. Previous research has also demonstrated geographic location as an effective factor on FHL [ 18 ]. Playing the role of a source for many influential factors on FHL, geographic location seems to be a basic social determinant with great influence on HL. This outstanding determinant perpetuates the disparities in many social determinants of health such as income [ 5 ], and the number of family members [ 39 ]. Although family size is still with lack of evidence to be considered as a proxy for poor socioeconomic status, our results in the present study shed light to the associations between gender, education, family size, SES, and HL. Based on the findings, we can assume that parents with poor education status in the MENA region families are not well empowered to take control over their fertility mode, which may result in a higher number of family members. As a result, the SES of the family may be weakened and the provision of opportunities to promote HL become less possible. This presumption may be happened with a more severity in the rural areas located in the remote/agricultural settings- where men mainly work outdoors as either farmers or ranchers with lack of access to both general and HL promotion programs. Such assumptions should be focused with more details in the future studies. Despite such remarkable disparities in HL and its determinants, healthcare services to urban-rural populations in many MENA region countries, like Iran, are still delivered with a lack of attention in equity considerations [ 40 ]. Although some contemporary efforts are made by the Iranian government to promote general literacy within the society, there are still remarkable gender-based disparities in health and wellbeing between the urban and rural inhabitants [ 18 ]. In order to decrease such disparities, promoting the level of internet use through increasing the level of internet accessibility and internet use skills as well as HL education through social and mass media campaigns are recommended. As local mass media (radio and television) in the most of rural areas in MENA region are with a suitable coverage, and considering that the rural inhabitants are with a positive attitude and inclination toward using such media, implementing HL promotion programs and campaigns with a focus on radio and television may be an effective approach to improve gender-specific disparities in the FHL and its associates among the inhabitants. This study presented a novel analysis of HL that indicated the relative contribution of a range of sociodemographic factors to FHL. Moreover, it was the first study to examine gender differences in FHL within a MENA setting. However, the research had some limitations. Considering the cross-sectional design of the study, we are unable to determine causal relationships from the findings. We collected data through face to face interview. Moreover, due to the nature of interview, a risk of underreporting by participants is possible. Finally, the use of a unidimensional HL tool that does not capture the broad range of skills and resources that make up HL also limits the study. Further research is required to investigate the broad range of HL abilities and resources, such as having good social support and relationships with healthcare providers, to develop interventions to engage groups with inadequate FHL in healthcare and health management. Conclusion Although gender was not the strongest contributing factor for FHL inequalities, poor FHL was mostly concentrated among men. Instead, geographic location (rural/urban) played the most remarkable role in contributing to inequality in FHL. As discussed inside, different factors were attributed to FHL inequality by gender, which should be considered while designing strategies aiming at the provision of skills to promote accessibility and application of health information and communication with the healthcare delivery system. Our findings shed light the critical role of social determinants of health (SDH) in promoting the HL of populations, particularly MENA region countries, like Iran. Our findings on the quantified disparities within HL by the determinants seem to be beneficial in informing health policymakers on needs-based resource allocation for reducing HL disparities within the populations. The findings also suggest a reorientation in the delivery of healthcare services with a focus on planning gender-specific and geographical location-based HL promotion programs. Also, health policy makers and health promotion specialists should try to alleviate such inequalities in FHL in disadvantaged groups through clear communication of health information via popular mass media like local radio and television channels. Abbreviations HL Health literacy FHL functional health literacy TOFHLA Test of functional health literacy in adults HCCs health care centers CID Concentration Index Decomposition Declarations Ethics Approval and consent to participate Ethics approval was obtained from the Committee in the Research Affairs of Islamic Azad University-Sanandaj Branch, Iran (Ethics Code: 92/2311241). Consent for publication Not applicable. Availability of data and materials Data and materials are available per request. Competing Interest The authors declare that they have no competing interests. Funding This article was financially supported by Research Committee in Islamic Azad University-Sanandaj Branch, grant number: 93-10-15. The committee, as the funding body, peer-reviewed the protocol, prior to initiation of the study. So, it had no other role in the design of the study; collection, analysis, and interpretation of data; and in writing the manuscript. SMH is supported by a Deakin University Dean’s Research Postdoctoral Fellowship. Authors' contributions HN, HM, and SHS have been the leading authors on this study and have participated in all steps and the writing process. RM, SH, and KK conducted data analysis, helped in data collection and drafting and completing the manuscript. AI, FS, SA and PSS have participated in data collection and manipulation and supported the leading authors in all steps of the writing process. All authors read and approved the final manuscript. Acknowledgments We thank all those who supported us to complete the study. References Baker DW. The meaning and the measure of health literacy. J Gen Intern Med. 2006;21:878–83. Sørensen K, et al. Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health. 2012;12:80. Hosking SM, et al. Health literacy in a population-based sample of Australian women: a cross-sectional profile of the Geelong Osteoporosis Study. BMC Public Health. 2018;18:876. Nutbeam D. Health literacy as a population strategy for health promotion. Japanese Society of Health Education Promotion. 2017;25:210–22. Berkman ND, et al. Health literacy interventions and outcomes: an updated systematic review. Evid Rep Technol Assess (Full Rep). 2011;199:941. Nutbeam D. The evolving concept of health literacy. Soc Sci Med. 2008;67:2072–8. Rowlands G, et al. Health literacy and the social determinants of health: a qualitative model from adult learners. Health Promot Int. 2017;32:130–8. Frisch A-L, et al. Defining and measuring health literacy: how can we profit from other literacy domains? Health Promot Int. 2012;27:117–26. Kobayashi LC, et al. Aging and functional health literacy: a systematic review and meta-analysis. Journals of Gerontology Series B: Psychological Sciences Social Sciences. 2016;71(3):445–57. Fleary SA, Ettienne R. Social disparities in health literacy in the United States. HLRP: Health Literacy Research Practice. 2019;3(1):e47–52. Meyer PA, Yoon PW, Kaufmann RB. Introduction: CDC Health Disparities and Inequalities Report-United States, 2013. MMWR supplements. 2013;62(3):3–5. Clouston SAP, Manganello JA, Richards M. A life course approach to health literacy: the role of gender, educational attainment and lifetime cognitive capability. Age Ageing. 2017;46:493–9. Lee HY, Lee J, Kim NK. Gender differences in health literacy among Korean adults: do women have a higher level of health literacy than men? Am J Men's Health. 2015;9:370–9. Easton P, Entwistle VA, Williams B. How the stigma of low literacy can impair patient-professional spoken interactions and affect health: insights from a qualitative investigation. BMC Health Serv Res. 2013;13:319. Von Wagner C, et al. Functional health literacy and health-promoting behaviour in a national sample of British adults. Journal of Epidemiology Community Health. 2007;61:1086–90. Sun X, et al. Determinants of health literacy and health behavior regarding infectious respiratory diseases: a pathway model. BMC Public Health. 2013;13:261. Al-Jumaili AA, Al-Rekabi MD, Sorofman B. Evaluation of instruments to assess health literacy in Arabic language among Iraqis. Research in Social Administrative Pharmacy. 2015;11(6):803–13. Mahmoodi H, et al., A Systematic Review and Meta-Analysis of Health Literacy in the Iranian Population: Findings and Implications. Shiraz E-Medical Journal, 2019. 20 . Nair SC, et al. Assessing health literacy in the eastern and middle-eastern cultures. BMC Public Health. 2016;16(1):831. Wikkeling-Scott LF, Ajja RJY, Rikard RV. Health literacy research in the Eastern Mediterranean Region: An integrative review. International journal of public health. 2019;64(4):523–33. Golboni F, et al., Urban–rural differences in health literacy and its determinants in Iran: A community-based study . Australian Journal of Rural Health, 2018. 26. Tabrizi JS, Pourasghar F, Nikjoo RG. Status of Iran’s primary health care system in terms of health systems control knobs: a review article. Iranian journal of public health. 2017;46:1156. Tehrani Banihashemi S-A, et al. Health literacy and the influencing factors: a study in five provinces of Iran. Strides in development of medical education. 2007;4(1):1–9. Chow S-C, Wang H, Shao J. Sample size calculations in clinical research . 2007. Parker RM, et al. The test of functional health literacy in adults. J Gen Intern Med. 1995;10:537–41. Marques SRL, Lemos SMA. Health literacy assessment instruments: literature review. Audiol Commun Res [Internet]. 2017;22:e1757. Motulsky H. Intuitive biostatistics: a nonmathematical guide to statistical thinking. USA: Oxford University Press; 2014. O'Donnell O, et al. conindex: Estimation of concentration indices. The Stata journal. 2016;16:112–38. Moradzadeh R, et al. Economic inequalities amongst women with osteoporosis-related fractures: an application of concentration index decomposition. Health promotion perspectives. 2016;6:190–5. Fleurbaey M, Schokkaert E. Unfair inequalities in health and health care. J Health Econ. 2009;28:73–90. Paasche-Orlow MK, Wolf MS. Promoting health literacy research to reduce health disparities. Journal of health communication. 2010;15(S2):34–41. Tang C, et al. Examining income-related inequality in health literacy and health-information seeking among urban population in China. BMC Public Health. 2019;19:221. O'donnell O, et al., Analyzing health equity using household survey data: a guide to techniques and their implementation . 2007. Rikard RV, et al. Examining health literacy disparities in the United States: a third look at the National Assessment of Adult Literacy (NAAL). BMC Public Health. 2016;16:975. Rose PR. Health disparities, diversity, and inclusion . 2017. McCray AT. Promoting health literacy. J Am Med Inform Assoc. 2005;12(2):152–63. Berkman ND, et al. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011;155(2):97–107. Lindquist LA, et al. Relationship of health literacy to intentional and unintentional non-adherence of hospital discharge medications. J Gen Intern Med. 2012;27(2):173–8. Ishikawa H, Kiuchi T. Association of health literacy levels between family members. Frontiers in public health. 2019;7:169. Peabody JW, et al, "Improving the Quality of Care in Developing Countries.” In Disease Control Priorities in Developing Countries, second edition, edited by Jamison D T, Breman J G, Measham A R, Alleyne G, Claeson M, Evans D B, Jha P, Mills A, Musgrove P, editors. 2006, World Bank: Washington, DC. 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Geelong Waterfront Campus","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Sarah","middleName":"","lastName":"Hosking","suffix":""},{"id":1582942,"identity":"6ef53e3e-e8e5-4736-b63a-42b870ba5cb4","order_by":10,"name":"Haidar Nadrian","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+UlEQVRIiWNgGAWjYBACAwbGBgkw6wBjAwNDBZDBzNxAipYzIC2MhLQwMEC1ADFjG4hFQIs5++HGGz/33JHnu3248XPhvNpo/naglh8V23BqsexJbLbsefbMcOa5xGbpmduO5844zNjA2HPmNm6HHUhsk+A5cJhxwxnGBmnebcdyG4BamBnb8Gg5/7BN8s+Bw/ZALc2/eeccy51PUMuNxDZpoC2JQC1t0rwNNbkbCGt52Gwtc+Bw8kygFmueYwdyNwK1HMTrl/PpD2++OXDYtu8M++PbPDV1ufPOHz744EcFbi3o4DCYPEC0eiCoI0XxKBgFo2AUjBAAABNdZlGwitlNAAAAAElFTkSuQmCC","orcid":"https://orcid.org/0000-0003-3129-2475","institution":"Tabriz University of Medical Sciences","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Haidar","middleName":"","lastName":"Nadrian","suffix":""}],"badges":[],"createdAt":"2020-08-17 10:54:50","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-60909/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-60909/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":2028424,"identity":"5379a494-2bfd-4a87-a530-78430982c229","added_by":"auto","created_at":"2020-08-21 16:48:17","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":490094,"visible":true,"origin":"","legend":" The line is exactly 45° show the equity line, and other curve show concentration curve. Part A: Concentration curves of health literacy (y-axis) and cumulative population proportion (x-axis) in Sanandaj. Concentration index = 0.05 (CI 95%: 0.04, 0.06; p-value = 0.001), which means that the higher score for functional health literacy is concentrated among women; Part B: Gender inequality among urban participants; Concentration index = 0.04 (CI 95%: 0.03, 0.04; p-value = 0.044), which means that, in urban inhabitants, the higher score for functional health literacy is concentrated among women; Part C: Gender inequality among rural participants; Concentration index = 0.06 (CI 95%: 0.05, 0.06; p-value = 0.001), which means that, in rural inhabitants, the higher score for functional health literacy is concentrated among women. [CI stands for Concentration Index].","description":"","filename":"Fig1final.jpg","url":"https://assets-eu.researchsquare.com/files/rs-60909/v1/Fig1final.jpg"},{"id":13584361,"identity":"848a2e84-e3f4-4033-bad6-4a52cc2fd5b4","added_by":"auto","created_at":"2021-09-17 04:39:11","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":532919,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-60909/v1/561eab33-ba47-4479-ac66-22eb9bdb176b.pdf"}],"financialInterests":"","formattedTitle":"Gender-based Inequalities in Health literacy among an Iranian Kurd Population: Results of a Community Survey","fulltext":[{"header":"Background","content":" \u003cp\u003eHealth literacy (HL) is defined as the personal characteristics and social resources needed for individuals and communities to access, understand, appraise and take decisions in everyday life concerning healthcare, disease prevention and health promotion to maintain or improve quality of life during the life course [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. HL has been considered as a determinant of health in clinical settings, public health, and contemporary society [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Addressing HL barriers has been highlighted as a population level strategy for health promotion [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Low HL among individuals, patients and the wider community is contributed to poor health outcomes [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. However, addressing HL barriers in the delivery of health information and services has the potential to improve health outcomes for those with poorer HL abilities [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHL is a multidimensional concept that consists of seven dimensions of functional health literacy (FHL), factual and procedural knowledge, awareness, attitude and critical and affective dimensions [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Abilities related to reading, writing and numeracy are essential parts of FHL for effective daily function [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. FHL is made up of two parts. The first is \u0026lsquo;numeracy skills\u0026rsquo;, the ability to understand and act on numerical directions given by the healthcare provider. The second is \u0026lsquo;comprehension\u0026rsquo; referring to the ability to read and understand the printed medical information, for example, patient rights and responsibilities written on the insurance or informed consent forms [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In the literature, low HL and health disparities are considered as two significantly intertwined public health challenges [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], in a way that a significant overlap is reported in socio-demographic characteristics of those who are at risk for low HL and health disparities [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHL disparities have also been observed between men and women[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Some population groups demonstrate lower FHL, including older adults, individuals with lower education levels, those living in rural communities and economically disadvantaged individuals [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. In terms of gender, women have demonstrated a higher level of HL than men in understanding medical forms, directions on medication bottles, and written information offered by healthcare providers [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], and also engagement in preventive health behaviors [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Therefore, gender may be associated with HL [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Previous research suggests higher education level, adequate income and having a consistent place to receive care with significant positive effects on HL among women [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough in the Middle East and North African (MENA) region countries a number of studies have been carried out to investigate HL measures [\u003cspan additionalcitationids=\"CR18 CR19\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], among older adults and patients with chronic diseases [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], as well as the determination of HL [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], few studies have previously investigated the contribution of different socio-demographic factors to HL, and the associations between gender and HL in the region. Also, a majority of previous studies has only investigated the associations between socio-demographic characteristics and HL. So, there is lack of efforts in quantifying the differences in HL by the factors like gender, age and place of residence. From 2015 to 2016, a community survey was conducted to investigate the level of FHL and its associated factors in Sanandaj, Iran. In a previously published paper, urban-rural differences in the FHL and its determinants was reported [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Analyzing the data for that paper, a question arose for us that \u0026ldquo;were there gender inequalities in the FHL in this population?\u0026rdquo; In this manuscript, we tried to answer to this question through quantifying the disparities within HL by the factors (education, gender, income, age, and place of residence) that are indicative of health disparities. The following questions guided our study: 1) what socio-demographic factors may be contributed to FHL in the population of Sanandaj, Iran? 2) What differences may be in the contribution of these factors across genders?\u003c/p\u003e "},{"header":"Methods","content":" \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDesign and setting\u003c/h2\u003e \u003cp\u003eAs mentioned above, this study was part of a cross sectional study investigating urban\u0026ndash;rural differences in HL and its determinants in Iran. A detailed description of the research can be found in the project report [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The study was conducted from September 2015 to March 2016 in healthcare centers (HCCs) in Sanandaj, the center of Kurdistan province, western Iran. Although about 97% of inhabitants are from the Kurd ethnic group- an ancient Iranian ethnicity- with Kurdish language, a majority of the population in the County can understand and speak fluent Persian, the official language of the country. The population under study was the people older than 18 covered by the healthcare system in urban and rural areas of the County. According to the structure of primary healthcare system in Iran, there are health houses in each village and rural health centers which cover 1200 and 7000 inhabitants, respectively. HCCs provide primary and secondary healthcare services in Iran. Similar to the rural health-houses and health centers, the health posts and health centers in urban areas provide their populations with primary healthcare services [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants and sampling\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMultistage cluster sampling was employed to recruit 1000 people older than 18 years from 35 urban and 10 rural HCCs. Assuming a rate of 55% for adequate FHL [\u003ca href=\"#_ENREF_23\"\u003e23\u003c/a\u003e], and 0.95 confidence level, the sample size was calculated using the formula n = Z\u003csup\u003e2\u003c/sup\u003ePQ/d\u003csup\u003e2\u003c/sup\u003e [\u003ca href=\"#_ENREF_24\"\u003e24\u003c/a\u003e], where (the prevalence of FHL = 0.55), Q = 0.45 and d = 0.04. In order to consider the design effect variance inflation factor, the sample size was multiplied by 1.5 (n = 892). Finally, anticipating a non-response rate of 10% (Final sample size= Effective sample size / (1- non response rate anticipated), the final sample size was set to ~992 which was rounded to 1000.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Based on the health records of population in the HCCs, twenty-three individuals were randomly selected from each center and were then contacted by the healthcare providers of the HCCs via phone call and invited to participate in the study (the response rate = 89.2%). In the case of accepting the invitation, the participants were set an appointment in locales convenient to them.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAt the time of appointments, the trained interviewers referred to the locales, and collected data applying TOFHLA (Test of Functional Health Literacy in Adults) questionnaire. Data were collected through face-to-face interviews ensuring participants who may experience difficulties in reading health information and completing questionnaires were still able to participate. This data collection method helped us to ensure participants with diverse HL needs to not be inadvertently excluded. At the beginning of the interview sessions, the interviewers explained to the participants the purpose of the study and their rights as participants, and all those participated in the study signed an informed consent form.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMeasurements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were collected applying the following instruments:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSocio-demographic Characteristics Form.\u003c/strong\u003e Participants were asked to report their age, marital status (married/single), educational status, current occupation, the number of family members living in the home, whether they (parent in the household) were the head of household (the main income earner) (Yes/No), having one or more hospitalization in the previous 10 years (Yes/No), having one or more chronic diseases (Yes/No) and monthly household income.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTOFHLA \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe used the Persian version [\u003ca href=\"#_ENREF_23\"\u003e23\u003c/a\u003e] of the full-length TOFHLA questionnaire to assess the FHL of participants. The TOFHLA consists of two parts; (i) reading comprehension (50-item) in which some questions are asked about preparation for an upper gastrointestinal series, the patient rights and responsibilities section of a medical application form, prescription container labels and discharge instructions, and (ii) numerical ability (17-item) in using actual hospital forms and labeled prescription vials. It tests a patient's ability to comprehend directions for taking medicines, monitoring blood glucose, keeping clinic appointments, and obtaining financial assistance. Patients are presented with cue cards or labeled prescription bottles and asked to respond to oral questions regarding information about the cards or bottles [\u003ca href=\"#_ENREF_25\"\u003e25\u003c/a\u003e]. Scores for the TOFHLA range from 0 to 100 and are categorized as; 0 to 59 inadequate, 60 to 74 marginal and 75 to 100 adequate FHL [\u003ca href=\"#_ENREF_26\"\u003e26\u003c/a\u003e].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Analyses of descriptive characteristics (mean, standard deviation and frequency) were undertaken by gender. Independent t-tests and chi-square tests were used to identify gender differences in sociodemographic characteristics. Splitting data by gender and adjusting for sociodemographic factors, stepwise backward regression was used to estimate the relationships between socio-demographic variables (as explanatory variables) and TOFHLA scores (as outcome variables). In the regression analysis, we used collinearity diagnostics test to test for multicollinearity, which represented the variance inflation factor (VIF)[\u003ca href=\"#_ENREF_27\"\u003e27\u003c/a\u003e]. In both the tests for FHL among men and women, the VIF factors were from 1 to 5. We found some multicollinearities, but as the factors did not exceed 10, so we consider them to be acceptable for our further analysis.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConcentration index decomposition\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThere are a number of methods used to measure socioeconomic inequalities in health. A common approach, namely the Concentration Index Decomposition (CID), involves comparing two different groups (in this case, men and women) on the basis of an outcome measure (in this case, FHL). Interpretation is based on the rate ratio or the rate difference of the outcome variable between the two groups. When percentiles are used, the ratio or difference often refers to quintiles. Although relatively easy to construct and interpret, the rate ratio and rate difference methods mask the extent of the inequality between the two groups. Alternatively, it is possible to use concentration indices to measure inequality in one variable over the distribution of another [\u003ca href=\"#_ENREF_28\"\u003e28\u003c/a\u003e]. CID has previously been used to measure socioeconomic-related health inequality in different populations [\u003ca href=\"#_ENREF_28\"\u003e28\u003c/a\u003e, \u003ca href=\"#_ENREF_29\"\u003e29\u003c/a\u003e]. In the present study, a concentration index (CI) was used to assess the inequalities in FHL (as outcome variable) between different socio-demographic groups (age, marital status, educational status, occupation, number of family members, being the head of the household, having a history of hospitalization for at least one time in the previous 10 years, experience of suffering from a chronic disease and monthly income). CI is a way to quantify the socioeconomic inequality of health by taking into account every individual\u0026rsquo;s level of health and every individual\u0026rsquo;s rank in the socioeconomic domain [\u003ca href=\"#_ENREF_30\"\u003e30\u003c/a\u003e]. All analyses were performed using Stata v. 13 (Stata Corp, Texas, USA).\u003c/p\u003e "},{"header":"Results","content":" \u003cp\u003eThe data on 869 respondents were included into statistical analysis. Participant characteristics are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.The mean (\u0026plusmn;\u0026thinsp;SD) age of participants was 33.68 (\u0026plusmn;\u0026thinsp;13.0), ranging from 18 to 98\u0026nbsp;years. More than half of participants were men (57.3%), and 84.8% of participants had adequate FHL. Nearly two-thirds were married (62%) and 68.6% reported an education level of high school or greater.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocio-economic and underlying characteristics of the respondents\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en (%)/mean (SD)\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;869\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003cp\u003en (%)/mean (SD)\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;369\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003cp\u003en (%)/mean (SD)\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;500\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAge, yrs.\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.68 (\u0026plusmn;\u0026thinsp;13.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.92(\u0026plusmn;\u0026thinsp;13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33.44(\u0026plusmn;\u0026thinsp;12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSize of household\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.27 (\u0026plusmn;\u0026thinsp;2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.34(\u0026plusmn;\u0026thinsp;2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.18(\u0026plusmn;\u0026thinsp;2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eEducation level\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo formal education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e141(16.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e64(12.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e76(20.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eElementary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e125(14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e80(16.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e45(12.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97(11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59(11.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36(9.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePre-university/diploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e210(24.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e143(28.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e67(18.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUniversity degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e292(33.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e149(30.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e142(8.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMarital Status\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e528(62.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e299(61.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e229 (63.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnmarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e323(38.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e189(38.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e134(36.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHead of Household\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e342(39.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e305(61.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e37(10.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e521(60.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e189(38.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e332(90.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHistory of Hospitalization\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e209(24.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e111(22.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e98(26.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e653(75.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e385(77.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e268(73.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eWith chronic disease\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72(8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35(7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e37(0.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e791(91.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e461(92.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e330(89.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGeographic location\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e489(56.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e300(60.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e189(51.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e0.010\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e380(43.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e200(40.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e180(48.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eMonthly household income\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;300,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e196(26.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e93(21.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e103(33.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e300,000 to 500,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e264(35.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e147(33.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e117(38.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;500,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e284(38.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e196(45.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e88(28.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eTOFHLA score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51.9 (0.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50.7 (0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e52.23 (0.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eSignificant p-values shown in bold, determined by chi-square or t-test as appropriate; *Indicates missing data\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eUsing chi-square and t-tests, differences between male and female participants were observed in education level, likelihood of being the \u0026lsquo;head of household\u0026rsquo;, geographic location and income. Compared to men (mean\u0026thinsp;=\u0026thinsp;50.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4), women (mean\u0026thinsp;=\u0026thinsp;52.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.46) demonstrated a greater level of TOFHLA score (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \n\u003cp\u003eAll sociodemographic variables displayed in Table 1 were included in a regression model to determine associations with TOFHLA scores. Using a Backward Stepwise Regression approach, variables demonstrating a p-value \u0026gt; 0.2 were removed, leaving the final model displayed in Table 2. As presented in Table 2, older age (\u0026beta; -0.17 [95%CI (-0.21- -0.13]), being the head of household (\u0026beta; 3.62 [95%CI (3.44 - 3.89]), rural location (\u0026beta; 1.80 [95%CI 1.67-1.93]) and lower monthly income (\u0026beta; 2.11 [95%CI 1.99-2.23]) were associated with lower levels of FHL in women. Similarly, rural location (\u0026beta; 2.21 [95%CI 2.12-2.34]) and lower monthly income (\u0026beta; 2.22 [95%CI 2.13-2.34]) were also associated with lower FHL in men. Greater size of household (\u0026beta; -0.93 [95%CI -0.99- -0.86]) and having \u0026ge;1 chronic condition (\u0026beta; -3.56 [95%CI -3.71- -3.45]) were associated with lower TOFHLA score in men, but not women.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2:\u003c/strong\u003e Factors associated with TOFHLA score among male and female participants\u003c/p\u003e\n\u003ctable style=\"width: 4.8e+2pt;margin-left:-29.25pt;border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:133.9pt;border:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.7pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width:169.85pt;border:solid windowtext 1.0pt;border-left:none;padding:0in 5.4pt 0in 5.4pt;height:11.7pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eFemale\u003csup\u003e*\u003c/sup\u003e\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width:2.5in;border:solid windowtext 1.0pt;border-left:none;padding:0in 5.4pt 0in 5.4pt;height:11.7pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eMale\u003csup\u003e**\u003c/sup\u003e\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:133.9pt;border:solid windowtext 1.0pt;border-top: none;padding:0in 5.4pt 0in 5.4pt;height:11.7pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height:107%;font-family:\"Times New Roman\",serif;'\u003eVariable Name\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:111.35pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.7pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height: 107%;font-family:\"Times New Roman\",serif;'\u003e\u0026beta; Coefficient (95% Confidence Interval)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:58.5pt;border-top:none;border-left:none;border-bottom: solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.7pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height: 107%;font-family:\"Times New Roman\",serif;'\u003eP-value\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:105.75pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.7pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height: 107%;font-family:\"Times New Roman\",serif;'\u003e\u0026beta; Coefficient (95% Confidence Interval)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:74.25pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.7pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height: 107%;font-family:\"Times New Roman\",serif;'\u003eP-value\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133.9pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top: 0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eAge\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111.35pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e-0.17 (-0.21- - 0.13)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u0026lt;0.001\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105.75pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e-0.07 (-0.11-0.03)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74.25pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.12\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133.9pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 12.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eSize of household\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111.35pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e-\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e-\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105.75pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e-0.93 (\u003c/span\u003e\u003cspan style='font-size:16px;font-family: \"Times New Roman\",serif;color:#242021;'\u003e-0.99- -0.86\u003c/span\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74.25pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133.9pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top: 0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eMarital Status\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111.35pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e-\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e-\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105.75pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e2.20 (2.03-2.41)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74.25pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.10\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133.9pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 12.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eHead of Household\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111.35pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e3.62 (3.44 - 3.89)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.04\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105.75pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e-\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74.25pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e-\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133.9pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003ePrevious hospitalization\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111.35pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e-\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e-\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105.75pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e1.84 (1.67-1.99)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74.25pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.08\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133.9pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 12.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u0026ge;1 chronic condition\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111.35pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e-\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e-\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105.75pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e-3.56 (\u003c/span\u003e\u003cspan style='font-size:16px;font-family: \"Times New Roman\",serif;color:#242021;'\u003e-3.71- -3.45\u003c/span\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74.25pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.04\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133.9pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eGeographic location\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111.35pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e1.80 (\u003c/span\u003e\u003cspan style='font-size:16px;font-family: \"Times New Roman\",serif;color:#242021;'\u003e1.67-1.93\u003c/span\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u0026lt;0.001\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105.75pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e2.21 (\u003c/span\u003e\u003cspan style='font-size:16px;font-family: \"Times New Roman\",serif;color:#242021;'\u003e2.12-2.34\u003c/span\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74.25pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133.9pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 12.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top: 0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eMonthly income\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111.35pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e2.11 (\u003c/span\u003e\u003cspan style='font-size:16px;font-family: \"Times New Roman\",serif;color:#242021;'\u003e1.99-2.23\u003c/span\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u0026lt;0.001\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105.75pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e2.22 (\u003c/span\u003e\u003cspan style='font-size:16px;font-family: \"Times New Roman\",serif;color:#242021;'\u003e2.13-2.34\u003c/span\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74.25pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*R-squared: 0.19; **R-squared: 0.20; those that were not reported had P-value \u0026gt; 0.2 and were not included in the final regression model.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; As illustrated in Figure 1, part A (x-axis shows cumulative percentage of FHL and y-axis shows the cumulative population proportion), the majority of higher scores for FHL is placed under the line of equality, showing that the higher levels of HL are more prevalent among women.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; The decomposition of inequality in HL is presented in Table 3. In the total population, 54.3% of FHL inequality was attributed to geographic location.\u0026nbsp; The contribution of gender, age, size of household, and being head of household were 10.9%, 11%, 12.5%, and 16.7%, respectively.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3:\u003c/strong\u003e Decomposing Inequalities in Health literacy among an Iranian Kurd Population\u003c/p\u003e\n\u003ctable style=\"width: 4.9e+2pt;margin-left:-31.75pt;border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:143.05pt;border:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:12.1pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height:107%;font-family:\"Times New Roman\",serif;'\u003eVariable Name\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:68.15pt;border:solid windowtext 1.0pt;border-left: none;padding:0in 5.4pt 0in 5.4pt;height:12.1pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height: 107%;font-family:\"Times New Roman\",serif;'\u003eElasticity\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:86.25pt;border:solid windowtext 1.0pt;border-left: none;padding:0in 5.4pt 0in 5.4pt;height:12.1pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height: 107%;font-family:\"Times New Roman\",serif;'\u003eConcentration Index\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:79.55pt;border:solid windowtext 1.0pt;border-left: none;padding:0in 5.4pt 0in 5.4pt;height:12.1pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height: 107%;font-family:\"Times New Roman\",serif;'\u003eContribution\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108.15pt;border-top: 1pt solid windowtext;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-image: initial;border-left: none;padding: 0in 5.4pt;height: 12.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height: 107%;font-family:\"Times New Roman\",serif;'\u003eContribution (%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 143.05pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top: 0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eAge\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68.15pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e-.21415972\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86.25pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e-.0193148\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79.55pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e.00413645\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108.15pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e11\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 143.05pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top: 0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eGender\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68.15pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e.02251563\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86.25pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e.17169435\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79.55pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e.00386581\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108.15pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e10.9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 143.05pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eSize of household\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68.15pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e-.18215007\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86.25pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e-.02432816\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79.55pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e.00443138\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108.15pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e12.5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 143.05pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top: 0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eEducation level\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68.15pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e.06474684\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86.25pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e.0306539\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79.55pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;.00198474\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108.15pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e5.6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 143.05pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top: 0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eMarital Status\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68.15pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e.06279967\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86.25pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e.00194113\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79.55pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e.0001219\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n 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style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eHead of Household\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68.15pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e.07288442\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86.25pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e.08115433\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79.55pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e.00591489\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108.15pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n 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windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e.066603\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86.25pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e.00122529\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79.55pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e.00008161\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108.15pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e.02\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 143.05pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eWith chronic disease\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68.15pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New 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style='font-family:\"Times New Roman\",serif;'\u003e.00028043\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108.15pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e.07\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 143.05pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eGeographic location\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68.15pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e.22309934\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86.25pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e.08626815\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79.55pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e.01924637\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108.15pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e54.3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 143.05pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top: 0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eMonthly household income\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68.15pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e.2686311\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86.25pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e-.01285406\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79.55pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e-.003453\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108.15pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e-9.7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; The gender-based differences in the decomposition of FHL inequality are shown in Table 4. Among women, age, education level, head of household, place of residence and monthly income contributed to 32%, 11.5%, 11%, 43% and 13% of FHL inequality, respectively. Also, the greatest contributing factors to the inequality were age and place of residence. Among men, however, size of household (15.1%), place of residence (45.2%) and monthly income (13.5%) were attributable to FHL inequality, and the greatest inequality was attributed to place of residence.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4:\u003c/strong\u003e Decomposing Inequalities in Functional Health literacy by gender among an Iranian Kurd Population\u003c/p\u003e\n\u003ctable style=\"width: 5.9e+2pt;border-collapse: collapse !msorm;border:none !msorm;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:97.95pt;border:solid windowtext 1.0pt !msorm;padding:0in 5.4pt 0in 5.4pt !msorm;height:17.95pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width:247.45pt;border:solid windowtext 1.0pt !msorm;border-left:none !msorm;padding:0in 5.4pt 0in 5.4pt !msorm;height:17.95pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eFemale\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 247.15pt;border-top: 1pt solid windowtext;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-image: initial;border-left: none;padding: 0in 5.4pt;height: 17.95pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eMale\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:97.95pt;border:solid windowtext 1.0pt !msorm;border-top: none !msorm;padding:0in 5.4pt 0in 5.4pt !msorm;height:17.95pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;line-height:107%;font-family:\"Times New Roman\",serif;'\u003eVariable Name\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:61.85pt;border-top: none !msorm;border-left:none !msorm;border-bottom:solid windowtext 1.0pt !msorm;border-right:solid windowtext 1.0pt !msorm;padding:0in 5.4pt 0in 5.4pt !msorm;height:17.95pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;line-height: 107%;font-family:\"Times New Roman\",serif;'\u003eElasticity\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:61.85pt;border-top: none !msorm;border-left:none !msorm;border-bottom:solid windowtext 1.0pt !msorm;border-right:solid windowtext 1.0pt !msorm;padding:0in 5.4pt 0in 5.4pt !msorm;height:17.95pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;line-height: 107%;font-family:\"Times New Roman\",serif;'\u003eConcentration Index\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:61.85pt;border-top: none !msorm;border-left:none !msorm;border-bottom:solid windowtext 1.0pt !msorm;border-right:solid windowtext 1.0pt !msorm;padding:0in 5.4pt 0in 5.4pt !msorm;height:17.95pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;line-height: 107%;font-family:\"Times New Roman\",serif;'\u003eContribution\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.95pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;line-height: 107%;font-family:\"Times New Roman\",serif;'\u003eContribution (%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:61.85pt;border-top: none !msorm;border-left:none !msorm;border-bottom:solid windowtext 1.0pt !msorm;border-right:solid windowtext 1.0pt !msorm;padding:0in 5.4pt 0in 5.4pt !msorm;height:17.95pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eElasticity\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:61.85pt;border-top: none !msorm;border-left:none !msorm;border-bottom:solid windowtext 1.0pt !msorm;border-right:solid windowtext 1.0pt !msorm;padding:0in 5.4pt 0in 5.4pt !msorm;height:17.95pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eConcentration Index\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:61.55pt;border-top: none !msorm;border-left:none !msorm;border-bottom:solid windowtext 1.0pt !msorm;border-right:solid windowtext 1.0pt !msorm;padding:0in 5.4pt 0in 5.4pt !msorm;height:17.95pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eContribution\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 17.95pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eContribution (%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 97.95pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 20.2pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top: 0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eAge\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 20.2pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e-.32365022\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 20.2pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e-.05985552\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 20.2pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e.01937225\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 20.2pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e32.8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 20.2pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e-.15835058\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 20.2pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e-.01549298\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.55pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 20.2pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e.00245332\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 20.2pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e03.6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 97.95pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 19.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eSize of 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19.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e.00653689\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 19.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e11\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 19.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e-.22164007\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 19.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e-.0049915\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.55pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 19.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e.00110632\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 19.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e01.6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 97.95pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 20.2pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eHistory of Hospitalization\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 20.2pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e.01893105\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 20.2pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e.0042644\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 20.2pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e.00008073\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 20.2pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e00.13\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 20.2pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e.19502218\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 20.2pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e.0091931\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.55pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 20.2pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e.00179286\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 20.2pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e02.6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 97.95pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 19.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eWith chronic disease\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 19.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e-.06145641\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 19.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e.01359243\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 19.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e-.00083534\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 19.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e-01.41\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 19.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e-.4246012\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 19.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e.00092304\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.55pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 19.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e-.00039192\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 19.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e-0.005\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 97.95pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 20.2pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eGeographic location\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 20.2pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e.20995173\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 20.2pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e.12307978\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 20.2pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e.02584081\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 20.2pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e43.8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 20.2pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e.23915177\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 20.2pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e.12575373\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.55pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 20.2pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e.03007423\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 20.2pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e45.2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 97.95pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 19.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top: 0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eMonthly income\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 19.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e.24672997\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 19.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e.03245904\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 19.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e.00800862\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 19.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e13.5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 19.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e.29861645\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 19.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e.03680047\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.55pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 19.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e.01098923\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.85pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 19.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e16.5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Figure 1, parts B and C illustrate gender inequality in FHL among urban and rural participants, respectively. As figure 1 shows, the majority of higher scores for FHL is placed under the line of equality, showing that among both urban and rural participants the higher levels of FHL are more prevalent among women.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; As 54% of inequality in FHL were attributed to the place of geographic location, we chose to perform a further analysis to investigate the decomposition of inequality in FHL by this variable. Table 5 shows the decomposition of FHL by geographic location. For residents of urban areas, a majority of the FHL inequality was attributable to gender (26.9%), marital status (17.7%), head of household (-16.9%) and monthly income (-41.8%). Among rural inhabitants, in contrast, size of household (20.4%), head of household (40.5%) and monthly income (-16.5%) were the greatest contributing factors to FHL inequality. Also, monthly income (in all respondents) and head of household (in rural participants only) contributed to FHL, inversely.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5:\u003c/strong\u003e Decomposing Inequalities in Functional Health literacy by place of residence among an Iranian Kurd Population\u003c/p\u003e\n\u003ctable style=\"width: 5.9e+2pt;border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:1.25in;border:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.7pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width:242.75pt;border:solid windowtext 1.0pt;border-left:none;padding:0in 5.4pt 0in 5.4pt;height:11.7pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eUrban\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 261pt;border-top: 1pt solid windowtext;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-image: initial;border-left: none;padding: 0in 5.4pt;height: 11.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eRural\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:1.25in;border:solid windowtext 1.0pt;border-top: none;padding:0in 5.4pt 0in 5.4pt;height:11.7pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:107%;font-family:\"Times New Roman\",serif;'\u003eVariable Name\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:58.5pt;border-top:none;border-left:none;border-bottom: solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.7pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height: 107%;font-family:\"Times New Roman\",serif;'\u003eElasticity\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:58.5pt;border-top:none;border-left:none;border-bottom: solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.7pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height: 107%;font-family:\"Times New Roman\",serif;'\u003eConcentration Index\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:58.5pt;border-top:none;border-left:none;border-bottom: solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.7pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height: 107%;font-family:\"Times New Roman\",serif;'\u003eContribution\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67.25pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 11.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height: 107%;font-family:\"Times New Roman\",serif;'\u003eContribution (%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:.75in;border-top:none;border-left:none;border-bottom: solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.7pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eElasticity\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:1.0in;border-top:none;border-left:none;border-bottom: solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.7pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eConcentration Index\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:67.5pt;border-top:none;border-left:none;border-bottom: solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.7pt;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eContribution\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 11.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eContribution (%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 1.25in;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top: 0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eAge\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e.14162154\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e-.02803752\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e-.00397072\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67.25pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e-14.77\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.75in;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e-.2780881\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1in;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e-.00575269\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e.00159975\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;4.32\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 1.25in;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top: 0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eSex\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e.42768268\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e.1696193\u003c/span\u003e\u003c/p\u003e\n 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none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e-.0006203\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67.25pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e-02.31\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd 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13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e-.00038885\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e- 1.06\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 1.25in;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 12.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eHead of Household\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e-.54058015\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e.08452889\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e-.04569464\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67.25pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e-16.97\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.75in;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e.20350718\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1in;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e.07293269\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e.01484233\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e40.52\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 1.25in;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eHistory of Hospitalization\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e.84622306\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e.00362503\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e.00306759\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67.25pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e11.46\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.75in;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e.04221882\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1in;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e.00041671\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e.00001759\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e0.04\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 1.25in;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 12.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eWith chronic disease\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e-.07650152\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e-.00212005\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e.00016219\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67.25pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e00.62\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.75in;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e-.36227497\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1in;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e-.00655104\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e.00237328\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;6.48\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 1.25in;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 12.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top: 0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eMonthly income\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e.81703175\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e-.01376995\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e-.01125049\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67.25pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e-41.81\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.75in;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e.27480418\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1in;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e-.0215846\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e-.00593154\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:center;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e-16.19\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":" \u003cp\u003eThe aim of this study was to investigate the contribution of sociodemographic characteristics to FHL scores across gender in an Iranian Kurd population. Women in our study demonstrated a higher average in FHL scores than men. However, our results showed that the concentration index for gender (contribution: 10.9%) did not explain the highest variance for inequalities in HL, and instead, geographic location (rural/urban) played the greatest role in contributing to inequality in FHL. Our results showed that to successfully remove disparities in HL, there is a need to improve the HL of men and rural inhabitants by about 11% and 54%, respectively. Among women, place of residence, age, monthly income, education level, and head of household were the factors affecting the FHL inequality. In contrast, among men, place of residence, sizes of household and monthly income were attributable factors to FHL inequality. We, also, found that various sociodemographic factors were contributed differently to FHL depending on geographic location.\u003c/p\u003e \u003cp\u003eIn accordance with the present results, previous studies have demonstrated greater levels of FHL in women, compared to men [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. However, some studies find either no [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] or partial [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] differences in HL by gender. A study of HL in Korean adults suggested that the higher HL in women was associated with a higher level of education and having a consistent place to receive care [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], which is similar to those found in our study. Although we found geographic location, age and monthly income with greater contribution to FHL, compared to gender, our findings still confirms those reported by Lee et al., who suggested gender differences in HL as an international phenomenon [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Fleary et al., in a previous study emphasized that one general HL intervention for all groups in a society may not take effect [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Therefore, while designing gender-specific HL promotion intervention programs, healthcare providers and health promotion specialists should take into account the most disparate groups within the factors with high contribution to disparities in HL [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In other words, in such gender-specific interventions, there should be a great focus on clear communication criteria particularly for those who inhabited in rural areas, are the head of household, and with lower monthly income and education level.\u003c/p\u003e \u003cp\u003eOur study indicated that lower income was associated with poorer FHL. These results are consistent with previous research which established a relationship between low HL and income inequalities [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Previous studies have also shown that lower income may negatively affect HL and thus increase the risk of poor health outcomes [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Research has demonstrated that disadvantaged social and socioeconomic conditions may not only be contributed to low HL, but HL may also mediate the relationship between social disadvantage and poor health outcomes [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Previous studies showed consistently lower levels of HL among minor ethnicities, compared to other people with the same educational attainment, income, gender and age [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Furthermore, low income and low educational attainment are intertwined [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. A lower income can limit educational opportunities and a lower level of education may similarly limit economic opportunities; therefore both are associated with inequality of HL and difficulties in understanding health information. People with lower levels of education/income are more likely to have stressors that make practicing HL difficult [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Thus, health policymakers and stakeholders are suggested to plan for improving health outcomes in disadvantaged groups within the population through clear communication of health information in ways that meet the needs of those with inadequate FHL. Such planning needs deliberate and consistent efforts to weave the best practices of communication into the culture of the community. In the planning process, the policymakers should take into account the continual evaluation of HL promotion practices in terms of effectiveness and efficacy through community surveys. Literature shows associations between lower HL and poorer health outcomes and lower use of healthcare services [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e], as well as misunderstanding discharge instructions or unintentional medication discrepancies [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. So, they should also hold the health practitioners and healthcare providers across the healthcare system accountable for the providers\u0026rsquo; role in advancing health communication excellence.\u003c/p\u003e \u003cp\u003eIn the present study, geographic location played the most critical role in contributing to inequality in FHL. For rural inhabitants, head of household and size of household were contributed to the inequality in FHL, and among urban residents, monthly income and gender were mostly attributable to FHL inequality. In the initial paper derived from the project reporting the urban\u0026ndash;rural differences in HL and its determinants [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], we concluded that the differences found in FHL by geographic location may originate from the disparities in the number of family members, educational status, monthly income, and history of contact with the healthcare system between urban and rural areas. Previous research has also demonstrated geographic location as an effective factor on FHL [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Playing the role of a source for many influential factors on FHL, geographic location seems to be a basic social determinant with great influence on HL. This outstanding determinant perpetuates the disparities in many social determinants of health such as income [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], and the number of family members [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Although family size is still with lack of evidence to be considered as a proxy for poor socioeconomic status, our results in the present study shed light to the associations between gender, education, family size, SES, and HL. Based on the findings, we can assume that parents with poor education status in the MENA region families are not well empowered to take control over their fertility mode, which may result in a higher number of family members. As a result, the SES of the family may be weakened and the provision of opportunities to promote HL become less possible. This presumption may be happened with a more severity in the rural areas located in the remote/agricultural settings- where men mainly work outdoors as either farmers or ranchers with lack of access to both general and HL promotion programs. Such assumptions should be focused with more details in the future studies. Despite such remarkable disparities in HL and its determinants, healthcare services to urban-rural populations in many MENA region countries, like Iran, are still delivered with a lack of attention in equity considerations [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Although some contemporary efforts are made by the Iranian government to promote general literacy within the society, there are still remarkable gender-based disparities in health and wellbeing between the urban and rural inhabitants [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In order to decrease such disparities, promoting the level of internet use through increasing the level of internet accessibility and internet use skills as well as HL education through social and mass media campaigns are recommended. As local mass media (radio and television) in the most of rural areas in MENA region are with a suitable coverage, and considering that the rural inhabitants are with a positive attitude and inclination toward using such media, implementing HL promotion programs and campaigns with a focus on radio and television may be an effective approach to improve gender-specific disparities in the FHL and its associates among the inhabitants.\u003c/p\u003e \u003cp\u003eThis study presented a novel analysis of HL that indicated the relative contribution of a range of sociodemographic factors to FHL. Moreover, it was the first study to examine gender differences in FHL within a MENA setting. However, the research had some limitations. Considering the cross-sectional design of the study, we are unable to determine causal relationships from the findings. We collected data through face to face interview. Moreover, due to the nature of interview, a risk of underreporting by participants is possible. Finally, the use of a unidimensional HL tool that does not capture the broad range of skills and resources that make up HL also limits the study. Further research is required to investigate the broad range of HL abilities and resources, such as having good social support and relationships with healthcare providers, to develop interventions to engage groups with inadequate FHL in healthcare and health management.\u003c/p\u003e "},{"header":"Conclusion","content":"\u003cp\u003eAlthough gender was not the strongest contributing factor for FHL inequalities, poor FHL was mostly concentrated among men. Instead, geographic location (rural/urban) played the most remarkable role in contributing to inequality in FHL. As discussed inside, different factors were attributed to FHL inequality by gender, which should be considered while designing strategies aiming at the provision of skills to promote accessibility and application of health information and communication with the healthcare delivery system. Our findings shed light the critical role of social determinants of health (SDH) in promoting the HL of populations, particularly MENA region countries, like Iran. Our findings on the quantified disparities within HL by the determinants seem to be beneficial in informing health policymakers on needs-based resource allocation for reducing HL disparities within the populations. The findings also suggest a reorientation in the delivery of healthcare services with a focus on planning gender-specific and geographical location-based HL promotion programs. Also, health policy makers and health promotion specialists should try to alleviate such inequalities in FHL in disadvantaged groups through clear communication of health information via popular mass media like local radio and television channels.\u003c/p\u003e"},{"header":"Abbreviations","content":" \u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHealth literacy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eFHL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003efunctional health literacy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTOFHLA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTest of functional health literacy in adults\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHCCs\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ehealth care centers\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCID\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eConcentration Index Decomposition\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthics approval was obtained from the Committee in the Research Affairs of Islamic Azad University-Sanandaj Branch, Iran (Ethics Code: 92/2311241).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData and materials are available per request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cbr /\u003e \u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis article was financially supported by Research Committee in Islamic Azad University-Sanandaj Branch, grant number: 93-10-15. The committee, as the funding body, peer-reviewed the protocol, prior to initiation of the study. So, it had no other role in the design of the study; collection, analysis, and interpretation of data; and in writing the manuscript. SMH is supported by a Deakin University Dean\u0026rsquo;s Research Postdoctoral Fellowship.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHN, HM, and SHS have been the leading authors on this study and have participated in all steps and the writing process. RM, SH, and KK conducted data analysis, helped in data collection and drafting and completing the manuscript.\u0026nbsp; AI, FS, SA and PSS have participated in data collection and manipulation and supported the leading authors in all steps of the writing process. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank all those who supported us to complete the study.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e \u003cspan\u003eBaker DW. The meaning and the measure of health literacy. J Gen Intern Med. 2006;21:878\u0026ndash;83.\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eS\u0026oslash;rensen K, et al. Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health. 2012;12:80.\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eHosking SM, et al. Health literacy in a population-based sample of Australian women: a cross-sectional profile of the Geelong Osteoporosis Study. BMC Public Health. 2018;18:876.\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eNutbeam D. 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Ann Intern Med. 2011;155(2):97\u0026ndash;107.\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eLindquist LA, et al. Relationship of health literacy to intentional and unintentional non-adherence of hospital discharge medications. J Gen Intern Med. 2012;27(2):173\u0026ndash;8.\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eIshikawa H, Kiuchi T. Association of health literacy levels between family members. Frontiers in public health. 2019;7:169.\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003ePeabody JW, et al, \u003cem\u003e\"Improving the Quality of Care in Developing Countries.\u0026rdquo; In Disease Control Priorities in Developing Countries, second edition, edited by Jamison D T, Breman J G, Measham A R, Alleyne G, Claeson M, Evans D B, Jha P, Mills A, Musgrove P, editors.\u003c/em\u003e 2006, World Bank: Washington, DC.\u003c/span\u003e \u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Health literacy, Gender, inequality, concentration index","lastPublishedDoi":"10.21203/rs.3.rs-60909/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-60909/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eHealth literacy, as a social determinant of health, has a decisive role in providing different populations with healthcare services in an equal manner. Our aim in this study was to investigate the contribution of socio-demographic factors to functional health literacy (FHL) in a population of Iranian adults and identify differences in the contribution of these factors across genders.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis community-based cross-sectional study was conducted in 2015 to 2016 in Sanandaj, Iran. Multistage cluster sampling was employed to recruit 1000 people older than 18 (response rate\u0026thinsp;=\u0026thinsp;89.2%) from 35 urban and 10 rural health care centers. Test of functional health literacy in adults (TOFHLA) was used to assess FHL. In order to measure inequality in FHL, concentration index decomposition was used.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eIn total, 869 respondents (response rate: 86.9%) with a mean age (standard deviation; SD) of 33.68 (13.0) completed TOFHLA questionnaire. More than half of participants were women (57.5%). Participants demonstrated an average TOFHLA score of 51.9. Women demonstrated slightly higher TOFHLA scores (52.2 [SD: 0.46]) compared to men (50.7 [SD: 0.4]). However, the concentration index for gender was 10.9% suggesting gender contributed only moderately to TOFHLA scores. Comparatively, 54.3% of TOFHLA differences were attributed to geographic location. Among women, place of residence, monthly income, age, education level and being head of household contributed to 43%, 32%, 13%, 11.5% and 11% of FHL inequality, respectively. Among men, however, place of residence (45.2%), size of household (15.1%) and monthly income (13.5%) contributed most to inequality in FHL.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eAlthough gender was not the strongest contributing factor for FHL inequalities, poor FHL was mostly concentrated among men. Different factors were attributed to FHL inequality by gender, as discussed inside. Understanding these differences may assist in identifying and targeting interventions towards men and women with low levels of FHL. Our findings shed light the critical role of social determinants of health (SDH) in promoting the health literacy of populations, particularly in developing countries like Iran.\u003c/p\u003e","manuscriptTitle":"Gender-based Inequalities in Health literacy among an Iranian Kurd Population: Results of a Community Survey","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2020-08-21 16:48:16","doi":"10.21203/rs.3.rs-60909/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f1b4300e-9e12-43d9-b40e-3f6c5eea3a9b","owner":[],"postedDate":"August 21st, 2020","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":340933,"name":"Health Policy"},{"id":340934,"name":"Health Economics \u0026 Outcomes Research"}],"tags":[],"updatedAt":"2020-09-06T15:00:15+00:00","versionOfRecord":[],"versionCreatedAt":"2020-08-21 16:48:16","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-60909","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-60909","identity":"rs-60909","version":["v1"]},"buildId":"rHA-KDH7Qsr4HCuvH75dn","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}