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Broomhead T, England R, Mason S, Sereny M, Taylor S, Tsakos G, Williams D, Baker SR. Using Standardised International Oral Health-Related Datasets in 6 Countries. Int Dent J 2024; 74:647-655. [PMID: 38309993 PMCID: PMC11123530 DOI: 10.1016/j.identj.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/14/2023] [Accepted: 01/02/2024] [Indexed: 02/05/2024] Open
Abstract
INTRODUCTION Oral diseases affect a significant proportion of the world's population, yet international comparisons involving oral health outcomes have often been limited due to differences in the way country-level primary data are collected. In response to this, the World Dental Federation (FDI) Oral Health Observatory project was launched with the goal of collecting and producing standardised international data on oral health across countries. The aim of this descriptive cross-sectional study was to examine associations between self-reported general health and a range of factors (sociodemographics, oral health-related behaviours, oral impacts, clinical variables) using these standardised international datasets. METHODS Dentists within FDI member National Dental Associations who chose to take part in the project were selected using a multistage sampling method. The number of dentists in each cluster was set according to the proportion of the national population living in the area, and 50 patients per dentist were systematically approached to take part. Patients and dentists completed 2 separate questionnaires on a mobile app. Ordinal logistic regression (conducted in December 2022) was used to analyse the linked patient and dentist data from 6 countries: China (n = 2242); Colombia (n = 1029); India (n = 999); Italy (n = 711); Japan (n = 1271); and Lebanon (n = 798). Self-reported general health was the dependent variable, with age, sex, education, self-reported oral health-related behaviours, self-reported oral impacts, and clinical variables acting as the independent variables. RESULTS The results demonstrated a different pattern of associations in the different countries. Better self-reported general health was associated with degree-level education in all 6 countries and with reporting no oral impact and no sensitive teeth in 4 countries. Several country-specific patterns were also found, including the importance of tooth brushing in Colombia, periodontal health in Italy, and differing associations with sugary drinks consumption in India and Japan. CONCLUSIONS These descriptive findings provide a basis for further research and, importantly, for advocacy in identifying patient oral health care needs according to both person-reported and clinical aspects. This can facilitate optimisation of service provision and potentially influence policy and investments.
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Affiliation(s)
- Tom Broomhead
- Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | | | - Stephen Mason
- Haleon Research & Development (formerly GlaxoSmithKine Consumer Healthcare R&D), Weybridge, UK
| | | | - Sean Taylor
- FDI World Dental Federation, Geneva-Cointrin, Switzerland
| | - Georgios Tsakos
- Department of Epidemiology and Public Health, University College London, London, UK
| | - David Williams
- Centre for Dental Public Health and Primary Care, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sarah R Baker
- Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, Sheffield, UK.
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Levinsky M. Can countries shape the association between cumulative adversity and old-age health? Front Public Health 2024; 12:1364868. [PMID: 38813420 PMCID: PMC11133626 DOI: 10.3389/fpubh.2024.1364868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 04/24/2024] [Indexed: 05/31/2024] Open
Abstract
Introduction The present study examined the relationships of Lifetime Cumulative Adversity (LCA) and country inequalities, as well as the interactions between them, with the self-rated health (SRH) in old age. Methods Using data from the Survey of Health, Aging and Retirement in Europe (SHARE), the study regressed self-rated health on Lifetime Cumulative Adversity and country-level inequality indices across European countries in two points in time. The analysis also considered adversity-inequality interactions, controlling for confounders. The sample was comprised of 28,789 adults, aged 50 to 80, from 25 European countries and Israel. Results The findings pointed out that LCA is negatively associated with SRH, but democracy and welfare regimes modify the ill effects of LCA on health. These effects are reduced as the LCA level increases. The effects remained significant over two measurement time-points over three years, showing that life-course trajectories may be shaped by individual accumulated risk exposure to stress, along with inequalities at the society level. Discussion The study provides constructive and important guidance for decreasing the harmful effect of lifetime adversity in old age, by the modification of the country's welfare policies.
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Affiliation(s)
- Michal Levinsky
- The Paul Baerwald School of Social Work and Social Welfare, Hebrew University of Jerusalem, Jerusalem, Israel
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Rødseth SC, Høvik H, Bjertness E, Skudutyte-Rysstad R. Exploring socioeconomic inequality in caries experience in an adult Norwegian population; the HUNT4 Oral Health Study. Community Dent Oral Epidemiol 2024. [PMID: 38566348 DOI: 10.1111/cdoe.12960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 01/12/2024] [Accepted: 03/18/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES To investigate socioeconomic inequality in caries experience in an adult Norwegian population. METHODS This population-based study included 4549 dentate participants aged 25-94 years from the cross-sectional HUNT4 Oral Health Study conducted in Central Norway in 2017-2019. Participants were randomly sampled from the larger HUNT4 Survey and answered questionnaires and underwent clinical and radiographic examinations. Caries experience was measured as numbers of decayed, missing and filled teeth (DMFT index) and socioeconomic position was denoted by education and household income. Negative binomial regression models were used to estimate associations between caries experience and socioeconomic position. RESULTS Lower levels of both education and income were associated with higher caries experience, particularly pronounced for missing teeth. Socioeconomic gradients were observed for all outcomes DMFT, DT, MT and FT (p-value linear trends <.001). Gradients were similar for both income and education and were apparent for all age groups but were most evident in middle-aged and older individuals. High level of education was associated with a 50% lower mean number of missing teeth compared with basic level education, whereas high income was associated with a 24% lower mean number of decayed teeth and a 15% higher mean number of filled teeth than low income. CONCLUSIONS There was a socioeconomic gradient for caries experience in the study population that was present from early adulthood and increased with age. The gradient was particularly pronounced for missing teeth. Findings indicate that inequality was more associated with treatment given than with untreated disease.
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Affiliation(s)
- Siri Christine Rødseth
- Oral Health Centre of Expertise in Eastern Norway, Oslo, Norway
- Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
| | - Hedda Høvik
- Center for Oral Health Services and Research, Mid Norway, Trondheim, Norway
| | - Espen Bjertness
- Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
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Ferreira RC, Souza JGS, Soares ARDS, Vieira RV, Kawachi I. Income- and education-based inequalities of edentulism and dental services utilization in Brazil. Community Dent Oral Epidemiol 2023; 51:829-837. [PMID: 35801281 DOI: 10.1111/cdoe.12771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/05/2022] [Accepted: 06/17/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Tooth loss is a worldwide public health problem affecting mainly socioeconomically disadvantaged groups. Dental services utilization may increase access to preventive actions and conservative treatment, reducing the prevalence of tooth loss. This study evaluated the income- and education-based inequalities in edentulism according to the utilization of dental services among adults and older adults in Brazil. METHODS Data from the National Oral Health Survey (SB Brazil, 2010) of adults (ages 35-44 years, n = 9779) and older adults (ages 65-74 years, n = 7619) were analysed. Socioeconomic indicators (SES) included education and income. The magnitude of inequality in edentulism by education and income levels was estimated by the Relative Index of Inequality (RII) and the Slope Index of Inequality (SII). The changes in the RII and SII according to the utilization of dental services were estimated. Regression models estimated the association between SES and edentulism and whether dental services utilization modified this association. RESULTS Higher edentulism prevalence was observed among those with lower education and income levels. The utilization of dental services changed the education-based inequality index in edentulism for adults, with percentage changes of 17.4% (RII) and 56.8% (SII). For adults with low education (0-4 years of study), the odds of edentulism were 80% (OR 0.2; 95% CI 0.1-0.6) and 90% (OR 0.1; 95% CI 0.01-0.2) lower for those who had used dental services within the preceding year and within 1-2 years compared with those who had used such services within the preceding 3 or more years, respectively. CONCLUSION There was a social gradient in the prevalence of edentulism in adults and older adults, and the education-based inequalities in edentulism were lower among adults reporting utilization of dental services in the preceding year.
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Affiliation(s)
- Raquel Conceição Ferreira
- Department of Community and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - João Gabriel Silva Souza
- Department of Community and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Dental Research Division, Guarulhos University, São Paulo, Brazil
- Dental Science School (Faculdade de Ciências Odontológicas - FCO), Brazil
| | - Anna Rachel Dos Santos Soares
- Department of Community and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Renato Vitor Vieira
- Department of Community and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ichiro Kawachi
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
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Kovács N, Liska O, Idara-Umoren EO, Mahrouseh N, Varga O. Trends in dental care utilisation among the elderly using longitudinal data from 14 European countries: A multilevel analysis. PLoS One 2023; 18:e0286192. [PMID: 37294829 PMCID: PMC10256212 DOI: 10.1371/journal.pone.0286192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 05/11/2023] [Indexed: 06/11/2023] Open
Abstract
BACKGROUND The use of dental care among older people is low compared to other forms of health care, with significant health consequences. However, the evidence on the extent to which countries' welfare systems and socio-economic factors influence the uptake of dental care by older people is limited. This study aimed to describe trends of dental care utilisation, and to compare use of dental care with other types of healthcare services among the elderly, considering different socio-economic factors and welfare systems in European countries. METHODS Multilevel logistic regression analysis was performed using longitudinal data from four waves (between Wave 5 and 8) of the Survey of Health, Ageing and Retirement in Europe database, with a follow-up period of 7 years. The study sample included 20,803 respondents aged 50 years or older from 14 European countries. RESULTS The annual dental care attendance was the highest in Scandinavian countries (85.7%), however, improving trends of dental attendance was recognized in Southern and Bismarckian countries (p<0.001). The difference in use of dental care services between socio-economic groups was expanding over time regarding low- and high-income level and residential area. A more marked difference was observed between social groups in dental care utilisation compared to other forms of care. Income level and unemployed status had significant effect on forgoing dental care due to cost and unavailability. CONCLUSION The observed differences between socioeconomic groups may highlight the health consequences of the different organization and financing of dental care. The elderly population could benefit from adopting policies aiming to reduce the financial barriers to dental care usage, especially in Southern and Eastern European countries.
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Affiliation(s)
- Nóra Kovács
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Orsolya Liska
- Faculty of Dentistry, Clinical Center, University of Debrecen, Debrecen, Hungary
| | | | - Nour Mahrouseh
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Orsolya Varga
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Office for Supported Research Groups, Eötvös Loránd Research Network, Budapest, Hungary
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Pergeline J, Rivière S, Rey S, Fresson J, Rachas A, Tuppin P. Social deprivation and the use of healthcare services over one year by children less than 18 years of age in 2018: A French nationwide observational study. PLoS One 2023; 18:e0285467. [PMID: 37224152 DOI: 10.1371/journal.pone.0285467] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 03/07/2023] [Indexed: 05/26/2023] Open
Abstract
This study aimed to describe the health status of children and how social deprivation affects their use of healthcare services and mortality. Children living in mainland France were selected from the national health data system (SNDS) on their date of birth or birthday in 2018 (< 18 years) and followed for one year. Information included data on healthcare reimbursements, long-term chronic diseases (LTDs) eligible for 100% reimbursement, geographic deprivation index (FDep) by quintile (Q5 most disadvantaged), and individual complementary universal insurance (CMUc) status, granted to households with an annual income below the French poverty level. The number of children who had at least one annual visit or hospital admission was compared using the ratio of geographic deprivation (rQ5/Q1) and CMUc (rCMUc/Not) after gender and age-standardization. Over 13 million children were included; 17.5% had CMUc, with an increase across quintiles (rQ5/Q1 = 3.5) and 4.0% a LTD (rQ5/Q1 = 1.44). The 10 most frequent LTDs (6 psychiatric) were more common as the deprivation increased. Visits to general practitioners (GPs) were similar (≈84%) for each FDep quintile and the density of GPs similar. The density decreased with increasing deprivation for specialists and visits: paediatricians (rQ5/Q1 = 0.46) and psychiatrists (rQ5/Q1 = 0.26). Dentist visits also decreased (rQ5/Q1 = 0.86) and deprived children were more often hospitalised for dental caries (rQ5/Q1 = 2.17, 2.1% vs 0.7%). Emergency department (ED) visits increased with deprivation (rCMUc/Not = 1.35, 30% vs 22%) but 50% of CMUc children lived in a municipality with an ED vs. 25% without. Approximately 9% of children were admitted for a short stay and 4.5% for a stay > 1 night (rQ5/Q1 = 1.44). Psychiatric hospitalization was more frequent for children with CMUc (rCMUc/Not = 3.5, 0.7% vs 0.2%). Higher mortality was observed for deprived children < 18 years (rQ5/Q1 = 1.59). Our results show a lower use of pediatricians, other specialists, and dentists among deprived children that may be due, in part, to an insufficient supply of care in their area of residence. These results have been used to recommend optimization and specifically adapted individual or area-wide policies on the use of healthcare services, their density, and activities.
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Affiliation(s)
- Jeanne Pergeline
- Caisse Nationale de l'assurance Maladie (Cnam), Direction de la Stratégie des études et des Statistiques, Paris, France
| | - Sébastien Rivière
- Caisse Nationale de l'assurance Maladie (Cnam), Direction de la Stratégie des études et des Statistiques, Paris, France
| | - Sylvie Rey
- Direction de la Recherche, des études, de l'évaluation et des Statistiques (Drees), Paris, France
| | - Jeanne Fresson
- Direction de la Recherche, des études, de l'évaluation et des Statistiques (Drees), Paris, France
| | - Antoine Rachas
- Caisse Nationale de l'assurance Maladie (Cnam), Direction de la Stratégie des études et des Statistiques, Paris, France
| | - Philippe Tuppin
- Caisse Nationale de l'assurance Maladie (Cnam), Direction de la Stratégie des études et des Statistiques, Paris, France
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Tsakos G, Watt RG, Guarnizo-Herreño CC. Reflections on oral health inequalities: Theories, pathways and next steps for research priorities. Community Dent Oral Epidemiol 2023; 51:17-27. [PMID: 36744970 DOI: 10.1111/cdoe.12830] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/29/2022] [Accepted: 12/05/2022] [Indexed: 02/07/2023]
Abstract
Health inequalities, including those in oral health, are a critical problem of social injustice worldwide, while the COVID-19 pandemic has magnified previously existing inequalities and created new ones. This commentary offers a summary of the main frameworks used in the literature of oral health inequalities, reviews the evidence and discusses the potential role of different pathways/mechanisms to explain inequalities. Research in this area needs now to move from documenting oral health inequalities, towards explaining them, understanding the complex mechanisms underlying their production and reproduction and looking at interventions to tackle them. In particular, the importance of interdisciplinary theory-driven research, intersectionality frameworks and the use of the best available analytical methodologies including qualitative research is discussed. Further research on understanding the role of structural determinants on creating and shaping inequalities in oral health is needed, such as a focus on political economy analysis. The co-design of interventions to reduce oral health inequalities is an area of priority and can highlight the critical role of context and inform decision-making. The evaluation of such interventions needs to consider their public health impact and employ the wider range of methodological tools available rather than focus entirely on the traditional approach, based primarily on randomized controlled trials. Civil society engagement and various advocacy strategies are also necessary to make progress in the field.
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Affiliation(s)
- Georgios Tsakos
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Richard G Watt
- Department of Epidemiology and Public Health, University College London, London, UK
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Broomhead T, Baker SR. From micro to macro: Structural determinants and oral health. Community Dent Oral Epidemiol 2023; 51:85-88. [PMID: 36749674 DOI: 10.1111/cdoe.12803] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 09/22/2022] [Accepted: 10/11/2022] [Indexed: 02/08/2023]
Abstract
The structural determinants of health include social, economic and political mechanisms which generate social stratification and the socioeconomic positions of individuals within society. Despite their importance, these 'causes of the causes' are still relatively under-studied within oral health research. Yet it is important to assess the effects of these 'upstream' determinants, given that most individuals cannot influence or change them. It is also important to move beyond focusing primarily on downstream determinants and approaches at the individual or household level. This review will offer a brief overview of what is currently known about structural determinants and upstream interventions in relation to oral health. The review starts by briefly summarizing oral health focused studies of structural determinants, including welfare regimes, governance and macroeconomic, social and public policies. Current knowledge on upstream interventions associated with oral health such as community water fluoridation, sugar sweetened beverage taxes and dental payment structures will also be covered. The article will then assess gaps in the research base, including current limitations and barriers-as well as opportunities-in analysing the effects of structural determinants and upstream interventions. The review finishes by suggesting next steps for better understanding and addressing these determinants and interventions-including considerations around theory, data and approaches from other fields such as systems science-with the hope that these can help make contributions to future policy decision making processes.
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Affiliation(s)
- Tom Broomhead
- Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Sarah R Baker
- Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
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The Contribution of Material, Behavioral, Psychological, and Social-Relational Factors to Income-Related Disparities in Cardiovascular Risk Among Older Adults. J Cardiovasc Nurs 2021; 36:E38-E50. [PMID: 36036986 PMCID: PMC8201797 DOI: 10.1097/jcn.0000000000000808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Supplemental digital content is available in the text. Understanding the factors underlying health disparities is vital to developing strategies to improve health equity in old age. Such efforts should be encouraged in Korea.
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Martignon S, Roncalli AG, Alvarez E, Aránguiz V, Feldens CA, Buzalaf MAR. Risk factors for dental caries in Latin American and Caribbean countries. Braz Oral Res 2021; 35:e053. [PMID: 34076077 DOI: 10.1590/1807-3107bor-2021.vol35.0053] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/09/2021] [Indexed: 11/22/2022] Open
Abstract
Identifying the risk factors for dental caries is vital in epidemiology and clinical practices for developing effective preventive strategies, both, at the individual and collective levels. Different causality/determination models have been proposed to understand the development process of dental caries. In the present review, we designed a model inspired by the world-known social determinants models proposed in the 90s and more recently in the 10s, wherein the contextual factors are placed more externally and encompass the individual factors. The contextual factors included those related to the cultural and societal values, as well as the social and health government policies. The individual factors were classified into the following categories: socioeconomic (social class, occupation, income, and education level), demographic characteristics (age, sex, and ethnicity), behavioral factors (non-use of fluoride dentifrice, sugar consumption, poor oral hygiene, and lack of preventive dental care), and biological factors (recent caries experience/active caries lesions, biofilm retentive factors, developmental defects of the enamel, disabilities, saliva amount and quality, cariogenic biofilm). Each of these variables was addressed, while focusing on the current evidence from studies conducted in Latin American and Caribbean countries (LACC). Based on the proposed model, educational aspects were addressed, and individual caries risk assessment and management decisions were proposed; further, implications for public health policies and clinical practice were described. The identification of modifiable risk factors for dental caries should be the basis for multi-strategy actions that consider the diversity of Latin American communities.
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Affiliation(s)
- Stefania Martignon
- Universidad El Bosque, Caries Research Unit, Research Department, Bogotá, Colombia
| | | | - Evelyn Alvarez
- Universidad Científica del Sur, School of Dentistry, Department of Pediatric Dentistry, Lima, Perú
| | - Vicente Aránguiz
- Universidad de los Andes, Faculty of Dentistry, Cariology Unit, Santiago, Chile
| | - Carlos Alberto Feldens
- Universidade Luterana do Brasil, School of Dentistry, Department of Pediatric Dentistry, Canoas, RS, Brazil
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Guarnizo-Herreño CC, Scholes S, Heilmann A, O'Connor R, Fuller E, Shen J, Watt RG, Morris S, Wildman J, Tsakos G. Dental attendance and behavioural pathways to adult oral health inequalities. J Epidemiol Community Health 2021; 75:1063-1069. [PMID: 33893184 DOI: 10.1136/jech-2020-216072] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/22/2021] [Accepted: 04/13/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND While inequalities in oral health are documented, little is known about the extent to which they are attributable to potentially modifiable factors. We examined the role of behavioural and dental attendance pathways in explaining oral health inequalities among adults in England, Wales and Northern Ireland. METHODS Using nationally representative data, we analysed inequalities in self-rated oral health and number of natural teeth. Highest educational attainment, equivalised household income and occupational social class were used to derive a latent socioeconomic position (SEP) variable. Pathways were dental attendance and behaviours (smoking and oral hygiene). We used structural equation modelling to test the hypothesis that SEP influences oral health directly and also indirectly via dental attendance and behavioural pathways. RESULTS Lower SEP was directly associated with fewer natural teeth and worse self-rated oral health (standardised path coefficients, -0.21 (SE=0.01) and -0.10 (SE=0.01), respectively). We also found significant indirect effects via behavioural factors for both outcomes and via dental attendance primarily for self-rated oral health. While the standardised parameters of total effects were similar between the two outcomes, for number of teeth, the estimated effect of SEP was mostly direct while for self-rated oral health, it was almost equally split between direct and indirect effects. CONCLUSION Reducing inequalities in dental attendance and health behaviours is necessary but not sufficient to tackle socioeconomic inequalities in oral health.
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Affiliation(s)
- Carol C Guarnizo-Herreño
- Departamento de Salud Colectiva, Facultad de Odontología, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Shaun Scholes
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Anja Heilmann
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Rhiannon O'Connor
- School of Dental Sciences and Centre for Oral Health Research, Newcastle University, Newcastle upon Tyne, UK
| | | | - Jing Shen
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.,GlaxoSmithKline, Wavre, Belgium (Although Jing Shen works now for GSK, the work associated with the paper was conducted during her time at Newcastle University)
| | - Richard G Watt
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Steve Morris
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - John Wildman
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Georgios Tsakos
- Department of Epidemiology and Public Health, University College London, London, UK
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Åstrøm AN, Lie SA, Özkaya F. Influences of behaviour and attitude on education related inequality in tooth loss: findings from Norway and Sweden over 5 years of follow- up. Acta Odontol Scand 2021; 79:81-88. [PMID: 32584634 DOI: 10.1080/00016357.2020.1785002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Following community dwelling cohorts in Norway and Sweden from 65 to 70 years, this study aimed to answer the following questions; Is there cross country variation in educational inequality in tooth loss between the Norwegian and Swedish cohorts? Does oral health behaviours and attitudinal beliefs play a role in explaining educational inequality in tooth loss across time and cohorts? MATERIAL AND METHODS In 2007 and 2012 Statistics Norway administered mailed questionnaires to all individuals born in 1942 in three counties. The response rate was 58% (n = 4211) in 2007 and 54.5% (n = 3733) in 2012. In Sweden the same questionnaires were sent to the 1942 cohort in two counties. The final response rate in 2007 and 2012 were respectively, 73.1% (n = 6078) and 72.2% (n = 5697). RESULTS In Norway, tooth loss prevalence was 21.8% in 2007 and 23.2% in 2012. Corresponding figures in Sweden were 25.9% and 27.3%. The prevalence of tooth loss was higher among lower than higher educated participants and the gradient was significantly weaker in Sweden than in Norway. Multiple variable analyses adjusting for oral behavioural and attitudinal variables attenuated education related gradients in both cohorts. CONCLUSION Education related inequality in tooth loss was stronger in the Norwegian than in the Swedish cohort across the survey years. Oral behaviours and attitudinal beliefs played a role in explaining the gradients across time. This illustrates a necessity to promote oral health enhancing behaviours and attitudinal beliefs, particularly so in lower educational groups.
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Affiliation(s)
- Anne Nordrehaug Åstrøm
- Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Bergen, Norway
- Oral Health Center of Expertise in Western Norway, Western Norway, Norway
| | - Stein Atle Lie
- Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Ferda Özkaya
- Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Bergen, Norway
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Åstrøm AN, Smith ORF, Sulo G. Early-life course factors and oral health among young Norwegian adults. Community Dent Oral Epidemiol 2020; 49:55-62. [PMID: 32918289 DOI: 10.1111/cdoe.12576] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Using a national sample of young Norwegian adults, we examined whether unpleasant experience with dental care during childhood is associated with tooth loss and oral health-related quality of life in adulthood after accounting for early- and later-life socio-behavioural circumstances and dental avoidance behaviour. METHODS 2433 individuals aged 25-35 years participated in an electronic survey. Oral quality of life was measured using the oral impact of daily performance (OIDP) inventory. Generalized linear models and negative binomial regression models were used to estimate the association of early unpleasant experiences with dental care and tooth loss and OIDP scores. Incidence rate ratio (IRR) and 95% confidence intervals (CI) were used to estimate the relative differences in prevalence of tooth loss and OIDP scores. RESULTS Adjusting for early-life characteristics only, the prevalence of tooth loss was 1.42 (IRR = 1.42, 95% CI: 1.24-1.64) and 1.96 (IRR = 1.96, 95% CI: 1.70-2.26) times higher among individuals who reported unpleasant experiences a few times or several times, than in individuals who did not report unpleasant experiences with dental care in childhood. Adjusting further for educational level, smoking and tooth brushing attenuated the relative differences (IRR = 1.40, 95% CI: 1.22-1.62 and IRR = 1.88, 95% CI: 1.62-2.17, respectively). Lastly, when adjusting for dental avoidance behaviour, the prevalence of tooth loss was 1.29 (IRR = 1.29, 95% CI: 1.11-1.50) and 1.58 (IRR = 1.58, 95% CI: 1.32-1.88) times higher among individuals who reported unpleasant experiences a few times or several times than in those who did not. Corresponding associations of early unpleasant experience with OIDP were (IRR = 1.41 95% CI: 1.22-1.63) and (IRR = 1.69, 95% CI: 1.42-2.01) when adjusting for early-life characteristics, and (IRR = 1.39, 95% CI: 1.20-1.60) and (IRR = 1.51, 95% CI: 1.27-1.80) when adjusting for education, smoking and tooth brushing. When adjusting for dental avoidance behaviour, the association of early unpleasant experience with OIDP became nonsignificant. CONCLUSION Unpleasant dental care experiences during childhood are associated with poor oral health in adulthood, independent of later-life socio-behavioural characteristics including negative dental care seeking. This highlights the importance of tailoring regular contacts with dental healthcare services in childhood to build confidence in children and thus has implications for healthcare policy.
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Affiliation(s)
- Anne Nordrehaug Åstrøm
- Department of Clinical Dentistry, University of Bergen, Bergen, Norway.,Oral Health Centre of Expertise in Western Norway, Bergen, Norway
| | - Otto Robert Frans Smith
- Department of Health Promotion, Norwegian Institute of Public Health, Oslo, Norway.,Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Gerhard Sulo
- Oral Health Centre of Expertise in Western Norway, Bergen, Norway.,Division of Mental and Physical Health, Centre for Disease Burden, Norwegian Institute of Public Health, Oslo, Norway
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Ramji R, Carlson E, Brogårdh-Roth S, Olofsson AN, Kottorp A, Rämgård M. Understanding behavioural changes through community-based participatory research to promote oral health in socially disadvantaged neighbourhoods in Southern Sweden. BMJ Open 2020; 10:e035732. [PMID: 32265249 PMCID: PMC7245372 DOI: 10.1136/bmjopen-2019-035732] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 03/03/2020] [Accepted: 03/18/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Inequalities in oral health have been on the rise globally. In Sweden, these differences exist not between regions, but among subgroups living in vulnerable situations. This study aims at understanding behavioural change after taking part in participatory oral health promotional activity among families living in socially disadvantaged neighbourhoods in Southern Sweden. SETTING The current study involved citizens from a socially disadvantaged neighbourhood in Malmö, together with actors from the academic, public and private sectors. These neighbourhoods were characterised by high rates of unemployment, crime, low education levels and, most importantly, poor health. PARTICIPANTS Families with children aged 7-14 years from the neighbourhood were invited to participate in the health promotional activities by a community representative, known as a health promoter, using snowball sampling. Between 8 and 12 families participated in the multistage focus groups over 6 months. Data were analysed using qualitative content analysis. RESULTS Three main themes emerged from the analysis, providing an understanding of the determinants for behavioural change, including meaningful social interactions, family dynamics and health trajectories. The mothers in the study valued the social aspects of their participation; however, they believed that gaining knowledge in combination with social interaction made their presence also meaningful. Further, the participants recognised the role of family dynamics primarily the interactions within the family, family structure and traditional practices as influencing oral health-related behaviour among children. Participants reported having experienced a change in general health owing to changed behaviour. They started to understand the association between general health and oral health that further motivated them to follow healthier behavioural routines. CONCLUSIONS The results from this study show that oral health promotion through reflection and dialogue with the communities, together with other stakeholders, may have the potential to influence behavioural change and empower participants to be future ambassadors for change.
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Affiliation(s)
- Rathi Ramji
- Department of Care Science, Malmö Universitet, Malmö, Skane, Sweden
| | | | - Susanne Brogårdh-Roth
- Department of Pediatric Dentistry, Faculty of Odontology, Malmö Universitet, Malmö, Skåne, Sweden
| | - Anna Nilvéus Olofsson
- Department of Odontology and Scientific Affairs, TePe Oral Hygiene Products, Malmö, Skåne, Sweden
| | - Anders Kottorp
- Department of Care Science, Malmö Universitet, Malmö, Skane, Sweden
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15
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Silva Junior MF, Sousa MDLRD, Batista MJ. Reducing social inequalities in the oral health of an adult population. Braz Oral Res 2020; 33:e102. [PMID: 31939495 DOI: 10.1590/1807-3107bor-2019.vol33.0102] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 09/01/2019] [Indexed: 11/22/2022] Open
Abstract
The objective of this study was to evaluate the association between social inequality indicators and oral health conditions in an adult population. This prospective cohort study assessed a probabilistic sampling of adults (aged 20-64 years) living in Piracicaba, São Paulo, Brazil. Oral examinations were performed in 2011 and 2015, conducted at home, and used the decay-missing-filled (DMFT) index of permanent teeth, the Community Periodontal Index (CPI), and the visible biofilm criterion. A questionnaire was administered to determine demographic and socioeconomic aspects and dental services used, and collect oral health-related quality of life (OHRQoL) data. Social inequality indicators were evaluated according to social class (high, middle or low) and type of dental service used (public, health insurance or private), and compared with oral health conditions (visible biofilm, DMFT and incidence of tooth loss, periodontal pockets and bleeding, and OHRQoL), evaluated between 2011 and 2015. Analysis using chi-squared or Fisher tests (p < 0.05) and Cochran's Q test was conducted separately for each category analyzed between 2011 and 2015 (p < 0.05). A total of 143 adults who participated in an earlier study were examined after four years of follow-up. Although the occurrence of oral disease did not decrease over the study period (4 years), there was a reduction in inequality among lower social classes in regard to presence of tooth decay and oral health impact on self-perceived quality of life between 2011 and 2015 (p < 0.05). These results suggest that the Brazilian National Oral Health Policy has achieved its principles, especially that of greater equity.
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Affiliation(s)
| | - Maria da Luz Rosário de Sousa
- Universidade Estadual de Campinas - Unicamp, School of Dentistry, Department of Health Sciences and Pediatric Dentistry, Piracicaba, SP Brazil
| | - Marília Jesus Batista
- Universidade Estadual de Campinas - Unicamp, School of Medicine, Department of Community Health, Jundiaí, SP, Brazil
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Bassim CW, MacEntee MI, Nazmul S, Bedard C, Liu S, Ma J, Griffith LE, Raina P. Self‐reported oral health at baseline of the Canadian Longitudinal Study on Aging. Community Dent Oral Epidemiol 2019; 48:72-80. [DOI: 10.1111/cdoe.12506] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 10/09/2019] [Accepted: 10/09/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Carol W. Bassim
- Department of Health Research Methods, Evidence, and Impact McMaster University Hamilton ON Canada
| | | | - Sohel Nazmul
- Department of Health Research Methods, Evidence, and Impact McMaster University Hamilton ON Canada
| | - Chloe Bedard
- Department of Health Research Methods, Evidence, and Impact McMaster University Hamilton ON Canada
| | - Siying Liu
- Department of Health Research Methods, Evidence, and Impact McMaster University Hamilton ON Canada
| | - Jinhui Ma
- Department of Health Research Methods, Evidence, and Impact McMaster University Hamilton ON Canada
| | - Lauren E. Griffith
- Department of Health Research Methods, Evidence, and Impact McMaster University Hamilton ON Canada
| | - Parminder Raina
- Department of Health Research Methods, Evidence, and Impact McMaster University Hamilton ON Canada
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Hach M, Christensen LB, Lange T, Hvidtfeldt UA, Danielsen B, Diderichsen F, Osler M, Prescott E, Andersen I. Social inequality in tooth loss, the mediating role of smoking and alcohol consumption. Community Dent Oral Epidemiol 2019; 47:416-423. [DOI: 10.1111/cdoe.12468] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/18/2019] [Accepted: 04/25/2019] [Indexed: 12/29/2022]
Affiliation(s)
- Maria Hach
- Department of Odontology and School of Oral Health Care, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Lisa B. Christensen
- Department of Odontology, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Theis Lange
- Section of Biostatistics, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
- Statistical Science Peking University Peking China
| | - Ulla A. Hvidtfeldt
- Diet, Genes and Environment Danish Cancer Society Research Center Copenhagen Denmark
| | - Bo Danielsen
- Faculty of Health and Medical Sciences, School of Oral Health Care University of Copenhagen Copenhagen Denmark
| | - Finn Diderichsen
- Department of Public Health University of Copenhagen Copenhagen Denmark
- Oswaldo Cruz Foundation Rio de Janeiro Brazil
| | - Merete Osler
- Center for Clinical Research and Prevention Frederiksberg/Bispebjerg Hospitals Frederiksberg Denmark
- Department of Public Health, Section of Epidemiology, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Eva Prescott
- Department of Cardiology, Bispebjerg/Frederiksberg Hospitals University of Copenhagen Copenhagen Denmark
| | - Ingelise Andersen
- Department of Public Health, Section of Social Medicine, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
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