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Scruggs L, Fox A, Reynolds MM. Is Redistribution Good for Our Health? Examining the Macrocorrelation between Welfare Generosity and Health across EU Nations over the Last 40 Years. JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2024; 49:855-884. [PMID: 38567772 DOI: 10.1215/03616878-11257040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
CONTEXT Social determinants of health are finally getting much-needed policy attention, but their political origins remain underexplored. In this article, the authors advance a theory of political determinants as accruing along three pathways of welfare state effects (redistribution, poverty reduction, and status preservation), and they test these assumptions by examining impacts of policy generosity on life expectancy (LE) over the last 40 years. METHODS The authors merge new and existing welfare policy generosity data from the Comparative Welfare Entitlement Project with data on LE spanning 1980-2018 across 21 countries in the Organization for Economic Cooperation and Development. They then examine relationships between five welfare policy generosity measures and LE using cross-sectional differencing and autoregressive lag models. FINDINGS The authors find consistent and positive effects for total generosity (an existing measure of social insurance generosity) on LE at birth across different model specifications in the magnitude of an increase in LE at birth of 0.10-0.15 years (p < 0.05) as well as for a measure of status preservation (0.11, p < 0.05). They find less consistent support for redistribution and poverty reduction measures. CONCLUSIONS The authors conclude that in addition to generalized effects of policy generosity on health, status-preserving social insurance may be an important, and relatively overlooked, mechanism in increasing LE over time in advanced democracies.
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Affiliation(s)
| | - Ashley Fox
- University at Albany, State University of New York
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2
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Yekkalam N, Storm Mienna C, Stoor JPA, San Sebastian M. Social determinants of self-reported oral health among Sámi in Sweden. Community Dent Oral Epidemiol 2023; 51:1258-1265. [PMID: 37489613 DOI: 10.1111/cdoe.12894] [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: 01/25/2023] [Revised: 04/07/2023] [Accepted: 07/14/2023] [Indexed: 07/26/2023]
Abstract
OBJECTIVES To investigate the prevalence of poor self-reported oral health and to identify socio-demographic, socio-economic and cultural-related risk factors associated with poor oral health among Sámi in Sweden. METHODS A Sámi sample frame was constructed drawing from three pre-existing registers. All identified persons aged 18-84 were invited to participate in the study during February-May 2021. Among the 9249 invitations, 3779 answered the survey. The frequencies of the independent variables in terms of socio-economic, socio-demographic and cultural-related factors as well as the outcome, self-reported oral health, were calculated first. Prevalence ratios (PRs) and their 95% confidence interval (95% CI) were estimated to assess the relationship between the independent variables and the outcome. RESULTS Overall, 32.5% of the participants reported a poor oral health with a higher prevalence among men compared to women. Among the socio-demographic factors, being old (PR: 1.99; 95% CI: 1.59-2.51), unmarried (PR: 1.17; 95% CI: 1.03-1.33) and divorced or widow-er (PR: 1.27; 95% CI: 1.09-1.46) were statistically associated to poor self-reported oral health. Among the socio-economic factors, a low education level (PR: 1.56; 95% CI: 1.29-1.89), belonging to the poorest quintile (PR: 1.63; 95% CI: 1.35-1.96), and experiencing difficulties to make ends meet several times during the last 12 months (PR: 1.74; 95% CI: 1.51-1.99) were statistically significant related to poor oral health. CONCLUSIONS The self-reported oral health among Sámi in Sweden appears to be worse than that of the general Swedish population. Several socio-economic and socio-demographic factors were found to be strongly associated with poor self-reported oral health. Targeted interventions addressing these social determinants are needed to reduce inequalities in oral health among the Sámi population.
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Affiliation(s)
- Negin Yekkalam
- Department of Odontology, Clinical Oral Physiology, Umeå University, Umeå, Sweden
| | - Christina Storm Mienna
- Department of Odontology, Clinical Oral Physiology, Umeå University, Umeå, Sweden
- Várdduo-Centre for Sámi Research, Umeå University, Umeå, Sweden
| | - Jon Petter Anders Stoor
- Department of Epidemiology and Global Health, Lávvuo-Research and Education for Sámi Health, Umeå University, Umeå, Sweden
| | - Miguel San Sebastian
- Department of Epidemiology and Global Health, Lávvuo-Research and Education for Sámi Health, Umeå University, Umeå, Sweden
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3
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Wright FAC, Shu ECC, Cumming RG, Naganathan V, Blyth FM, Hirani V, Le Couteur DG, Handelsman DJ, Seibel MJ, Waite LM, Stanaway FF. Oral health-related quality of life of older Australian men. Community Dent Oral Epidemiol 2023; 51:767-777. [PMID: 35561045 DOI: 10.1111/cdoe.12754] [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: 05/07/2021] [Revised: 02/16/2022] [Accepted: 04/24/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aims of this study were to assess oral health-related quality of life (OHRQoL) in a cohort of older Australian men and explore the association between their general health conditions, socio-demographic factors and OHRQoL. METHODS The Concord Health and Ageing in Men Project (CHAMP) is a cohort study of the health of a representative sample of Australian men, initiated in 2005-2006 with an initial sample of 1705 men 70 years or over. Participants completed a self-administered health and socio-demographic questionnaire and attended an interview and clinical assessment at baseline and each of three follow-up assessments. Information on oral health and responses to the Oral Health Impact Profile (OHIP-14) were collected in the 4th follow-up in which 778 men completed the OHIP-14 questionnaire and 614 men had a dental assessment. The prevalence of oral health impact was defined as a response of fairly often or very often to one or more of the OHIP-14 questions. Mean OHIP-14 scores were calculated for the 14 questions and used as the dependent variable in the regression analyses. Zero-inflated Poisson regression was used to estimate prevalence rate ratios (PRR). RESULTS Only 10% of men presented oral health impacts. In multivariate regression modelling, being born in Italy/Greece (PRR: 2.16, 95% CI: 1.93-2.42) or in other countries (PRR: 2.12, 95% CI: 1.89-2.38), having poor self-rated general health (PRR: 1.38, 95% CI: 1.24-1.53), having poor mental wellbeing (PRR: 1.14, 95% CI: 1.04-1.24), having ≥6 depressive symptoms (PRR: 1.18, 95% CI: 1.05-1.32), being a current smoker (PRR: 1.34, 95% CI: 1.06-1.70) and having more decayed tooth surfaces (PRR:1.01, 95% CI: 1.00-1.02) were associated with higher impact scores. CONCLUSIONS Overall, older Australian men exhibit good oral health-related quality of life. The inter-relationship between perceptions of general health and well-being, health and oral health variables and social background supports policy objectives of closer integration of general health and oral health services for older Australian men.
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Affiliation(s)
- Fredrick Alan Clive Wright
- Centre for Education and Research on Ageing, Concord Clinical School the University of Sydney and Sydney Local Health District, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Ellie C-C Shu
- Centre for Education and Research on Ageing, Concord Clinical School the University of Sydney and Sydney Local Health District, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Robert G Cumming
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Vasi Naganathan
- Centre for Education and Research on Ageing, Concord Clinical School the University of Sydney and Sydney Local Health District, Concord Repatriation General Hospital, Concord, New South Wales, Australia
- Department of Geriatric Medicine, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Fiona M Blyth
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Vasant Hirani
- School of Life and Environmental Sciences, Charles Perkins Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - David G Le Couteur
- Centre for Education and Research on Ageing, Concord Clinical School the University of Sydney and Sydney Local Health District, Concord Repatriation General Hospital, Concord, New South Wales, Australia
- Department of Geriatric Medicine, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - David J Handelsman
- ANZAC Research Institute, Concord Repatriation General Hospital, University of Sydney, Concord, New South Wales, Australia
| | - Markus J Seibel
- Concord Clinical School, University of Sydney and Sydney Local Health District, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Louise M Waite
- Centre for Education and Research on Ageing, Concord Clinical School the University of Sydney and Sydney Local Health District, Concord Repatriation General Hospital, Concord, New South Wales, Australia
- Department of Geriatric Medicine, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Fiona F Stanaway
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
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Nguyen TM, Bridge G, Hall M, Theodore K, Lin C, Scully B, Heredia R, Le LKD, Mihalopoulos C, Calache H. Is value-based healthcare a strategy to achieve universal health coverage that includes oral health? An Australian case study. J Public Health Policy 2023; 44:310-324. [PMID: 37142745 PMCID: PMC10232653 DOI: 10.1057/s41271-023-00414-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2023] [Indexed: 05/06/2023]
Abstract
The 2021 Resolution on Oral Health by the 74th World Health Assembly supports an important health policy direction: inclusion of oral health in universal health coverage. Many healthcare systems worldwide have not yet addressed oral diseases effectively. The adoption of value-based healthcare (VBHC) reorients health services towards outcomes. Evidence indicates that VBHC initiatives are improving health outcomes, client experiences of healthcare, and reducing costs to healthcare systems. No comprehensive VBHC approach has been applied to the oral health context. Dental Health Services Victoria (DHSV), an Australian state government entity, commenced a VBHC agenda in 2016 and is continuing its efforts in oral healthcare reform. This paper explores a VBHC case study showing promise for achieving universal health coverage that includes oral health. DHSV applied the VBHC due to its flexibility in scope, consideration of a health workforce with a mix of skills, and alternative funding models other than fee-for-service.
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Affiliation(s)
- Tan M Nguyen
- Deakin Health Economics, Deakin University, Level 3, Building BC, 221 Burwood Highway, Burwood, Melbourne, VIC, 3125, Australia.
- Dental Health Services Victoria, Level 1, Corporate Services, 720 Swanston Street, Carlton, Melbourne, VIC, 3053, Australia.
- Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
| | - Gemma Bridge
- Queen Mary University of London, Mile End Road, London, E1 4NS, UK
| | - Martin Hall
- Dental Health Services Victoria, Level 1, Corporate Services, 720 Swanston Street, Carlton, Melbourne, VIC, 3053, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Katy Theodore
- Deakin Health Economics, Deakin University, Level 3, Building BC, 221 Burwood Highway, Burwood, Melbourne, VIC, 3125, Australia
| | - Clare Lin
- Dental Health Services Victoria, Level 1, Corporate Services, 720 Swanston Street, Carlton, Melbourne, VIC, 3053, Australia
- Melbourne Dental School, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Ben Scully
- Dental Health Services Victoria, Level 1, Corporate Services, 720 Swanston Street, Carlton, Melbourne, VIC, 3053, Australia
| | - Ruth Heredia
- Dental Health Services Victoria, Level 1, Corporate Services, 720 Swanston Street, Carlton, Melbourne, VIC, 3053, Australia
| | - Long K-D Le
- Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Cathrine Mihalopoulos
- Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Hanny Calache
- Deakin Health Economics, Deakin University, Level 3, Building BC, 221 Burwood Highway, Burwood, Melbourne, VIC, 3125, Australia
- La Trobe University, Bendigo, VIC, 3552, Australia
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Hong CL, Thomson WM, Broadbent JM. Oral Health-Related Quality of Life from Young Adulthood to Mid-Life. Healthcare (Basel) 2023; 11:515. [PMID: 36833050 PMCID: PMC9957151 DOI: 10.3390/healthcare11040515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/27/2023] [Accepted: 02/02/2023] [Indexed: 02/12/2023] Open
Abstract
Quality of life varies with time, often worsening, and is affected by circumstances, events, and exposures at different stages of life. Little is known about how oral health-related quality of life (OHRQoL) changes during middle age. We investigated OHRQoL changes from age 32 to 45 years among participants in a population-based birth cohort, along with clinical and socio-behavioural associations. Generalised estimating equation models were used to investigate the association between OHRQoL (assessed at ages 32, 38, and 45 years; n = 844), and the socioeconomic position in childhood (up to age 15 years) and adulthood (ages 26 through to 45 years), dental self-care (dental services utilisation and tooth brushing), oral conditions (such as tooth loss), and experiencing a dry mouth. The multivariable analyses were controlled for sex and personality traits. At each stage of life, those of a lower socioeconomic status were at greater risk of experiencing OHRQoL impacts. Those who engaged in favourable dental self-care habits (the regular use of dental services and at least twice daily tooth brushing) experienced fewer impacts. A social disadvantage at any stage of life has enduring deleterious effects on one's quality of life in middle age. Ensuring access to timely and appropriate dental health services in adulthood may reduce the impacts of oral conditions on one's quality of life.
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Affiliation(s)
| | | | - Jonathan M. Broadbent
- Department of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin 9016, New Zealand
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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: 15] [Impact Index Per Article: 15.0] [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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Hajek A, König HH, Kretzler B, Zwar L, Lieske B, Seedorf U, Walther C, Aarabi G. Does Oral Health-Related Quality of Life Differ by Income Group? Findings from a Nationally Representative Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10826. [PMID: 36078541 PMCID: PMC9518370 DOI: 10.3390/ijerph191710826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/24/2022] [Accepted: 08/28/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Clarify the association between income group and oral health-related quality of life. METHODS Data were used from a nationally representative online survey with n = 3075 individuals. It was conducted in late Summer 2021. The established Oral Health Impact Profile (OHIP-G5) was used to measure oral health-related quality of life. The income group (household net income) was used as key independent variable. It was adjusted for several covariates. Full-information maximum likelihood was used to address missing values. RESULTS Individuals in the lowest income decile had a lower oral health-related quality of life (Cohen's d = -0.34) compared to individuals in the second to ninth income deciles. Individuals in the highest income decile had a higher oral health-related quality of life (Cohen's d = 0.20) compared to individuals in the second to ninth income deciles. Consequently, there was a medium difference (Cohen's d = 0.53) between individuals in the lowest income decile and individuals in the highest income decile. Additionally, multiple linear regressions showed significant differences between individuals in the lowest income decile and individuals in the second to ninth income deciles (β = 0.72, p < 0.01). In contrast, only marginal significant differences were identified between individuals in the second to ninth income deciles and individuals in the highest income decile (β = -0.28, p < 0.10). CONCLUSIONS The current study particularly stressed the association between low income and low oral health-related quality of life in the general adult population. Increasing oral health-related quality of life in individuals with low income is a major issue which should be targeted.
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Affiliation(s)
- André Hajek
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, 20246 Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, 20246 Hamburg, Germany
| | - Benedikt Kretzler
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, 20246 Hamburg, Germany
| | - Larissa Zwar
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, 20246 Hamburg, Germany
| | - Berit Lieske
- Department of Periodontics, Preventive and Restorative Dentistry, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Udo Seedorf
- Department of Periodontics, Preventive and Restorative Dentistry, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Carolin Walther
- Department of Periodontics, Preventive and Restorative Dentistry, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Ghazal Aarabi
- Department of Periodontics, Preventive and Restorative Dentistry, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
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Chari M, Ravaghi V, Sabbah W, Gomaa N, Singhal S, Quiñonez C. Comparing the magnitude of oral health inequality over time in Canada and the United States. J Public Health Dent 2021; 82:453-460. [PMID: 34821390 PMCID: PMC10078632 DOI: 10.1111/jphd.12486] [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] [Received: 04/15/2021] [Revised: 09/24/2021] [Accepted: 11/02/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To assess the magnitude of, and changes in, absolute and relative oral health inequality in Canada and the United States, from the 1970s till the first decade of the new millennium. METHODS Data were obtained from four national surveys; two Canadian (NCNS 1970-1972 and CHMS 2007-2009) and two American (HANES 1971-1974 and NHANES 2007-2008). The slope and relative index of inequality were used to measure absolute and relative inequality, respectively. Percentage change in inequality was also calculated. RESULTS Relative inequality for untreated decay increased by 91% in Canada and 189% in the United States, while for filled teeth it declined by 63% in Canada and 16% in the United States. Relative inequality in edentulism rose by 200% and 78% in Canada and United States, respectively. Absolute inequality declined in both countries. CONCLUSIONS There was persistent absolute and relative inequality in Canada and the United States. An increase in relative inequality for adverse outcomes suggests that improvements in oral health were occurring primarily among the rich, while reductions in relative inequality for filled teeth indicate higher utilization of restorative services among the poor. These results point to the necessity of tackling the sociopolitical determinants of health to mitigate oral health inequality in Canada and the United States.
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Affiliation(s)
- Malini Chari
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Vahid Ravaghi
- School of Dentistry, University of Birmingham, Birmingham, UK
| | - Wael Sabbah
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - Noha Gomaa
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Sonica Singhal
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada
| | - Carlos Quiñonez
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
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10
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Beşiroğlu E, Lütfioğlu M. Relations between periodontal status, oral health-related quality of life and perceived oral health and oral health consciousness levels in a Turkish population. Int J Dent Hyg 2020; 18:251-260. [PMID: 32367616 DOI: 10.1111/idh.12443] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/18/2020] [Accepted: 04/29/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study aimed to evaluate the interrelationship of periodontal status, socio-demographic characteristics, perceived oral health and oral health consciousness levels as well as the impact of these factors on quality of life using a questionnaire and the Oral Health Impact Profile-14(OHIP-14) scale. METHODS Seven hundred and fifty systemically healthy individuals aged ≥18 years referred to a Periodontology Department were included in the study. The OHIP-14 scale and survey were applied to identify socio-demographic characteristics, oral hygiene characteristics, perceived oral health and oral hygiene consciousness levels. Three groups were established based on periodontal status (periodontally healthy [H], gingivitis [G] and periodontitis [P]) determined using periodontal indexes, and the relationship between the above-mentioned factors and periodontal status with quality of life was assessed. RESULTS Oral health-related quality of life differed significantly by gender, marital status, education level, oral hygiene habits and periodontal status. A statistically significant positive relationship was found between high OHIP-14 scores and unfavourable socio-demographic characteristics, increased severity of periodontal disease, and irregular dental care practices. The perceived oral health and oral health consciousness levels significantly differed due to periodontal status. CONCLUSION Periodontal status, gender, marital status, education level, dental care practices, perceived oral health and oral hygiene consciousness levels are important determinants of oral health-related quality of life (Clinical Trial No. NCT03549247).
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Affiliation(s)
- Ekin Beşiroğlu
- Periodontology Department, İstanbul Okan University Faculity of Dentistry, İstanbul, Turkey
| | - Müge Lütfioğlu
- Periodontology Department, Ondokuz Mayıs University Faculity of Dentistry, Samsun, Turkey
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11
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Zivkovic N, Aldossri M, Gomaa N, Farmer JW, Singhal S, Quiñonez C, Ravaghi V. Providing dental insurance can positively impact oral health outcomes in Ontario. BMC Health Serv Res 2020; 20:124. [PMID: 32066434 PMCID: PMC7027064 DOI: 10.1186/s12913-020-4967-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 02/06/2020] [Indexed: 11/30/2022] Open
Abstract
Background Universal coverage for dental care is a topical policy debate across Canada, but the impact of dental insurance on improving oral health-related outcomes remains empirically unexplored in this population. Methods We used data on individuals 12 years of age and older from the Canadian Community Health Survey 2013–2014 to estimate the marginal effects (ME) of having dental insurance in Ontario, Canada’s most populated province (n = 42,553 representing 11,682,112 Ontarians). ME were derived from multi-variable logistic regression models for dental visiting behaviour and oral health status outcomes. We also investigated the ME of insurance across income, education and age subgroups. Results Having dental insurance increased the proportion of participants who visited the dentist in the past year (56.6 to 79.4%, ME: 22.8, 95% confidence interval (CI): 20.9–24.7) and who reported very good or excellent oral health (48.3 to 57.9%, ME: 9.6, 95%CI: 7.6–11.5). Compared to the highest income group, having dental insurance had a greater ME for the lowest income groups for dental visiting behaviour: dental visit in the past 12 months (ME highest: 17.9; 95% CI: 15.9–19.8 vs. ME lowest: 27.2; 95% CI: 25.0–29.3) and visiting a dentist only for emergencies (ME highest: -11.5; 95% CI: − 13.2 to − 9.9 vs. ME lowest: -27.2; 95% CI: − 29.5 to − 24.8). Conclusions Findings suggest that dental insurance is associated with improved dental visiting behaviours and oral health status outcomes. Policymakers could consider universal dental coverage as a means to support financially vulnerable populations and to reduce oral health disparities between the rich and the poor.
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Affiliation(s)
- Nevena Zivkovic
- Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, Canada.
| | - Musfer Aldossri
- Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, Canada
| | - Noha Gomaa
- Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, Canada
| | - Julie W Farmer
- Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, Canada
| | - Sonica Singhal
- Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, Canada
| | - Carlos Quiñonez
- Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, Canada
| | - Vahid Ravaghi
- School of Dentistry, University of Birmingham, Birmingham, England
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Singh A, Peres MA, Watt RG. The Relationship between Income and Oral Health: A Critical Review. J Dent Res 2019; 98:853-860. [PMID: 31091113 DOI: 10.1177/0022034519849557] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
In this critical review, we summarized the evidence on associations between individual/household income and oral health, between income inequality and oral health, and income-related inequalities in oral health. Meta-analyses of mainly cross-sectional studies confirm that low individual/household income is associated with oral cancer (odds ratio, 2.41; 95% confidence interval [CI], 1.59-3.65), dental caries prevalence (prevalence ratio, 1.29; 95% CI, 1.18-1.41), any caries experience (odds ratio, 1.40; 95% CI, 1.19-1.65), tooth loss (odds ratio, 1.66; 95% CI, 1.48-1.86), and traumatic dental injuries (odds ratio, 0.76; 95% CI, 0.65-0.89). Reviews also confirm qualitatively that low income is associated with periodontal disease and poor oral health-related quality of life. Limited evidence from the United States shows that psychosocial and behavioral explanations only partially explain associations between low individual/household income and oral health. Few country-level studies and a handful of subnational studies from the United States, Japan, and Brazil show associations between area-level income inequality and poor oral health. However, this evidence is conflicting given that the association between area-level income inequality and oral health outcomes varies considerably by contexts and by oral health outcomes. Evidence also shows cross-national variations in income-related inequalities in oral health outcomes of self-rated oral health, dental care, oral health-related quality of life, outcomes of dental caries, and outcomes of tooth loss. There is a lack of discussion in oral health literature about limitations of using income as a measure of social position. Future studies on the relationship between income and oral health can benefit substantially from recent theoretical and methodological advancements in social epidemiology that include application of an intersectionality framework, improvements in reporting of inequality, and causal modeling approaches. Theoretically well-informed studies that apply robust epidemiological methods are required to address knowledge gaps for designing relevant policy interventions to reduce income-related inequalities in oral health.
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Affiliation(s)
- A Singh
- 1 Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - M A Peres
- 2 Menzies Health Institute Queensland and School of Dentistry and Oral Health, Griffith University, Gold Coast, Queensland, Australia
| | - R G Watt
- 3 Research Department of Epidemiology and Public Health, University College London, London, UK
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Vancea M, Shore J, Utzet M. Role of employment-related inequalities in young adults' life satisfaction: A comparative study in five European welfare state regimes. Scand J Public Health 2019; 47:357-365. [PMID: 30678524 DOI: 10.1177/1403494818823934] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
AIMS There is evidence that young people are less satisfied with their lives when they are unemployed or working in precarious conditions. This study aims to shed light on how the life satisfaction of unemployed and precariously employed young people varies across welfare states with different labour market policies and levels of social protection. METHODS The analyses are based on representative cross-sectional survey data from five European countries (Denmark, the UK, Germany, Spain and the Czech Republic), corresponding to five different welfare state regimes. For economically active young adults ( N=6681), the prevalence ratios of low life satisfaction were estimated through multivariate logistic regressions. RESULTS In all five countries, unemployed young adults presented a higher prevalence of low life satisfaction. When we compared employees with people with permanent and temporary contracts, the former were more satisfied with their lives only in Germany and the UK, examples of conservative and liberal welfare regimes, respectively. Experience of unemployment decreased young adults' life satisfaction only in Germany and the Czech Republic, examples of a conservative and an eastern European welfare regime, respectively. In almost all countries, young adults with low economic self-sufficiency presented a higher prevalence of low life satisfaction. CONCLUSIONS There are nuanced patterns of employment type and life satisfaction across European states that hint at welfare state regimes as possible moderators in this relationship. The results suggest that the psychological burdens of unemployment or work uncertainty cannot be overlooked and should be addressed according to different types of social provisions.
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Affiliation(s)
- Mihaela Vancea
- 1 Department of Political and Social Sciences, Universitat Pompeu Fabra, Spain
| | - Jennifer Shore
- 2 Mannheim Centre for European Social Research, University of Mannheim, Germany
| | - Mireia Utzet
- 3 Department of Sociology 2, University of the Basque Country UPV/EHU, Spain
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El Osta N, El Osta L, Khabbaz LR, Saad R, Abi-Ghosn C, Hennequin M, Tubert-Jeannin S, Fakhouri J. Social inequalities in oral health in a group of older people in a Middle Eastern country: a cross-sectional survey. Aging Clin Exp Res 2018. [PMID: 29520511 DOI: 10.1007/s40520-018-0927-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVE The percentage of Lebanese older people has increased considerably. Given that Lebanese seniors are marginalized in the health policy-making process, we suggest a high social inequality in oral health that has not been studied so far. The purpose of our study was to describe and compare oral health status in a group of Lebanese older people according to their socioeconomic status (SES) MATERIALS AND METHODS: Participants were recruited from three different primary health care clinics in Beirut, Lebanon. Data were collected from an administered questionnaire that included sociodemographic variables, perception of oral health, and regular dental visits. Oral examination included the number of missing and decayed teeth, the prosthetic status, and the number of functional dental units (FUs). The SES of the participants was determined by educational level, previous or actual work, and neighborhood level. RESULTS 264 participants aged 71.4 ± 6.27 years (64.7% female) were included in the study. Regular dental visit, dental status, FU, and oral health perception were significantly related to the participants' place of residence, educational level, and work. Moreover, the mean number of missing teeth (p = 0.048) and decayed teeth (p = 0.018) was significantly elevated in the low SES. CONCLUSION There is a clear socioeconomic inequality in oral health among the Lebanese older people. Further researches should explore the potential contribution of psychosocial and behavioral factors in explaining these disparities.
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Mejia GC, Elani HW, Harper S, Murray Thomson W, Ju X, Kawachi I, Kaufman JS, Jamieson LM. Socioeconomic status, oral health and dental disease in Australia, Canada, New Zealand and the United States. BMC Oral Health 2018; 18:176. [PMID: 30367654 PMCID: PMC6204046 DOI: 10.1186/s12903-018-0630-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 10/04/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Socioeconomic inequalities are associated with oral health status, either subjectively (self-rated oral health) or objectively (clinically-diagnosed dental diseases). The aim of this study is to compare the magnitude of socioeconomic inequality in oral health and dental disease among adults in Australia, Canada, New Zealand and the United States (US). METHODS Nationally-representative survey examination data were used to calculate adjusted absolute differences (AD) in prevalence of untreated decay and fair/poor self-rated oral health (SROH) in income and education. We pooled age- and gender-adjusted inequality estimates using random effects meta-analysis. RESULTS New Zealand demonstrated the highest adjusted estimate for untreated decay; the US showed the highest adjusted prevalence of fair/poor SROH. The meta-analysis showed little heterogeneity across countries for the prevalence of decayed teeth; the pooled ADs were 19.7 (95% CI = 16.7-22.7) and 12.0 (95% CI = 8.4-15.7) between highest and lowest education and income groups, respectively. There was heterogeneity in the mean number of decayed teeth and in fair/poor SROH. New Zealand had the widest inequality in decay (education AD = 0.8; 95% CI = 0.4-1.2; income AD = 1.0; 95% CI = 0.5-1.5) and the US the widest inequality in fair/poor SROH (education AD = 40.4; 95% CI = 35.2-45.5; income AD = 20.5; 95% CI = 13.0-27.9). CONCLUSIONS The differences in estimates, and variation in the magnitude of inequality, suggest the need for further examining socio-cultural and contextual determinants of oral health and dental disease in both the included and other countries.
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Affiliation(s)
- Gloria C. Mejia
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, SA 5005 Australia
| | - Hawazin W. Elani
- Harvard School of Dental Medicine, Harvard University, Boston, MA USA
| | - Sam Harper
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Quebec H3A 1A2 Canada
| | - W. Murray Thomson
- Sir John Walsh Research Institute, Faculty of Dentistry, The University of Otago, Dunedin, New Zealand
| | - Xiangqun Ju
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, SA 5005 Australia
| | - Ichiro Kawachi
- Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115 USA
| | - Jay S. Kaufman
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Quebec H3A 1A2 Canada
| | - Lisa M. Jamieson
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, SA 5005 Australia
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Blanco S, Laurino CG, Toassi RFC, Abegg C. Assistência odontológica em programas sociais para populações socialmente vulneráveis na perspectiva do programa Uruguay Trabaja. SAUDE E SOCIEDADE 2018. [DOI: 10.1590/s0104-12902018180433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Este trabalho discute características do subprograma da saúde bucal do programa Uruguai Trabaja (UT), em Montevidéu, e identifica os tratamentos odontológicos iniciados, completados e abandonados de 2008 a 2015. Por meio de análise documental, o UT é discutido a partir de dois níveis categóricos. O primeiro refere-se ao contexto macrossocial, relacionando-se à expansão da cobertura da assistência odontológica integrada nos sistemas de proteção social, enquanto o segundo se origina da observação sistemática da assistência odontológica inserida em programas de acompanhamento social. UT é um programa social anual de nove meses de duração dirigido a pessoas de 18 a 65 anos em situação de vulnerabilidade socioeconômica e desempregadas há muito tempo. Seu propósito é melhorar a empregabilidade e a integração social dos participantes. Assistência odontológica integral é um dos benefícios do programa, a qual não é disponibilizada pelo Sistema Nacional Integrado de Saúde. Dos 2.592 tratamentos odontológicos iniciados, 941 (36,3%) não chegaram ao final. Programas focalizados como o UT, enquanto dispositivos de proteção social, devem estar articulados funcionalmente a políticas sociais universais que devem responder adequadamente as necessidades da população. A saúde bucal, nesse contexto, deve ser incluída no Sistema Nacional Integrado de Saúde do Uruguai, garantindo o direito à saúde.
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Reda SM, Krois J, Reda SF, Thomson WM, Schwendicke F. The impact of demographic, health-related and social factors on dental services utilization: Systematic review and meta-analysis. J Dent 2018; 75:1-6. [PMID: 29673686 DOI: 10.1016/j.jdent.2018.04.010] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 04/03/2018] [Accepted: 04/12/2018] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Regular and/or preventive dental services utilization is an indicator of healthcare access and associated with improved health outcomes. We assessed the proportion of individuals regularly/preventively utilizing dental services, and how this was affected by demographic, health-related and social factors. SOURCES Three electronic databases (Medline, Embase, Central) were searched (2005-2017). STUDY SELECTION We included observational studies investigating the association between preventive/regular dental service utilization and age, oral and general health, edentulism, family structure and health literacy. DATA The proportion of individuals with regular/preventive utilization overall and in different sub-groups were extracted. Random-effects meta-analyses, with subgroup analyses by region, were performed. Meta-regression was used to assess whether and how associations changed with time and countries' human developmental status (HDI). 103 studies on 7,395,697 participants from 28 countries were included. The global mean (95% CI) proportion of individuals regularly/preventively utilizing dental services was 54% (50-59%). In countries with higher HDI, more individuals regularly/preventively utilized services (p < 0.001). Age did not have a significant impact on utilization in adults (OR = 1.00; 0.89-1.12). Utilization was significantly lower in younger than older children (OR = 0.52; 0.46-0.59), individuals with poorer general health (OR = 0.73; 0.65-0.80) and poorer oral health (OR = 0.64; 0.52-0.75), edentulous individuals (OR = 0.32; 0.23-0.41), and individuals with less supportive family structures (OR = 0.81; 0.73-0.89) or poor health literacy (OR = 0.41; 0.01-0.81). The observed differences within populations did not significantly change with time and were universally present. CONCLUSIONS Regular/preventive utilization varied widely between and within countries. Understanding and tackling the reasons underlying this may help to consistently improve utilization. CLINICAL SIGNIFICANCE Higher developmental status of countries is reflected in greater regular/preventive utilization of dental services. However, large demographic, health-related and social differences in utilization remain. These may contribute to dental health inequalities.
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Affiliation(s)
- Seif Magdy Reda
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Germany
| | - Joachim Krois
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Germany
| | - Sophie Franziska Reda
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Germany
| | - William Murray Thomson
- Sir John Walsh Research Institute, Faculty of Dentistry, The University of Otago, Dunedin, New Zealand
| | - Falk Schwendicke
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Germany.
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18
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Baker SR, Foster Page L, Thomson WM, Broomhead T, Bekes K, Benson PE, Aguilar-Diaz F, Do L, Hirsch C, Marshman Z, McGrath C, Mohamed A, Robinson PG, Traebert J, Turton B, Gibson BJ. Structural Determinants and Children's Oral Health: A Cross-National Study. J Dent Res 2018; 97:1129-1136. [PMID: 29608864 DOI: 10.1177/0022034518767401] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Much research on children's oral health has focused on proximal determinants at the expense of distal (upstream) factors. Yet, such upstream factors-the so-called structural determinants of health-play a crucial role. Children's lives, and in turn their health, are shaped by politics, economic forces, and social and public policies. The aim of this study was to examine the relationship between children's clinical (number of decayed, missing, and filled teeth) and self-reported oral health (oral health-related quality of life) and 4 key structural determinants (governance, macroeconomic policy, public policy, and social policy) as outlined in the World Health Organization's Commission for Social Determinants of Health framework. Secondary data analyses were carried out using subnational epidemiological samples of 8- to 15-y-olds in 11 countries ( N = 6,648): Australia (372), New Zealand (three samples; 352, 202, 429), Brunei (423), Cambodia (423), Hong Kong (542), Malaysia (439), Thailand (261, 506), United Kingdom (88, 374), Germany (1498), Mexico (335), and Brazil (404). The results indicated that the type of political regime, amount of governance (e.g., rule of law, accountability), gross domestic product per capita, employment ratio, income inequality, type of welfare regime, human development index, government expenditure on health, and out-of-pocket (private) health expenditure by citizens were all associated with children's oral health. The structural determinants accounted for between 5% and 21% of the variance in children's oral health quality-of-life scores. These findings bring attention to the upstream or structural determinants as an understudied area but one that could reap huge rewards for public health dentistry research and the oral health inequalities policy agenda.
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Affiliation(s)
- S R Baker
- 1 Unit of Dental Public Health, School of Clinical Dentistry, Claremont Crescent, University of Sheffield, Sheffield, UK
| | - L Foster Page
- 2 Department of Oral Sciences, Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Otago, New Zealand
| | - W M Thomson
- 2 Department of Oral Sciences, Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Otago, New Zealand
| | - T Broomhead
- 1 Unit of Dental Public Health, School of Clinical Dentistry, Claremont Crescent, University of Sheffield, Sheffield, UK
| | - K Bekes
- 3 Department of Paediatric Dentistry, School of Dentistry, Medical University of Vienna, Vienna, Austria
| | - P E Benson
- 1 Unit of Dental Public Health, School of Clinical Dentistry, Claremont Crescent, University of Sheffield, Sheffield, UK
| | - F Aguilar-Diaz
- 4 Department of Public Health, National Autonomous University of Mexico León Unit, León, Guanajuato, México
| | - L Do
- 5 Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, Australia
| | - C Hirsch
- 6 Department of Paediatric Dentistry, University of Leipzig, Leipzig, Germany
| | - Z Marshman
- 1 Unit of Dental Public Health, School of Clinical Dentistry, Claremont Crescent, University of Sheffield, Sheffield, UK
| | - C McGrath
- 7 Periodontology & Public Health, Faculty of Dentistry, University of Hong Kong, Hong Kong
| | - A Mohamed
- 8 Department of Dental Services, Ministry of Health, Brunei Darussalam
| | - P G Robinson
- 9 Bristol Dental School, The University of Bristol, Bristol, UK
| | - J Traebert
- 10 Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Santa Catarina, Brazil
| | - B Turton
- 11 Department of Dentistry, University of Puthisastra, Phnom Penh, Cambodia
| | - B J Gibson
- 1 Unit of Dental Public Health, School of Clinical Dentistry, Claremont Crescent, University of Sheffield, Sheffield, UK
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Singh A, Harford J, Peres MA. Investigating societal determinants of oral health-Opportunities and challenges in multilevel studies. Community Dent Oral Epidemiol 2018; 46:317-327. [PMID: 29461626 DOI: 10.1111/cdoe.12369] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 01/15/2018] [Indexed: 11/30/2022]
Abstract
The high prevalence of oral diseases and the persistent nature of socioeconomic inequalities in oral health outcomes across societies presents a significant challenge for public health globally. A debate exists in epidemiology on the merits of investigating population variations in health and its determinants over studying individual health and its individual risk factors. The choice of analytical unit for health outcomes at the population level has policy implications and consequences for the causal understanding of population-level variations in health/disease. There is a lack of discussion in oral epidemiology on the relevance of studying population variations in oral health. Evidence on the role of societal factors in shaping variations in oral health at both the individual level and the population level is also mounting. Multilevel studies are increasingly applied in social epidemiology to address hypotheses generated at different levels of social organization, but the opportunities offered by multilevel approaches are less applied for studying determinants of oral health at the societal level. Multilevel studies are complex as they aim to examine hypotheses generated at multiple levels of social organization and require attention to a range of theoretical and methodological aspects from the stage of design to analysis and interpretation. This discussion study aimed to highlight the value in studying population variations in oral health. It discusses the opportunities provided by multilevel approaches to study societal determinants of oral health. Finally, it reviews the key methodological aspects related to operationalizing multilevel studies of societal determinants of oral health.
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Affiliation(s)
- Ankur Singh
- Australian Research Centre for Population Oral Health (ARCPOH), Adelaide Dental School, The University of Adelaide, Adelaide, SA, Australia.,Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Jane Harford
- Australian Research Centre for Population Oral Health (ARCPOH), Adelaide Dental School, The University of Adelaide, Adelaide, SA, Australia
| | - Marco A Peres
- Australian Research Centre for Population Oral Health (ARCPOH), Adelaide Dental School, The University of Adelaide, Adelaide, SA, Australia
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Shen J, Listl S. Investigating social inequalities in older adults' dentition and the role of dental service use in 14 European countries. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2018; 19:45-57. [PMID: 28064379 PMCID: PMC5773639 DOI: 10.1007/s10198-016-0866-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 12/13/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Oral disease, despite being largely preventable, remains the most common chronic disease worldwide and has a significant negative impact on quality of life, particularly among older adults. OBJECTIVE This study is the first to comprehensively and at a large scale (14 European countries) measure the social inequalities in the number of natural teeth (an informative oral health marker) in the over 50-year-old population and to investigate the extent to which such inequalities are attributable to dental service use. METHODS Using Wave 5 of the Survey of Health, Ageing and Retirement in Europe, which included internationally harmonized information on over 50,000 individuals across 14 European countries, we calculated Gini and Concentration indices (CI) as well as the decompositions of CIs by socioeconomic factors. RESULTS Sweden consistently performed the best with the lowest inequalities as measured by Gini (0.1078), CI by income (0.0392), CI by education (0.0407), and CI by wealth (0.0296). No country performed the worst in all inequality measures. However, unexpectedly, some wealthier countries (e.g., the Netherlands and Denmark) had higher degrees of inequalities than less-wealthy countries (e.g., Estonia and Slovenia). Decomposition analysis showed that income, education, and wealth contributed substantially to the inequalities, and dental service use was an important contributor even after controlling for income and wealth. CONCLUSIONS The study highlighted the importance of comprehensively investigating oral health inequalities. The results are informative to policymakers to derive country-specific health policy recommendations to reduce oral health inequalities in the older population and also have implications for oral health improvement of the future generations.
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Affiliation(s)
- Jing Shen
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
| | - Stefan Listl
- Quality and Safety of Oral Care, Radboud University, Nijmegen, The Netherlands
- Translational Health Economics, Heidelberg University, Heidelberg, Germany
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Reda SF, Reda SM, Thomson WM, Schwendicke F. Inequality in Utilization of Dental Services: A Systematic Review and Meta-analysis. Am J Public Health 2017; 108:e1-e7. [PMID: 29267052 DOI: 10.2105/ajph.2017.304180] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Dental diseases are among the most prevalent conditions worldwide, with universal access to dental care being one key to tackling them. Systematic quantification of inequalities in dental service utilization is needed to identify where these are most pronounced, assess factors underlying the inequalities, and evaluate changes in inequalities with time. OBJECTIVES To evaluate the presence and extent of inequalities in dental services utilization. SEARCH METHODS We performed a systematic review and meta-analysis by searching 3 electronic databases (MEDLINE, Embase, Cochrane Central Database), covering the period from January 2005 to April 2017. SELECTION CRITERIA We included observational studies investigating the association between regular dental service utilization and sex, ethnicity, place of living, educational or income or occupational position, or insurance coverage status. Two reviewers undertook independent screening of studies and made decisions by consensus. DATA COLLECTION AND ANALYSIS Our primary outcome was the presence and extent of inequalities in dental service utilization, measured as relative estimates (usually odds ratios [ORs]) comparing different (high and low utilization) groups. We performed random effects meta-analysis and subgroup analyses by region, and we used meta-regression to assess whether and how associations changed with time. MAIN RESULTS A total of 117 studies met the inclusion criteria. On the basis of 7 830 810 participants, dental services utilization was lower in male than female participants (OR = 0.85; 95% confidence interval [CI] = 0.74, 0.95; P < .001); ethnic minorities or immigrants than ethnic majorities or natives (OR = 0.71; 95% CI = 0.59, 0.82; P < .001); those living in rural than those living in urban places (OR = 0.87; 95% CI = 0.76, 0.97; P = .011); those with lower than higher educational position (OR = 0.61; 95% CI = 0.55, 0.68; P < .001) or income (OR = 0.66; 95% CI = 0.54, 0.79; P < .001); and among those without insurance coverage status than those with such status (OR = 0.58; 95% CI = 0.49, 0.68; P < .001). Occupational status (OR = 0.95; 95% CI = 0.81, 1.09; P = .356) had no significant impact on utilization. The observed inequalities did not significantly change over the assessed 12-year period and were universally present. AUTHORS' CONCLUSIONS Inequalities in dental service utilization are both considerable and globally consistent. Public Health Implications. The observed inequalities in dental services utilization can be assumed to significantly cause or aggravate existing dental health inequalities. Policymakers should address the physical, socioeconomic, or psychological causes underlying the inequalities in utilization.
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Affiliation(s)
- Sophie F Reda
- Sophie F. Reda, Seif M. Reda, and Falk Schwendicke are with Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin, Berlin, Germany. W. Murray Thomson is with the Sir John Walsh Research Institute, Faculty of Dentistry, The University of Otago, Dunedin, New Zealand
| | - Seif M Reda
- Sophie F. Reda, Seif M. Reda, and Falk Schwendicke are with Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin, Berlin, Germany. W. Murray Thomson is with the Sir John Walsh Research Institute, Faculty of Dentistry, The University of Otago, Dunedin, New Zealand
| | - W Murray Thomson
- Sophie F. Reda, Seif M. Reda, and Falk Schwendicke are with Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin, Berlin, Germany. W. Murray Thomson is with the Sir John Walsh Research Institute, Faculty of Dentistry, The University of Otago, Dunedin, New Zealand
| | - Falk Schwendicke
- Sophie F. Reda, Seif M. Reda, and Falk Schwendicke are with Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin, Berlin, Germany. W. Murray Thomson is with the Sir John Walsh Research Institute, Faculty of Dentistry, The University of Otago, Dunedin, New Zealand
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Wide U, Hakeberg M. Oral health-related quality of life, measured using the five-item version of the Oral Health Impact Profile, in relation to socio-economic status: a population survey in Sweden. Eur J Oral Sci 2017; 126:41-45. [DOI: 10.1111/eos.12393] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Ulla Wide
- Department of Behavioral and Community Dentistry; Institute of Odontology; The Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Magnus Hakeberg
- Department of Behavioral and Community Dentistry; Institute of Odontology; The Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
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23
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Hakeberg M, Wide Boman U. Self-reported oral and general health in relation to socioeconomic position. BMC Public Health 2017; 18:63. [PMID: 28747180 PMCID: PMC5530538 DOI: 10.1186/s12889-017-4609-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 07/19/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND During the past two decades, several scientific publications from different countries have shown how oral health in the population varies with social determinants. The aim of the present study was to explore the relationship between self-reported oral and general health in relation to different measures of socioeconomic position. METHODS Data were collected from a randomly selected sample of the adult population in Sweden (n = 3500, mean age 53.4 years, 53.1% women). The response rate was 49.7%. Subjects were interviewed by telephone, using a questionnaire including items on self-reported oral and general health, socioeconomic position and lifestyle. RESULTS A significant gradient was found for both oral and general health: the lower the socioeconomic position, the poorer the health. Socioeconomic position and, above all, economic measures were strongly associated with general health (OR 3.95) and with oral health (OR 1.76) if having an income below SEK 200,000 per year. Similar results were found in multivariate analyses controlling for age, gender and lifestyle variables. CONCLUSIONS For adults, there are clear socioeconomic gradients in self-reported oral and general health, irrespective of different socioeconomic measures. Action is needed to ensure greater equity of oral and general health.
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Affiliation(s)
- Magnus Hakeberg
- Department of Behavioral and Community Dentistry, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, P.O. Box 450, 40530 Gothenburg, SE Sweden
| | - Ulla Wide Boman
- Department of Behavioral and Community Dentistry, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, P.O. Box 450, 40530 Gothenburg, SE Sweden
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Guarnizo-Herreño CC, Watt RG, Stafford M, Sheiham A, Tsakos G. Do welfare regimes matter for oral health? A multilevel analysis of European countries. Health Place 2017; 46:65-72. [PMID: 28500911 DOI: 10.1016/j.healthplace.2017.05.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 05/03/2017] [Accepted: 05/05/2017] [Indexed: 11/25/2022]
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Moeller J, Starkel R, Quiñonez C, Vujicic M. Income inequality in the United States and its potential effect on oral health. J Am Dent Assoc 2017; 148:361-368. [DOI: 10.1016/j.adaj.2017.02.052] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 02/07/2017] [Accepted: 02/24/2017] [Indexed: 10/19/2022]
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Crocombe LA, Mahoney GD. Does optimal access to dental care counteract the oral health-related quality of life social gradient? Aust Dent J 2016; 61:418-424. [DOI: 10.1111/adj.12393] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2015] [Indexed: 11/28/2022]
Affiliation(s)
- LA Crocombe
- Australian Research Centre for Population Oral Health, School of Dentistry; The University of Adelaide; Adelaide South Australia Australia
- Centre for Rural Health; The University of Tasmania; Hobart Tasmania Australia
| | - GD Mahoney
- School of Population Health; The University of Queensland; Brisbane Queensland Australia
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Bhandari B, Newton JT, Bernabé E. Social inequalities in adult oral health in 40 low- and middle-income countries. Int Dent J 2016; 66:295-303. [DOI: 10.1111/idj.12243] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Li MHM, Bernabé E. Tooth wear and quality of life among adults in the United Kingdom. J Dent 2016; 55:48-53. [PMID: 27693780 DOI: 10.1016/j.jdent.2016.09.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 09/12/2016] [Accepted: 09/27/2016] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To explore the association between tooth wear and quality of life among adults in the United Kingdom, independently of sociodemographic factors and other common oral conditions. METHODS We used data from 5654 dentate adults who participated in the 2009 Adult Dental Health Survey. Tooth wear was assessed during clinical examination and classified as none, mild, moderate and severe based on the worst affected tooth recorded. The numbers of teeth with mild, moderate and severe tooth wear were used as alternative measures. Oral impacts on quality of life were measured using the short form of the Oral Health Impact Profile (OHIP-14). The associations between tooth wear measures and OHIP-14 total and domain scores were tested in negative binomial regression models adjusting for sociodemographic and clinical factors. RESULTS Overall, 62% of participants had mild, 13% moderate and 2% severe tooth wear. Adults with severe tooth wear had a crude OHIP-14 total score higher than those without tooth wear (Rate Ratio: 1.90; 95% Confidence Interval: 1.32-2.75). This association was attenuated after adjustment for confounders, particularly for other oral conditions (1.25; 95% CI: 0.90-1.73). Moreover, adults with severe tooth wear reported higher OHIP-14 domain scores in psychological discomfort (1.15; 95% CI: 1.06-1.25) and psychological disability (1.18; 95% CI: 1.10-1.30) than those without such condition. There was also evidence of a dose-response relationship; with higher OHIP-14 domain scores according to the number of teeth with severe tooth wear. CONCLUSION This nationwide study among UK adults shows that severe tooth wear was negatively associated with psychological impacts on people's life. CLINICAL SIGNIFICANCE Dentist should consider not only the patients' clinical characteristics, but also their impacts on quality of life and provide preventive or restorative management accordingly.
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Affiliation(s)
- Mary H M Li
- King's College London Dental Institute at Guy's, King's College and St. Thomas' Hospitals, Division of Population and Patient Health, London, United Kingdom
| | - Eduardo Bernabé
- King's College London Dental Institute at Guy's, King's College and St. Thomas' Hospitals, Division of Population and Patient Health, London, United Kingdom.
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Raittio E, Aromaa A, Kiiskinen U, Helminen S, Suominen AL. Income-related inequality in perceived oral health among adult Finns before and after a major dental subsidization reform. Acta Odontol Scand 2016; 74:348-54. [PMID: 26980421 DOI: 10.3109/00016357.2016.1142113] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objectives In Finland, a dental subsidization reform, implemented in 2001-2002, abolished age restrictions on subsidized dental care. The aim of this study was to investigate income-related inequality in the perceived oral health and its determinants among adult Finns before and after the reform. Materials and methods Three identical cross-sectional nationally representative postal surveys, concerning perceived oral health and the use of dental services among people born before 1971, were conducted in 2001 (n = 2157), in 2004 (n = 1814) and in 2007 (n = 1671). Three measures of perceived oral health were used: toothache or oral discomfort during the past 12 months, current need for dental care and self-reported oral health status. Concentration index was used to analyse the income-related inequalities. Its decomposition was used to study factors related to the inequalities. Results The proportion of respondents reporting need for dental care decreased from 2001 to 2007, while no changes were seen in reports of toothache or self-reported oral health status. Income-related inequalities in reports of toothache and perceived need for care widened, while the inequality in self-reported oral health remained stable. Most of the inequalities were related to income itself, perceived general health and the time since the last visit to dental care. Conclusions It seems that the income-related inequalities in perceived oral health remained or even widened after the reform.
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Affiliation(s)
- Eero Raittio
- University of Eastern Finland, Institute of Dentistry, Kuopio, Finland
| | - Arpo Aromaa
- Institute for Health and Welfare (THL), Helsinki, Finland
| | | | | | - Anna Liisa Suominen
- University of Eastern Finland, Institute of Dentistry, Kuopio, Finland
- Institute for Health and Welfare (THL), Helsinki, Finland
- Department of Oral and Maxillofacial Surgery, Kuopio University Hospital, Kuopio, Finland
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Raes S, Raes F, Cooper L, Giner Tarrida L, Vervaeke S, Cosyn J, De Bruyn H. Oral health-related quality of life changes after placement of immediately loaded single implants in healed alveolar ridges or extraction sockets: a 5-year prospective follow-up study. Clin Oral Implants Res 2016; 28:662-667. [DOI: 10.1111/clr.12858] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2016] [Indexed: 12/25/2022]
Affiliation(s)
- Stefanie Raes
- Department of Periodontology and Oral Implantology; Dental School; Faculty of Medicine and Health Sciences; University of Ghent; Ghent Belgium
| | - Filiep Raes
- Department of Periodontology and Oral Implantology; Dental School; Faculty of Medicine and Health Sciences; University of Ghent; Ghent Belgium
| | - Lyndon Cooper
- Department of Prosthodontics; University of North Carolina School of Dentistry; Chapel Hill NC USA
| | - Luis Giner Tarrida
- Research Department; Dentistry School; Universitat Internacional de Catalunya; Catalunya Spain
| | - Stijn Vervaeke
- Department of Periodontology and Oral Implantology; Dental School; Faculty of Medicine and Health Sciences; University of Ghent; Ghent Belgium
| | - Jan Cosyn
- Department of Periodontology and Oral Implantology; Dental School; Faculty of Medicine and Health Sciences; University of Ghent; Ghent Belgium
- Oral Health Research Group (ORHE); Faculty of Medicine and Pharmacy; Vrije Universiteit Brussel; Brussels Belgium
| | - Hugo De Bruyn
- Department of Periodontology and Oral Implantology; Dental School; Faculty of Medicine and Health Sciences; University of Ghent; Ghent Belgium
- Department of Prosthodontics; Faculty of Odontology; Malmö University; Malmö Sweden
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Validation of the English-language version of 5-item Oral Health Impact Profile. J Prosthodont Res 2016; 60:85-91. [PMID: 26795728 DOI: 10.1016/j.jpor.2015.12.003] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 10/05/2015] [Accepted: 12/10/2015] [Indexed: 01/17/2023]
Abstract
PURPOSE The Oral Health Impact Profile (OHIP) is currently the most widely used oral health-related quality of life (OHRQoL) instrument. The study validated the English-language 5-item OHIP by investigating its psychometric properties of dimensionality, reliability, and validity in the adult general population. METHODS In 405 subjects (mean age 45+15.7 years, 63% female) from the 2014 Minnesota State Fair, dimensionality was investigated by confirmatory factor analysis. Construct validity was assessed by using a structural equation model correlating OHRQoL and self-reported global oral health status. Reliability was calculated using Cronbach's alpha for OHIP5 total scores. RESULTS In the confirmatory factor analysis, the unidimensional model fit OHIP5 well as indicated by fit indices (RMSEA: 0.07, SRMR: 0.03, comparative fit indices: >0.95). In the structural equation model, self-reported global oral health status correlated with 0.46 with the latent OHRQoL factor, indicating sufficient construct validity. Cronbach's alpha, a measure of score reliability, was "satisfactory" with 0.75. CONCLUSION We validated the English-language version of OHIP5 in the adult general population. Ultrashort instruments such as the 5-item OHIP provide a conceptually appealing and technically feasible opportunity to measure the impact of oral disorders and dental interventions in settings such as general dental practice where the burden to collect and interpret OHRQoL information needs to be minimized.
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Raittio E, Lahti S, Kiiskinen U, Helminen S, Aromaa A, Suominen AL. Inequality in oral health-related quality of life before and after a major subsidization reform. Eur J Oral Sci 2015; 123:267-75. [PMID: 26015152 DOI: 10.1111/eos.12192] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Eero Raittio
- Institute of Dentistry; University of Eastern Finland; Kuopio Finland
| | - Satu Lahti
- Institute of Dentistry; University of Turku; Turku Finland
| | | | | | - Arpo Aromaa
- Institute for Health and Welfare (THL); Helsinki Finland
| | - Anna L. Suominen
- Institute of Dentistry; University of Eastern Finland; Kuopio Finland
- Institute for Health and Welfare (THL); Helsinki Finland
- Department of Oral and Maxillofacial Surgery; Kuopio University Hospital; Kuopio Finland
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Gabardo MCL, Moysés SJ, Moysés ST, Olandoski M, Olinto MTA, Pattussi MP. Social, economic, and behavioral variables associated with oral health-related quality of life among Brazilian adults. CIENCIA & SAUDE COLETIVA 2015; 20:1531-40. [DOI: 10.1590/1413-81232015205.13562014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 09/14/2014] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to investigate the association between sociodemographic, socioeconomic, psychosocial, and behavioral variables and oral health as assessed using the 14-question short version of the Oral Health Impact Profile (OHIP-14). A cross-sectional study was performed with 1095 adult residents from 38 census tracts in the municipality of São Leopoldo, State of Rio Grande do Sul, Brazil. Responses to the OHIP-14 were dichotomized, and bivariate (Chi-square) and multivariate analysis (logistic regression and Wald's test) were performed. In the bivariate analysis, the worse effects were reported by female individuals, the elderly, those with low family income, less schooling, those reporting a lower quality of life and social support, and smokers. In the multivariate analysis the following variables maintained their statistical significance: gender (female), age (50-59 years), family income (low), quality of life (low), social support (low, moderate), and smoking (smokers). Individuals' self-perception of their oral health was related to sociodemographic, socioeconomic, psychosocial, and behavioral variables, thus confirming that emphasis should be placed on social factors when addressing oral health problems.
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Gülcan F, Ekbäck G, Ordell S, Lie SA, Åstrøm AN. Inequality in oral health related to early and later life social conditions: a study of elderly in Norway and Sweden. BMC Oral Health 2015; 15:20. [PMID: 25881160 PMCID: PMC4328709 DOI: 10.1186/s12903-015-0005-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 01/30/2015] [Indexed: 11/13/2022] Open
Abstract
Background A life course perspective recognizes influences of socially patterned exposures on oral health across the life span. This study assessed the influence of early and later life social conditions on tooth loss and oral impacts on daily performances (OIDP) of people aged 65 and 70 years. Whether social inequalities in oral health changed after the usual age of retirement was also examined. In accordance with “the latent effect life course model”, it was hypothesized that adverse early-life social conditions increase the risk of subsequent tooth loss and impaired OIDP, independent of later-life social conditions. Methods Data were obtained from two cohorts studies conducted in Sweden and Norway. The 2007 and 2012 waves of the surveys were used for the present study. Early-life social conditions were measured in terms of gender, education and country of birth, and later-life social conditions were assessed by working status, marital status and size of social network. Logistic regression and Generalized Estimating Equations (GEE) were used to analyse the data. Inverse probability weighting (IPW) was used to adjust estimates for missing responses and loss to follow-up. Results Early-life social conditions contributed to tooth loss and OIDP in each survey year and both countries independent of later-life social conditions. Lower education correlated positively with tooth loss, but did not influence OIDP. Foreign country of birth correlated positively with oral impacts in Sweden only. Later-life social conditions were the strongest predictors of tooth loss and OIDP across survey years and countries. GEE revealed significant interactions between social network and survey year, and between marital status and survey year on tooth loss. Conclusion The results confirmed the latent effect life course model in that early and later life social conditions had independent effects on tooth loss and OIDP among the elderly in Norway and Sweden. Between age 65 and 70, inequalities in tooth loss related to marital status declined, and inequalities related to social network increased.
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Affiliation(s)
- Ferda Gülcan
- Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
| | - Gunnar Ekbäck
- Örebro County Council, Örebro, Sweden. .,School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
| | - Sven Ordell
- Dental Commissioning Unit, Östergötland County Council, Linköping University, Linköping, Sweden.
| | - Stein Atle Lie
- Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
| | - Anne Nordrehaug Åstrøm
- Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
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Gabardo MCL, Moysés SJ, Moysés ST, Olandoski M, Olinto MTA, Pattussi MP. Multilevel analysis of self-perception in oral health and associated factors in Southern Brazilian adults: a cross-sectional study. CAD SAUDE PUBLICA 2015; 31:49-59. [DOI: 10.1590/0102-311x00037814] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 08/05/2014] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to evaluate the association between individual and contextual variables related to self-perception in oral health among residents in the municipality of São Leopoldo, Rio Grande do Sul State, Brazil. The cross-sectional design involved 1,100 adults in 38 census tracts. The self-perception was evaluated using the Oral Health Impact Profile (OHIP-14) tool. A logistic multilevel analysis was performed. The multivariate analysis revealed that those who are of the female gender, older, with lower scores of quality of life and less social support, with poor healthy eating habits, smokers and those living in low-income census tracts presented higher odds of reporting worse oral health self-perception (OHIP-1). We concluded that individual and contextual variables are associated with oral health self-perception. This is essential information for planning health services wishing to meet the health needs of the population.
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Guarnizo-Herreño CC, Watt RG, Pikhart H, Sheiham A, Tsakos G. Inequalities in oral impacts and welfare regimes: analysis of 21 European countries. Community Dent Oral Epidemiol 2014; 42:517-25. [PMID: 25039854 DOI: 10.1111/cdoe.12119] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 06/06/2014] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Very few studies have analysed the relationship between political factors and oral health inequalities, and only one study has compared the magnitude of inequalities in oral health-related quality of life (OHRQoL) across welfare state regimes. This study aimed to compare socioeconomic inequalities in oral impacts on daily life among 21 European countries with different welfare state regimes (Scandinavian, Anglo-Saxon, Bismarckian, Southern, and Eastern). METHODS We analysed data from the Eurobarometer 72.3, a survey carried out in 2009 among adults in European countries. Inequalities in oral impacts by education, occupational social class and subjective social status (SSS) were estimated by means of age-standardized prevalence rates, odds ratios (ORs), the relative index of inequality (RII) and the slope index of inequality (SII). RESULTS Educational inequalities in the form of social gradients were observed in all welfare regimes. The Scandinavian and Southern welfare regimes also showed gradients for all SEP measures. There were not significant differences in the magnitude of relative inequalities (RII) across welfare state regimes. Absolute educational inequalities were largest in the Anglo-Saxon welfare regime (SII = 17.57; 95% CI: 7.80-27.33) and smallest in the Bismarckian (SII = 3.32; 95% CI: -2.18 to 8.83). CONCLUSIONS A significant difference in the magnitude of inequalities across welfare regimes was found for absolute educational inequalities but not for relative inequalities. Welfare state regimes may influence the relationship between knowledge-related resources and oral impacts on daily life.
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Affiliation(s)
- Carol C Guarnizo-Herreño
- Department of Epidemiology and Public Health, University College London, London, UK; Departamento de Salud Colectiva, Facultad de Odontología, Universidad Nacional de Colombia, Bogotá, Colombia
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Bergqvist K, Yngwe MA, Lundberg O. Understanding the role of welfare state characteristics for health and inequalities - an analytical review. BMC Public Health 2013; 13:1234. [PMID: 24369852 PMCID: PMC3909317 DOI: 10.1186/1471-2458-13-1234] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 12/02/2013] [Indexed: 11/16/2022] Open
Abstract
Background The past decade has witnessed a growing body of research on welfare state characteristics and health inequalities but the picture is, despite this, inconsistent. We aim to review this research by focusing on theoretical and methodological differences between studies that at least in part may lead to these mixed findings. Methods Three reviews and relevant bibliographies were manually explored in order to find studies for the review. Related articles were searched for in PubMed, Web of Science and Google Scholar. Database searches were done in PubMed and Web of Science. The search period was restricted to 2005-01-01 to 2013-02-28. Fifty-four studies met the inclusion criteria. Results Three main approaches to comparative welfare state research are identified; the Regime approach, the Institutional approach, and the Expenditure approach. The Regime approach is the most common and regardless of the empirical regime theory employed and the amendments made to these, results are diverse and contradictory. When stratifying studies according to other features, not much added clarity is achieved. The Institutional approach shows more consistent results; generous policies and benefits seem to be associated with health in a positive way for all people in a population, not only those who are directly affected or targeted. The Expenditure approach finds that social and health spending is associated with increased levels of health and smaller health inequalities in one way or another but the studies are few in numbers making it somewhat difficult to get coherent results. Conclusions Based on earlier reviews and our results we suggest that future research should focus less on welfare regimes and health inequalities and more on a multitude of different types of studies, including larger analyses of social spending and social rights in various policy areas and how these are linked to health in different social strata. But, we also need more detailed evaluation of specific programmes or interventions, as well as more qualitative analyses of the experiences of different types of policies among the people and families that need to draw on the collective resources.
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Affiliation(s)
- Kersti Bergqvist
- Centre for Health Equity Studies, Stockholm University/Karolinska Institutet, Stockholm, Sweden.
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Bambra C. In defence of (social) democracy: on health inequalities and the welfare state. J Epidemiol Community Health 2013; 67:713-4. [DOI: 10.1136/jech-2013-202937] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Socioeconomic inequalities in oral health in different European welfare state regimes. J Epidemiol Community Health 2013; 67:728-35. [DOI: 10.1136/jech-2013-202714] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Guarnizo-Herreño CC, Tsakos G, Sheiham A, Watt RG. Oral health and welfare state regimes: a cross-national analysis of European countries. Eur J Oral Sci 2013; 121:169-75. [PMID: 23659239 PMCID: PMC4255683 DOI: 10.1111/eos.12049] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2013] [Indexed: 11/30/2022]
Abstract
Very little is known about the potential relationship between welfare state regimes and oral health. This study assessed the oral health of adults in a range of European countries clustered by welfare regimes according to Ferrera's typology and the complementary Eastern type. We analysed data from Eurobarometer wave 72.3, a cross-sectional survey of 31 European countries carried out in 2009. We evaluated three self-reported oral health outcomes: edentulousness, no functional dentition (<20 natural teeth), and oral impacts on daily living. Age-standardized prevalence rates were estimated for each country and for each welfare state regime. The Scandinavian regime showed lower prevalence rates for all outcomes. For edentulousness and no functional dentition, there were higher prevalence rates in the Eastern regime but no significant differences between Anglo-Saxon, Bismarckian, and Southern regimes. The Southern regime presented a higher prevalence of oral impacts on daily living. Results by country indicated that Sweden had the lowest prevalences for edentulousness and no functional dentition, and Denmark had the lowest prevalence for oral impacts. The results suggest that Scandinavian welfare states, with more redistributive and universal welfare policies, had better population oral health. Future research should provide further insights about the potential mechanisms through which welfare-state regimes would influence oral health.
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Allen F. Embedding a population oral health perspective in the dental curriculum. Community Dent Oral Epidemiol 2012; 40 Suppl 2:127-33. [PMID: 22998317 DOI: 10.1111/j.1600-0528.2012.00732.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Over the past 40 years, oral healthcare has changed dramatically as a consequence of changing disease profiles and population demography. However, dental disease continues to be highly prevalent and costly to treat. Furthermore, it has been recognized that there are inequalities, with tooth loss being influenced by social, cultural and economic factors. Undergraduate education has been task oriented, with a heavy emphasis on training in technical aspects of treating disease. However, oral healthcare education needs to include a population health perspective, and each professional programme should describe appropriate learning outcomes for population oral health. This includes the need to understand health systems and health trends, and to have knowledge of the evidence base for community prevention strategies and health promotion. A key challenge in embedding population oral health into the curriculum is to break down traditional boundaries in the curriculum and to make teaching of this subject context specific and interdisciplinary. Embedding population oral health offers the potential to create synergies between educators and health service providers with the ultimate benefit of producing a reflective and holistic oral health practitioner. There are challenges, but it is important to produce graduates whose attitudes and clinical practices will be shaped by a sound knowledge of population oral health.
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Affiliation(s)
- Finbarr Allen
- Prosthodontics and Oral Rehabilitation, University College Cork, Cork University Dental School and Hospital, Wilton, Cork, Ireland.
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Abstract
OBJECTIVES To take an overview of the history and future of oral health surveillance. METHODS A brief review of the history and policy context of national surveys and equivalent large surveys of oral health and their objectives followed by an analysis of their fitness for modern purpose. RESULTS AND CONCLUSION The quality of oral health surveillance has improved immeasurably since the first attempts in the early 1960s, but national and regional surveys are still hampered by a lack of clarity about their purpose. The data they collect and describe are potentially invaluable and have the major advantages of being both robust and relatively straightforward to interpret and explain to policy makers. A greater clarity of purpose both from researchers and those who commission research would allow better use of data and a greater understanding of the limitations of surveillance. The international research community have a role to play in establishing and sharing best practice globally.
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Affiliation(s)
- Jimmy Steele
- School of Dental Sciences and Centre for Oral Health Research, Newcastle University, Newcastle upon Tyne, England, UK.
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Zhang Q, Witter DJ, Gerritsen AE, Bronkhorst EM, Creugers NHJ. Functional dental status and oral health-related quality of life in an over 40 years old Chinese population. Clin Oral Investig 2012; 17:1471-80. [PMID: 23015025 PMCID: PMC3691481 DOI: 10.1007/s00784-012-0834-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Accepted: 08/28/2012] [Indexed: 11/29/2022]
Abstract
Objectives This study aimed to assess oral health-related quality of life (OHRQoL) related to dental status. Material and methods One thousand four hundred sixty-two Chinese subjects over 40 years, dentate in both jaws, were categorized in a hierarchical functional classification system with and without tooth replacements. OHIP-14CN scores were used to assess OHRQoL and analyzed using multivariable logistic regression including five dental conditions (‘≥10 teeth in each jaw’; ‘complete anterior regions’; ‘sufficient premolar regions’ (≥3 posterior occluding pairs (POPs)); ‘sufficient molar regions’ (bilaterally ≥1 POP); and tooth replacement) after adjustment for five background variables. Likelihood ratios for impaired OHRQoL (OHIP total score ≥5) were assessed at each level of the classification system. Results In the hierarchical scheme, OHIP-14CN total scores were highest in branch ‘<10 teeth in each jaw’ (8.5 ± 9.5 to 12.3 ± 13.2). In branch ‘≥10 teeth’ scores ranged from 6.2 ± 7.7 to 8.3 ± 9.3. The most important dental condition discriminating for impact on OHRQoL was ‘≥10 teeth in each jaw’ (Likelihood ratio 1.59). In this branch subsequent levels were discriminative for impaired OHRQoL (Likelihoods 1.29–1.69), in the branch ‘<10 teeth in each jaw’ they were not (Likelihoods 0.99–1.04). Tooth replacements were perceived poorer as their natural counterparts (odd ratios, 1.30 for fixed and 1.47 for removable appliances). Conclusions OHRQoL was strongly associated with the presence of at least 10 teeth in each jaw. The hierarchical classification system predicted approximately 60 % of subjects correctly with respect to impaired OHRQoL. Clinical relevance From an OHRQoL perspective, natural teeth were preferred over artificial teeth.
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Affiliation(s)
- Qian Zhang
- Department of Prosthetic Dentistry, Affiliated Hospital of Medical School, Qingdao University, Jiangsu Road 16#, Qingdao, People's Republic of China.
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Espinoza I, Thomson WM, Gamonal J, Arteaga O. Disparities in aspects of oral-health-related quality of life among Chilean adults. Community Dent Oral Epidemiol 2012; 41:242-50. [DOI: 10.1111/cdoe.12001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Accepted: 07/27/2012] [Indexed: 01/22/2023]
Affiliation(s)
- Iris Espinoza
- Faculty of Dentistry; University of Chile; Santiago; Chile
| | - W. Murray Thomson
- Sir John Walsh Research Institute; School of Dentistry University of Otago; Dunedin; New Zealand
| | - Jorge Gamonal
- Faculty of Dentistry; University of Chile; Santiago; Chile
| | - Oscar Arteaga
- School of Public Health; University of Chile; Santiago; Chile
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Divaris K, Lee JY, Baker AD, Vann WF. The relationship of oral health literacy with oral health-related quality of life in a multi-racial sample of low-income female caregivers. Health Qual Life Outcomes 2011; 9:108. [PMID: 22132898 PMCID: PMC3248838 DOI: 10.1186/1477-7525-9-108] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Accepted: 12/01/2011] [Indexed: 11/15/2022] Open
Abstract
Background To investigate the association between oral health literacy (OHL) and oral health-related quality of life (OHRQoL) and explore the racial differences therein among a low-income community-based group of female WIC participants. Methods Participants (N = 1,405) enrolled in the Carolina Oral Health Literacy (COHL) study completed the short form of the Oral Health Impact Profile Index (OHIP-14, a measure of OHRQoL) and REALD-30 (a word recognition literacy test). Socio-demographic and self-reported dental attendance data were collected via structured interviews. Severity (cumulative OHIP-14 score) and extent of impact (number of items reported fairly/very often) scores were calculated as measures of OHRQoL. OHL was assessed by the cumulative REALD-30 score. The association of OHL with OHRQoL was examined using descriptive and visual methods, and was quantified using Spearman's rho and zero-inflated negative binomial modeling. Results The study group included a substantial number of African Americans (AA = 41%) and American Indians (AI = 20%). The sample majority had a high school education or less and a mean age of 26.6 years. One-third of the participants reported at least one oral health impact. The OHIP-14 mean severity and extent scores were 10.6 [95% confidence limits (CL) = 10.0, 11.2] and 1.35 (95% CL = 1.21, 1.50), respectively. OHL scores were distributed normally with mean (standard deviation, SD) REALD-30 of 15.8 (5.3). OHL was weakly associated with OHRQoL: prevalence rho = -0.14 (95% CL = -0.20, -0.08); extent rho = -0.14 (95% CL = -0.19, -0.09); severity rho = -0.10 (95% CL = -0.16, -0.05). "Low" OHL (defined as < 13 REALD-30 score) was associated with worse OHRQoL, with increases in the prevalence of OHIP-14 impacts ranging from 11% for severity to 34% for extent. The inverse association of OHL with OHIP-14 impacts persisted in multivariate analysis: Problem Rate Ratio (PRR) = 0.91 (95% CL = 0.86, 0.98) for one SD change in OHL. Stratification by race revealed effect-measure modification: Whites--PRR = 1.01 (95% CL = 0.91, 1.11); AA--PRR = 0.86 (95% CL = 0.77, 0.96). Conclusions Although the inverse association between OHL and OHRQoL across the entire sample was weak, subjects in the "low" OHL group reported significantly more OHRQoL impacts versus those with higher literacy. Our findings indicate that the association between OHL and OHRQoL may be modified by race.
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Affiliation(s)
- Kimon Divaris
- Department of Pediatric Dentistry, 228 Brauer Hall, CB#7450, UNC School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA.
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Tsakos G, Demakakos P, Breeze E, Watt RG. Social gradients in oral health in older adults: findings from the English longitudinal survey of aging. Am J Public Health 2011; 101:1892-9. [PMID: 21852627 PMCID: PMC3222342 DOI: 10.2105/ajph.2011.300215] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2011] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined prospective associations between socioeconomic position (SEP) markers and oral health outcomes in a national sample of older adults in England. METHODS Data were from the English Longitudinal Survey of Aging, a national cohort study of community-dwelling people aged 50 years and older. SEP markers (education, occupation, household income, household wealth, subjective social status, and childhood SEP) and sociodemographic confounders (age, gender, and marital status) were from wave 1. We collected 3 self-reported oral health outcomes at wave 3: having natural teeth (dentate vs edentate), self-rated oral health, and oral impacts on daily life. Using multivariate logistic regression models, we estimated associations between each SEP indicator and each oral health outcome, adjusted for confounders. RESULTS Irrespective of SEP marker, there were inverse graded associations between SEP and edentulousness, with proportionately more edentate participants at each lower SEP level. Lower SEP was also associated with worse self-rated oral health and oral impacts among dentate, but not among edentate, participants. CONCLUSIONS There are consistent and clear social gradients in the oral health of older adults in England, with disparities evident throughout the SEP hierarchy.
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Affiliation(s)
- Georgios Tsakos
- Department of Epidemiology and Public Health, University College London, United Kingdom.
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Muntaner C, Borrell C, Ng E, Chung H, Espelt A, Rodriguez-Sanz M, Benach J, O'Campo P. Politics, welfare regimes, and population health: controversies and evidence. SOCIOLOGY OF HEALTH & ILLNESS 2011; 33:946-64. [PMID: 21899562 DOI: 10.1111/j.1467-9566.2011.01339.x] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
In recent years, a research area has emerged within social determinants of health that examines the role of politics, expressed as political traditions/parties and welfare state characteristics, on population health. To better understand and synthesise this growing body of evidence, the present literature review, informed by a political economy of health and welfare regimes framework, located 73 empirical and comparative studies on politics and health, meeting our inclusion criteria in three databases: PubMed (1948-), Sociological Abstracts (1953-), and ISI Web of Science (1900-). We identified two major research programmes, welfare regimes and democracy, and two emerging programmes, political tradition and globalisation. Primary findings include: (1) left and egalitarian political traditions on population health are the most salutary, consistent, and substantial; (2) the health impacts of advanced and liberal democracies are also positive and large; (3) welfare regime studies, primarily conducted among wealthy countries, find that social democratic regimes tend to fare best with absolute health outcomes yet consistently in terms of relative health inequalities; and (4) globalisation defined as dependency indicators such as trade, foreign investment, and national debt is negatively associated with population health. We end by discussing epistemological, theoretical, and methodological issues for consideration for future research.
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Affiliation(s)
- Carles Muntaner
- Social Science and Health Research, Centre for Addiction and Mental Health (CAMH) and Global Health Program, University of Toronto, Toronto, Ontario, Canada
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Shearer DM, Thomson WM, Broadbent JM, Poulton R. Does maternal oral health predict child oral health-related quality of life in adulthood? Health Qual Life Outcomes 2011; 9:50. [PMID: 21736754 PMCID: PMC3150239 DOI: 10.1186/1477-7525-9-50] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Accepted: 07/07/2011] [Indexed: 05/26/2023] Open
Abstract
Background A parental/family history of poor oral health may influence the oral-health-related quality of life (OHRQOL) of adults. Objectives To determine whether the oral health of mothers of young children can predict the OHRQOL of those same children when they reach adulthood. Methods Oral examination and interview data from the Dunedin Study's age-32 assessment, as well as maternal self-rated oral health data from the age-5 assessment were used. The main outcome measure was study members' short-form Oral Health Impact Profile (OHIP-14) at age 32. Analyses involved 827 individuals (81.5% of the surviving cohort) dentally examined at both ages, who also completed the OHIP-14 questionnaire at age 32, and whose mothers were interviewed at the age-5 assessment. Results There was a consistent gradient of relative risk across the categories of maternal self-rated oral health status at the age-5 assessment for having one or more impacts in the overall OHIP-14 scale, whereby risk was greatest among the study members whose mothers rated their oral health as "poor/edentulous", and lowest among those with an "excellent/fairly good" rating. In addition, there was a gradient in the age-32 mean OHIP-14 score, and in the mean number of OHIP-14 impacts at age 32 across the categories of maternal self-rated oral health status. The higher risk of having one or more impacts in the psychological discomfort subscale, when mother rated her oral health as "poor/edentulous", was statistically significant. Conclusions These data suggest that maternal self-rated oral health when a child is young has a bearing on that child's OHRQOL almost three decades later. The adult offspring of mothers with poor self-rated oral health had poorer OHRQOL outcomes, particularly in the psychological discomfort subscale.
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Affiliation(s)
- Dara M Shearer
- Department of Oral Sciences, School of Dentistry, PO Box 647, Dunedin 9054, New Zealand.
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Mundt T, Polzer I, Samietz S, Grabe HJ, Dören M, Schwarz S, Kocher T, Biffar R, Schwahn C. Gender-dependent associations between socioeconomic status and tooth loss in working age people in the Study of Health in Pomerania (SHIP), Germany. Community Dent Oral Epidemiol 2011; 39:398-408. [PMID: 21241349 DOI: 10.1111/j.1600-0528.2010.00607.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Individual impact and the effect magnitude of socioeconomic key indicators (income, education and occupation) and of gender on oral health are ambiguous. In primary analyses of cross-sectional data among participants of the Study of Health in Pomerania (north-east Germany), women with low school education and low income were at highest risk for missing teeth, whereas being single was a risk indicator for missing teeth in men. Using the 5-year follow-up of this study, we aimed at verifying these findings and at investigating the gender-dependent impact of key socioeconomic indicators on tooth loss. METHODS The longitudinal data originate from 1971 subjects (1062 women) aged 25-59 enrolled from 1997 to 2001 and again from 2002 to 2006. The effects of marital status, household income, school education and occupational prestige for tooth loss were examined by gender using negative binomial regression analyses. RESULTS Low education and low income were moderately [relative risks (RR) between 1.6 and 2.0] associated with tooth loss among both women and men, whereas occupational prestige was not. After multiple imputations of missing data, less-educated women with lower income exhibited the highest risk of tooth loss [RR=3.1; 95% confidence interval (CI)=1.7-5.5 for <10 years of school education and the lowest income tertile] and tooth loss was more likely in single men (RR=1.5; 95% CI=1.0-2.2) than in single women (RR=0.9; 95% CI=0.6-1.3). CONCLUSIONS The primary cross-sectional results were partly confirmed. Socioeconomic factors help to explain differences in tooth loss, although the causal pathways are speculative. To improve dental health, the policies should target not only the individual, e.g. oral health promotion, but also an entire population by better education and higher wage employment.
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Affiliation(s)
- Torsten Mundt
- Department of Prosthodontics, Gerodontology and Dental Materials, Center of Oral Health, University of Greifswald, Rotgerberstraße 8, Greifswald,Germany.
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Williams SD, Parker ED, Jamieson LM. Oral health-related quality of life among rural-dwelling indigenous Australians. Aust Dent J 2010; 55:170-6. [PMID: 20604759 DOI: 10.1111/j.1834-7819.2010.01220.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is limited information on the impact of poor oral health on Indigenous Australian quality of life. This study aimed to determine the prevalence, extent and severity of, and to calculate risk indicators for, poor oral health-related quality of life among a convenience sample of rural-dwelling Indigenous Australians. METHODS Participants (n = 468) completed a questionnaire that included socio-demographic, lifestyle, dental service utilization, dental self-care and oral health-related quality of life (OHIP-14) factors. RESULTS The prevalence of having experienced one or more of OHIP-14 items 'fairly often' or 'very often' was 34.8%. The extent of OHIP-14 scores was 1.88, while the severity was 15.0. Risk indicators for having experienced one or more of OHIP-14 items 'fairly often' or 'very often' included problem-based dental attendance, avoiding dental care because of cost, difficulty paying a $100 dental bill and non-ownership of a toothbrush. An additional risk indicator for OHIP-14 extent was healthcare card ownership, while additional indicators for OHIP-14 severity were healthcare card ownership and having had 5+ teeth extracted. CONCLUSIONS Risk indicators for poor oral health-related quality of life among this marginalized population included socio-economic factors, dentate status factors, dental service utilization patterns, financial factors and dental self-care factors.
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Affiliation(s)
- S D Williams
- Australian Research Centre for Population Oral Health, The University of Adelaide, South Australia, Australia
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