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Fazli M, Yazdani R, Mohebbi SZ, Shamshiri AR. Oral Health Literacy and Its Determinants in Young Couples. Front Dent 2023; 20:27. [PMID: 37701653 PMCID: PMC10493116 DOI: 10.18502/fid.v20i27.13345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 12/15/2022] [Indexed: 09/14/2023] Open
Abstract
Objectives: Oral health literacy (OHL) is an interplay of cultural, social and individual factors and plays an effective role in public health promotion. This study aimed to assess OHL and its socioeconomic and demographic determinants among young couples. Materials and Methods: This analytical cross-sectional study was conducted on 828 adults between 15 to 35 years in 2018 in Zanjan city. Data regarding their OHL were collected by using a 17-item Oral Health Literacy-Adult Questionnaire (OHL-AQ) that was filled out by a combination of self-report and interview. OHL was categorized as adequate, marginal, and inadequate. The effects of age and gender as demographic variables, and floor area per person as a proxy of financial status on OHL were also assessed. Data were analyzed using the linear and multinomial logistic regression models. Results: The mean OHL score was 7.86±3.83 out of 17 in equal number of males and females. Only 21% of the couples had adequate OHL. The socioeconomic, but not demographic variables had significant correlations with the qualitative and quantitative variables of OHL even after controlling for the effect of confounders. A correlation was particularly found between inadequate OHL and years of education [odds ratio:6.00; 95% CI: 3.86-9.28); P<0.001]. Conclusion: Socioeconomic factors had independent correlations with inadequate OHL. Participants with higher levels of education, those living in urban areas, and individuals with better financial status had higher levels of OHL and lower odds of inadequate OHL.
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Affiliation(s)
- Maryam Fazli
- Research Center for Caries Prevention, Dental Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Community Oral Health, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Yazdani
- Research Center for Caries Prevention, Dental Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Community Oral Health, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Simin Zahra Mohebbi
- Research Center for Caries Prevention, Dental Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Community Oral Health, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Reza Shamshiri
- Research Center for Caries Prevention, Dental Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Community Oral Health, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
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Suokko H, Tolvanen M, Virtanen J, Suominen A, Karlsson L, Karlsson H, Lahti S. Parent's self-reported tooth brushing and use of fluoridated toothpaste: Associations with their one-year-old child's preventive oral health behaviour. Community Dent Oral Epidemiol 2023; 51:311-317. [PMID: 35312099 DOI: 10.1111/cdoe.12742] [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: 03/24/2021] [Revised: 02/22/2022] [Accepted: 03/09/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of the study was to examine if the tooth brushing frequency and use of fluoridated toothpaste of the mother and father were associated with the tooth brushing frequency and use of fluoridated toothpaste for their 1-year-old child. METHODS This cross-sectional study is part of the FinnBrain Birth Cohort Study. Questionnaire data were obtained from 1672 mothers and 867 fathers on tooth brushing and use of fluoridated toothpaste, age, education, number of siblings and parity (when the child was 1-year-old). For 763 families (mother and father), data from both parents were available. Tooth brushing was dichotomized to at least twice daily (2× day) and less than 2× day, and use of fluoridated toothpaste for child to at least once daily and less than once daily. The association between brushing of child's teeth (both parents less than 2× day) and use of fluoridated toothpaste for the child (both parents less than once daily) with parent's own tooth brushing was modelled with logistic regression analyses adjusted for family-related variables (parents' age and education, number of older siblings) using odds ratios (OR) and 95% confidence intervals (CI). RESULTS Families in which both parents brushed their own teeth less than 2× day were more likely to brush their child's teeth less than 2× day than families in which both parents brushed their own teeth 2× day (OR = 9.23; 95%CI = 5.42-15.69). The likelihood of not brushing the child's teeth 2× day was less strong when at least one of the parents brushed his/her own teeth 2× day (mother 2× day: OR = 1.97; 95%CI = 1.25-3.10; father 2× day: OR = 2.85; 95%CI = 1.51-5.40). CONCLUSIONS Less frequent tooth brushing of both mothers and fathers was strongly associated with less frequent tooth brushing of their child. When educating parents on child oral home care, parents' own home care and inclusion of fathers also need more attention.
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Affiliation(s)
- Hanna Suokko
- Department of Community Dentistry, University of Turku, Turku, Finland
| | - Mimmi Tolvanen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Jorma Virtanen
- Department of Community Dentistry, University of Turku, Turku, Finland
- Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Auli Suominen
- Department of Community Dentistry, University of Turku, Turku, Finland
| | - Linnea Karlsson
- Centre for Population Health Research, University of Turku, Turku, Finland
- FinnBrain Birth Cohort Study, Department of Clinical Medicine, Turku Brain and Mind Center, University of Turku, Turku, Finland
- Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland
| | - Hasse Karlsson
- Centre for Population Health Research, University of Turku, Turku, Finland
- FinnBrain Birth Cohort Study, Department of Clinical Medicine, Turku Brain and Mind Center, University of Turku, Turku, Finland
- Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland
| | - Satu Lahti
- Department of Community Dentistry, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku, Turku, Finland
- FinnBrain Birth Cohort Study, Department of Clinical Medicine, Turku Brain and Mind Center, University of Turku, Turku, Finland
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Rajeh MT, Alutaibi AR, Al-Badah AA, Alsubhi AS, Alluhaybi MM. Using the Extended Theory of Planned Behavior to Assess Adults' Intentions of Preventive Dental Care. J Int Soc Prev Community Dent 2023; 13:141-147. [PMID: 37223450 PMCID: PMC10202253 DOI: 10.4103/jispcd.jispcd_217_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 03/04/2023] [Accepted: 03/16/2023] [Indexed: 05/25/2023] Open
Abstract
Objective The objective of this study was to test an extended theory of planned behavior (TPB) that includes attitudes, subjective norms and self-efficacy, sociodemographic variables, dental beliefs and insurance on the intention to seek preventive dental care among adults in Makkah, Saudi Arabia. Materials and Methods This cross-sectional study was conducted on 397 Saudi adults living in Makkah. Data were collected through a self-administered online questionnaire. Structural equation modeling was performed to analyze the various factors that affect the likelihood of people seeking dental care. Results The results of the study revealed that perceived norms (estimate = 0.14; P = 0.004) and self-efficacy (estimate = 0.22; P < 0.001) were associated with the likelihood of people getting preventive dental care. However, attitudes showed no effect on the likelihood of people seeking dental care. The study also explained that the relationship between the beliefs of people and the intention to receive preventive care was moderated by subjective norms and perceived behavioral control (indirect effect t = 0.089, P < 0.001). Conclusion The study's results revealed that an integrative model of behavior prediction could be used to design effective interventions and strategies to enhance the likelihood of individuals seeking preventive dental care. In particular, these strategies should focus on enhancing subjective norms and self-efficacy.
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Affiliation(s)
- Mona Talal Rajeh
- Department of Dental Public Health, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
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El Tantawi M, Aly NM, Folayan MO. Unemployment and expenditure on health and education as mediators of the association between toothbrushing and global income inequalities. BMC Oral Health 2022; 22:539. [DOI: 10.1186/s12903-022-02570-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 11/08/2022] [Indexed: 11/25/2022] Open
Abstract
Abstract
Objective
The study assessed the association of country-level income inequalities with the percentage of schoolchildren toothbrushing-at-least-twice-daily; and the mediating effect of country-level unemployment rate and governmental expenditure on health and education (EH&E).
Methods
This was an ecological study. The dependent variable was country-level toothbrushing-at-least-twice-daily among 11-15-year-old schoolchildren. Data for the period 2009 to 2019 were extracted from two global surveys about schoolchildren’s health and from manuscripts identified through a systematic search of three databases. The independent variable was country-level income inequalities measured by the Gini coefficient (GC) extracted from the Sustainable Development Report 2021. The mediators were the unemployment rate and EH&E. We stratified the sample by the level of GC and assessed the correlation between the dependent and independent variables in each stratum. Linear regression was used to assess the relations between the dependent and independent variables, and mediation path analysis was used to quantify the direct, indirect, and total effects.
Results
Data were available for 127 countries. The mean (SD) percentage of children who brushed-at-least-twice-daily was 67.3 (16.1), the mean (SD) GC = 41.4 (8.2), unemployment rate = 7.5 (4.7) and EH&E = 8.4 (3.3). The percentage of children brushing at-least-twice-daily had weak and non-significant correlation with GC that was positive in countries with the least inequality and negative for countries with higher levels of inequality. A greater percentage of schoolchildren brushing-at-least-twice-daily was significantly associated with higher GC (B = 0.76, 95%CI: 0.33, 1.18), greater EH&E (B = 1.67, 95%CI: 0.69, 2.64) and lower unemployment rate (B=-1.03, 95%CI: -1.71, -0.35). GC had a significant direct positive effect (B = 0.76, 95%CI: 0.33, 1.18), a significant indirect negative effect through unemployment and EH&E (B=-0.47, 95%CI: -0.79, -0.24) and a non-significant total positive effect (B = 0.29, 95%CI: -0.09, 0.67) on the percentage of schoolchildren brushing-at-least-twice-daily.
Conclusion
Unemployment and EH&E mediated the association between income inequality and toothbrushing. Country-level factors may indirectly impact toothbrushing.
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Du S, Cheng M, Zhang C, Xu M, Wang S, Wang W, Wang X, Feng X, Tai B, Hu D, Lin H, Wang B, Wang C, Zheng S, Liu X, Rong W, Wang W, Xu T, Si Y. Income-related inequality and decomposition of edentulism among aged people in China. BMC Oral Health 2022; 22:215. [PMID: 35641983 PMCID: PMC9153164 DOI: 10.1186/s12903-022-02246-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/18/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The aim of this study was to assess the income-related inequality of edentulism among the aged in China and identify the contributing factors.
Methods
A secondary analysis of data from the 4th National Oral Health Epidemiology Survey in China was conducted, and 65–74 years old were selected for the analysis of income-related inequality of edentulism. The concentration curve, Concentration index (CI) and Erreygers-corrected concentration index (EI) were used to represent inequality and its degree qualitatively and quantitatively, respectively. A decomposition method based on probit model was employed to determine the contributors of inequality, including demographic factors, income status, oral health-related knowledge, attitude and practices and self-perceived general health status.
Results
In China, aged people with edentulism were concentrated in the poor. The CI was − 0.2337 (95% CIs: − 0.3503, − 0.1170). The EI was − 0.0413 (95% CIs: − 0.0619, − 0.0207). The decomposition results showed that income (75.02%) and oral health-related knowledge, attitude and practices (15.52%) were the main contributors to the inequality.
Conclusion
This study showed that pro-poor inequality among the elderly with edentulism existed in China. Corresponding policies against the contributors could be considered to promote the health equality of the elders.
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Kazemi-Karyani A, Yahyavi Dizaj J, Khoramrooz M, Soltani S, Soofi M, Irandoust K, Ramezani-Doroh V. Socio-economic inequality in reported dental self-care behavior among Iranian households: a national pooled study. Int J Dent Hyg 2022; 20:689-699. [PMID: 35080140 DOI: 10.1111/idh.12585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/27/2021] [Accepted: 01/21/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Setting out effective prevention strategies in dental diseases needs recognition related factors of the prevention behaviors and targeting the most disadvantaged groups in the term of dental hygiene. This study aimed to investigate socio-economic inequality in the dental self-care status (DSS) of Iranian households and decompose the measured inequality into its contributors. METHOD In this cross-sectional study pooled data was extracted from Households Income and Expenditure Surveys (HIESs) conducted in Iran from 2012 to 2017. The index of socioeconomic status (SES) for each household was constructed using principal components analysis (PCA). We used Wagstaff normalized concentration index as a measure of socioeconomic inequality in dental self-care. Decomposition analysis was applied to determine the main factors contributed to the measured inequality. RESULTS The prevalence of dental self-care in the whole population was 40.56%. The total concentration index was 0.271 (CI: 0.266, 0.275). The results of decomposition analysis for the measured inequality showed that SES, was the highest positive contributors (90.19 %) followed by sex of household's head (12.15 %), place of residence (11.79 %), and education level of household's head (11.71 %). Furthermore, the province of residence had the highest negative contribution (-11.37) to the inequality. CONCLUSION The findings of this study showed that a huge portion of the observed inequality was explained by SES that might give us a policy recommendation: There is room for improving dental health and reducing inequality in dental self-care by paying more attention to SES-disadvantaged households.
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Affiliation(s)
- Ali Kazemi-Karyani
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Jafar Yahyavi Dizaj
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Khoramrooz
- Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Shahin Soltani
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Moslem Soofi
- Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Kamran Irandoust
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Vajihe Ramezani-Doroh
- Department of Health Management and Economics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.,Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
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Ahmadi A, Shirani M, Khaledifar A, Hashemzadeh M, Solati K, Kheiri S, Sadeghi M, Mohammadian-Hafshejani A, Shahraki HR, Asgharzadeh A, Salehifard AZ, Mousavi M, Zarean E, Goujani R, Nazari SSH, Poustchi H, Dugué PA. Non-communicable diseases in the southwest of Iran: profile and baseline data from the Shahrekord PERSIAN Cohort Study. BMC Public Health 2021; 21:2275. [PMID: 34903205 PMCID: PMC8670056 DOI: 10.1186/s12889-021-12326-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 11/28/2021] [Indexed: 11/10/2022] Open
Abstract
Background Critical inter-provincial differences within Iran in the pattern of non-communicable diseases (NCDs) and difficulties inherent to identifying prevention methods to reduce mortality from NCDs have challenged the implementation of the provincial health system plan. The Shahrekord Cohort Study (SCS) was designed to address these gaps in Chaharmahal and Bakhtiari, a province of high altitude in the southwest of Iran, characterized by its large Bakhtiari population, along with Fars and Turk ethnicity groups. Methods This ongoing cohort, a prospective, large-scale longitudinal study, includes a unique, rich biobank and was conducted for the first time in Chaharmahal and Bakhtiari Province in Iran. SCS is a part of the PERSIAN (Prospective Epidemiological Research Studies in IrAN) cohort. The study began in 2015, recruited 10075 participants (52.8% female, 47.2% male) from both urban (n=7034) and rural (n=3041) areas, and participants will be annually followed up for at least 15 years. A cross-sectional analysis was conducted using baseline data from the SCS, using descriptive statistics and logistic regression. Data analysis was performed using Stata software. Results The prevalence of NCDs was 9.8% for type 2 diabetes, 17.1% for hypertension, 11.6% for thyroid disease, 0.2% for multiple sclerosis and 5.7, 0.9 and 1.3% for ischemic heart disease, stroke and myocardial infarction, respectively. The prevalence of multimorbidity (≥2 NCDs) was higher in women (39.1%) than men (24.9%). The means (standard deviations) of age, BMI, systolic blood pressure and fasting blood glucose were 49.5 (9) years, 27.6 (4.6) kg/m2, 115.4 (17.3) mmHg and 96.7 (27.3) mg/dL, respectively. Logistic regression models showed that older age, female gender, living in an urban area, non-native ethnicity, high wealth index, unemployment, obesity, low physical activity, hypertriglyceridemia, high fasting blood sugar, alkaline urine pH and high systolic and diastolic blood pressure were associated with increased prevalence of NCDs. Conclusions The SCS provides a platform for epidemiological studies that will be useful to better control NCDs in the southwest of Iran and to foster research collaboration. The SCS will be an essential resource for identifying NCD risk factors in this region and designing relevant public health interventions.
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Affiliation(s)
- Ali Ahmadi
- Modeling in Health Research Center, Shahrekord University of Medical Sciences, P.O. Box: 881-55383, Shahrekord, Iran. .,Department of Epidemiology and Biostatistics, School of Public Health, Shahrekord University of Medical Sciences, P.O. Box: 881-55383, Shahrekord, Iran.
| | - Majid Shirani
- Department of Urology, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Arsalan Khaledifar
- Modeling in Health Research Center, Shahrekord University of Medical Sciences, P.O. Box: 881-55383, Shahrekord, Iran.,Department of Cardiology, School of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Morteza Hashemzadeh
- Cellular and Molecular Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Kamal Solati
- Department of Psychiatry, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Soleiman Kheiri
- Modeling in Health Research Center, Shahrekord University of Medical Sciences, P.O. Box: 881-55383, Shahrekord, Iran.,Department of Epidemiology and Biostatistics, School of Public Health, Shahrekord University of Medical Sciences, P.O. Box: 881-55383, Shahrekord, Iran
| | - Mehraban Sadeghi
- Department of Environmental Engineering, School of Public Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Abdollah Mohammadian-Hafshejani
- Modeling in Health Research Center, Shahrekord University of Medical Sciences, P.O. Box: 881-55383, Shahrekord, Iran.,Department of Epidemiology and Biostatistics, School of Public Health, Shahrekord University of Medical Sciences, P.O. Box: 881-55383, Shahrekord, Iran
| | - Hadi Raeisi Shahraki
- Modeling in Health Research Center, Shahrekord University of Medical Sciences, P.O. Box: 881-55383, Shahrekord, Iran.,Department of Epidemiology and Biostatistics, School of Public Health, Shahrekord University of Medical Sciences, P.O. Box: 881-55383, Shahrekord, Iran
| | - Alireza Asgharzadeh
- School of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | | | - Masoumeh Mousavi
- Modeling in Health Research Center, Shahrekord University of Medical Sciences, P.O. Box: 881-55383, Shahrekord, Iran.,Department of Epidemiology and Biostatistics, School of Public Health, Shahrekord University of Medical Sciences, P.O. Box: 881-55383, Shahrekord, Iran
| | - Elaheh Zarean
- Modeling in Health Research Center, Shahrekord University of Medical Sciences, P.O. Box: 881-55383, Shahrekord, Iran
| | - Reza Goujani
- Modeling in Health Research Center, Shahrekord University of Medical Sciences, P.O. Box: 881-55383, Shahrekord, Iran
| | - Seyed Saeed Hashemi Nazari
- Safety Promotion and Injury Prevention Research Center, Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Poustchi
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Pierre-Antoine Dugué
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia.,Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
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Ju X, Do LG, Brennan DS, Luzzi L, Jamieson LM. Inequality and Inequity in the Use of Oral Health Services in Australian Adults. JDR Clin Trans Res 2021; 7:389-397. [PMID: 34315314 DOI: 10.1177/23800844211027489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Social determinants drive disparities in dental visiting. This study aimed to measure inequality and inequity in dental visiting among Australian adults. METHODS Data were obtained from the National Study of Adult Oral Health (2017 to 2018). Participants were Australian adults aged ≥30 y. The outcome of interest was dental visiting in the last 12 mo. Disparity indicators included education and income. Other sociodemographic characteristics included age, gender, Indigenous status, main language, place of birth, residential location, health card and dental insurance status, and individual's self-rated and impaired oral health. To characterize inequality in dental service use, we examined bivariate relationships using indices of inequality: the absolute and relative concentration indexes and the slope and relative indexes of inequality. Inequalities were depicted through concentration curves. Indirect standardization with a nonlinear model was used to measure inequity. RESULTS A total of 9,919 Australian adults were included. Bivariate analysis showed a gradient by education and income on dental visiting, with 48% of those with lowest educational attainment/income having not visited a dentist in the last 12 mo. The concentration curves showed pro-low education and pro-poor income inequalities. All measures of absolute and relative indices were negative, indicating that from the bottom to the top of the socioeconomic ladder (education and income), the prevalence of no dental visiting decreased: absolute and relative concentration index estimates were approximately 2.5% and 5.0%, while the slope and relative indexes of inequality estimates were 14% to 18% and 0.4%, respectively. After need standardization, the group with the highest education or income had almost 1.5-times less probability of not having a dental visit in the previous year than those with the lowest education or income. CONCLUSION The use of oral health services exhibited socioeconomic inequalities and inequities, disproportionately burdening disadvantaged Australian adults. KNOWLEDGE TRANSFER STATEMENT The results of this study can be used by policy makers when planning a dental labor force in relation to the capacity of supply dental services to 1) reduce the inequality and inequity in the use of oral health services and 2) meet identified oral health needs across the Australian population, which is important for preventive dental care.
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Affiliation(s)
- X Ju
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, Australia
| | - L G Do
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, Australia
| | - D S Brennan
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, Australia
| | - L Luzzi
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, Australia
| | - L M Jamieson
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, Australia
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Ju X, Mejia GC, Wu Q, Luo H, Jamieson LM. Use of oral health care services in the United States: unequal, inequitable-a cross-sectional study. BMC Oral Health 2021; 21:370. [PMID: 34301209 PMCID: PMC8299583 DOI: 10.1186/s12903-021-01708-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 07/01/2021] [Indexed: 11/17/2022] Open
Abstract
Background Social determinants drive disparities in dental visiting. Disparities can be measured simply by comparing outcomes between groups (inequality) but can also consider concepts of social justice or fairness (inequity). This study aimed to assess differences in dental visiting in the United States in terms of both social inequality and inequity. Methods Data were obtained from a cross-sectional study—the National Health and Nutrition Examination Survey (NHANES) 2015–2016, and participants were US adults aged 30+ years. The outcome of interest, use of oral health care services, was measured in terms of dental visiting in the past 12 months. Disparity was operationalized through education and income. Other characteristics included age, gender, race/ethnicity, main language, country of birth, citizenship and oral health status. To characterize existing inequality in dental service use, we examined bivariate relationships using indices of inequality: the absolute and relative concentration index (ACI and RCI), the slope index of inequality (SII) and relative index of inequality (RII) and through concentration curves (CC). Indirect standardization with a non-linear model was used to measure inequity. Results A total of 4745 US adults were included. Bivariate analysis showed a gradient by both education and income in dental visiting, with a higher proportion (> 60%) of those with lower educational attainment /lower income having not visited a dentist. The concentration curves showed pro-higher education and income inequality. All measures of absolute and relative indices were negative, indicating that from lower to higher socioeconomic position (education and income), the prevalence of no dental visiting decreased: ACI and RCI estimates were approximately 8% and 20%, while SII and RII estimates were 50% and 30%. After need-standardization, the group with the highest educational level had nearly 2.5 times- and the highest income had near three times less probability of not having a dental visit in the past 12 months than those with the lowest education and income, respectively. Conclusion The findings indicate that use of oral health care is threatened by existing social inequalities and inequities, disproportionately burdening disadvantaged populations. Efforts to reduce both oral health inequalities and inequities must start with action in the social, economic and policy spheres.
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Affiliation(s)
- Xiangqun Ju
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide Health and Medical Sciences Building, Adelaide, 5005, Australia.
| | - Gloria C Mejia
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide Health and Medical Sciences Building, Adelaide, 5005, Australia.,SA Aboriginal Chronic Disease Consortium, Wardliparingga, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Qiang Wu
- Department of Biostatistics, College of Allied Health Sciences, East Carolina University, Greenville, USA
| | - Huabin Luo
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, USA
| | - Lisa M Jamieson
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide Health and Medical Sciences Building, Adelaide, 5005, Australia
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