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Allen F, Guarnizo-Herreño CC, Fan SY, Tsakos G. Does subsidizing the cost of care impact on dental attendance patterns among older adults? Community Dent Oral Epidemiol 2024; 52:328-335. [PMID: 38084824 DOI: 10.1111/cdoe.12934] [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: 05/04/2023] [Revised: 09/29/2023] [Accepted: 11/27/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVES To assess whether eligibility for an age-related universal (pioneer generation [PG]) subsidy incentivises dental attendance by older Singaporeans. METHODS Data were collected between 2018 and 2021 from in-person interviews of Singaporean adults aged 60-90 years using a questionnaire and a clinical examination. The questionnaire included details of age, gender, ethnicity, education, residential status, socio-economic status, marital status, eligibility for subsidy (community health assistance/CHAS, PG or both) and frequency of dental attendance. The clinical examination recorded number of teeth (categorized as edentulous, 1-9 teeth;10-19 teeth; ≥20 teeth). To estimate the effect of the PG subsidy on dental attendance pattern, a regression discontinuity (RD) analysis was applied using age as the assignment variable. RESULTS A total of 1172 participants aged 60-90 years (64.2% female) were recruited, with 498 (43%) being eligible for the PG subsidy. For those eligible for PG subsidy, there was a higher proportion of regular attenders than irregular attenders (53.6% vs. 46.4%). In age adjusted RD analysis, those eligible for the PG subsidy were 1.6 (95% CI: 1.0, 2.7) times more likely to report regular attendance than their PG non-eligible counterparts. The association remained strong (OR 2.1; 95% CI: 1.1-3.7) even after further controlling for demographics, socioeconomic factors, number of teeth and eligibility for the CHAS subsidy. CONCLUSIONS Being eligible for the PG subsidy substantially increased the odds of regular dental attendance.
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Affiliation(s)
- Finbarr Allen
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
- Cork Dental School and Hospital, University College Cork, Cork, Ireland
| | | | - Sim Yu Fan
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | - Georgios Tsakos
- Department of Epidemiology and Public Health, University College London, London, UK
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Alautry HF, Namdari M, Khoshnevisan MH, Ghasemi H. Association between dental clinical measures and oral health-related quality of life among Iraqi schoolchildren: A cross-sectional study. PLoS One 2024; 19:e0293024. [PMID: 38662710 PMCID: PMC11045104 DOI: 10.1371/journal.pone.0293024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 10/04/2023] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVE The aim of this study was to assess the association between dental clinical measures and oral health-related quality of life (OHRQoL) together with the potential mediating role of sociodemographic factors and oral health behaviours on this association in a group of Iraqi children. METHODS The target population for this cross-sectional study consisted of 372 primary school children aged 8-10 years in the city of Kut, Iraq, during the year 2022. The participants were selected using a multi-stage random sampling technique. Detailed information about the children was collected through a comprehensive questionnaire that included demographic characteristics, oral health-related behaviors, the Arabic version of the Child Perceptions Questionnaire for 8-10-year-olds (CPQ8-10), and parental knowledge regarding oral health. Additionally, clinical dental evaluations were conducted, which included assessments of decayed, missing, and filled surfaces (DMFS, dmfs) as well as teeth (DMFT, dmft). Simplified oral hygiene index (OHI-S), bleeding on probing (BOP), and the community periodontal index (CPI) were also recorded for each participant using the recommended methodology by the World Health Organization (WHO). The statistical analysis included the Chi-square test, independent t-test, and simple and multiple linear regressions. RESULTS The mean age of the children was 9.0 (± 0.82) years. About one-third of children reported brushing at least two times per day and consuming a sweet snack once a day. Visiting a dentist during the past year was reported by 21% of children. Oral health behaviours demonstrated a significant association with the total CPQ8-10 scores (p < 0.001). Based on adjusted effects (β and 95% CI) from the multiple linear regressions, untreated dental caries (dt > 0, DT > 0) had a negative impact on the total CPQ8-10 score (adjusted β = 2.3 (95% CI: 0.67 to 3.91) and 3.4 (95% CI: 2.14 to 4.56), respectively). Decayed surfaces (DS), and teeth (DT) were associated with the total score of the CPQ8-10 and all its subscales (adjusted β range = 0.1 (95% C.I.: 0.03 to 0.19)-1.0 (95% CI: 0.72 to 1.26) and 0.2 (95% CI: 0.004 to 0.40)-1.2 (95% CI: 0.91 to 1.67), respectively). There was an association between oral hygiene index and total CPQ8-10 scores (adjusted β = 1.8 (95% CI: 0.62 to 3.02)), especially the functional limitations and emotional well-being subscales. CONCLUSION Findings of this study emphasizes the negative impact of dental caries and poor oral hygiene on children's OHRQoL. This association is highlighted more when considering that over two-thirds of these children do not comply with favourable levels of oral health behaviour. Enhancing the level of OHRQoL among these children, therefore, necessitates comprehensive programs for decreasing the volume of unmet oral health needs and improving children's adherence to recommended oral health behaviours.
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Affiliation(s)
- Hanan Fadhil Alautry
- Department of Community Oral Health, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahshid Namdari
- Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Hossein Khoshnevisan
- Department of Community Oral Health, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hadi Ghasemi
- Department of Community Oral Health, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Guarnizo-Herreño CC, Celeste RK, Peres MA. The ongoing fight for population oral health. Lancet 2024:S0140-6736(24)00536-1. [PMID: 38518794 DOI: 10.1016/s0140-6736(24)00536-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 03/13/2024] [Indexed: 03/24/2024]
Affiliation(s)
- Carol C Guarnizo-Herreño
- Departamento de Salud Colectiva, Facultad de Odontología, Universidad Nacional de Colombia, Bogotá, Colombia.
| | - Roger Keller Celeste
- Department of Preventive and Social Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Marco A Peres
- National Dental Research Institute, National Dental Centre and Oral Health Academic Clinical Programme and Health Services and Systems Research Program, Duke-NUS Medical School, Singapore
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Anticona C, Suominen AL, Holgerson PL, Gustafsson PE. Impact of an oral care subsidization reform on intersectional inequities in self-rated oral health in Sweden. Int J Equity Health 2024; 23:63. [PMID: 38504240 PMCID: PMC10953229 DOI: 10.1186/s12939-024-02121-7] [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] [Received: 09/27/2023] [Accepted: 02/02/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Oral health in Sweden is good at the population level, but seemingly with persisting or increasing inequities over the last decades. In 2008, a major Swedish reform introduced universal partial subsidies to promote preventive care and reduce the treatment cost for patients with extensive care needs. This study aimed to apply an intersectional approach to assess the impact of the 2008 subsidization reform on inequities in self-rated oral health among adults in Sweden over the period 2004-2018. METHODS Data from 14 national surveys conducted over 2004-2018 were divided into three study periods: pre-reform (2004-2007), early post-reform (2008-2012) and late post-reform (2013-2018). The final study population was 118,650 individuals aged 24-84 years. Inequities in self-rated oral health were examined by intersectional analysis of individual heterogeneity and discriminatory accuracy across 48 intersectional strata defined by gender, age, educational level, income, and immigrant status. RESULTS Overall, the prevalence of poor self-rated oral health decreased gradually after the reform. Gender-, education- and income-related inequities increased after the reform, but no discernible change was seen for age- or immigration-related inequities. The majority of intersectional strata experienced patterns of persistently or delayed increased inequities following the reform. CONCLUSIONS Increased inequities in self-rated oral health were found in most intersectional strata following the reform, despite the seemingly positive oral health trends at the population level. Applying an intersectional approach might be particularly relevant for welfare states with overall good oral health outcomes but unsuccessful efforts to reduce inequities.
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Affiliation(s)
- Cynthia Anticona
- Department of Epidemiology and Global Health, Umeå University, Umeå, SE-90187, Sweden.
- Department of Odontology, Umeå University, Umeå, SE-90187, Sweden.
| | - Anna Liisa Suominen
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
- Oral and Maxillofacial Teaching Unit, Kuopio University Hospital, Kuopio, Finland
| | - Pernilla Lif Holgerson
- Department of Odontology, Section of Pediatric Dentistry, Umeå University, Umeå, SE-90187, Sweden
| | - Per E Gustafsson
- Department of Epidemiology and Global Health, Umeå University, Umeå, SE-90187, Sweden
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Henschke C, Winkelmann J, Eriksen A, Orejas Pérez E, Klingenberger D. Oral health status and coverage of oral health care: A five-country comparison. Health Policy 2023; 137:104913. [PMID: 37757534 DOI: 10.1016/j.healthpol.2023.104913] [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: 08/31/2022] [Revised: 09/01/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023]
Abstract
Oral health has received increased attention in health services research and policy. This study aims to assess oral health outcomes and public coverage of oral health services in Belgium, Denmark, Germany, the Netherlands, and Spain. Various indicators were used to compare oral health outcomes concerning the most common disorders by age group. Coverage of oral health services was analyzed according to the dimensions of the WHO Universal Coverage Cube. The results showed major differences in the coverage of services for the adult population: coverage was most comprehensive in Germany, followed by Belgium and Denmark. In Spain and the Netherlands, public coverage was limited. Except in Spain, coverage of oral health services for children was high, although with some differences between countries. Regarding oral health outcomes measured by the T-Health index, no country showed outstanding results across all age groups. While Denmark, the Netherlands, and Spain performed above average among 5- to 7-year-olds, Denmark and Germany performed above average among 12- to 14-year-olds, the Netherlands, Spain, and Belgium among 35- to 44-year-olds, and Belgium and the Netherlands among 65- to 74-year-olds. The selection of countries of this study was limited due to the availability and quality of oral health data demonstrating the urgent need for the European member states to establish corresponding databases.
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Affiliation(s)
- Cornelia Henschke
- Department of Health Care Management, Technische Universität, Berlin, Germany; Berlin Centre for Health Economics Research, Technische Universität, Berlin, Germany.
| | | | - Astrid Eriksen
- Department of Health Care Management, Technische Universität, Berlin, Germany
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Raittio E, Suominen AL. Effects of universal oral healthcare coverage in an adult population: A long-term nationwide natural experiment. Community Dent Oral Epidemiol 2023; 51:908-917. [PMID: 36036466 DOI: 10.1111/cdoe.12785] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/20/2022] [Accepted: 08/05/2022] [Indexed: 09/19/2023]
Abstract
OBJECTIVES A large and long-term natural experiment occurred in Finland from the late 1980s-2000, when adults' entitlement to subsidized oral healthcare was strongly dependent on the arbitrary classification based on their year of birth: people born in 1956 or later were entitled to subsidized care, while people born before 1956 were not. The aim of this study was to investigate the effect of this expanded universal oral healthcare coverage on service use and oral health outcomes. METHODS Data from annual nationally representative cross-sectional postal surveys among 15-64-year-olds between 1990 and 2014 were used. For this study, the following outcome variables were formed: experiencing toothache during the past month (yes/no), the number of missing teeth with three different thresholds (over 10, over 5 or at least 1 missing tooth), brushing more than once a day and the number of visits to the dentist. Regression discontinuity plots and bias-corrected local polynomial regression discontinuity estimators measuring the effect of the extended universal coverage on the outcomes at the year-of-birth cut-off of 1956 were generated separately from the data from 1990 to 2000 and from 2002 to 2014. RESULTS Between 1990 and 2000, the number of visits to the dentist (0.2 visits, 95% CI, confidence intervals: -0.03; 0.43) and the proportion of those who visited the dentist during the past 12 months (4.2%, 95% CI: 0.1%; 8.3%) increased at the year-of-birth cut-off of 1956. There were minor drops (1.5%-1.9%) in the number of missing teeth across all thresholds (over 10, over 5, or at least 1 missing teeth) at the cut-off. Analyses with the data from the surveys from 2002 to 2014 showed that there were no discontinuities in these outcomes at the cut-off of 1956. Regression discontinuity estimates related to toothache experience and toothbrushing frequency were inconclusive due to high variability in the underlying data and the likely small effect of the more universal coverage on these outcomes. CONCLUSIONS The current study provided evidence of the beneficial effects of universal oral healthcare coverage on the oral healthcare service use and teeth preservation from a large and long-term natural experiment occurred in Finland from the late 1980s to 2000.
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Affiliation(s)
- Eero Raittio
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
| | - Anna Liisa Suominen
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
- Oral Health Teaching Clinic, Kuopio University Hospital, Kuopio, Finland
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
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Corovic S, Janicijevic K, Radovanovic S, Vukomanovic IS, Mihaljevic O, Djordjevic J, Djordjic M, Stajic D, Djordjevic O, Djordjevic G, Radovanovic J, Selakovic V, Slovic Z, Milicic V. Socioeconomic inequalities in the use of dental health care among the adult population in Serbia. Front Public Health 2023; 11:1244663. [PMID: 37790713 PMCID: PMC10545090 DOI: 10.3389/fpubh.2023.1244663] [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: 06/22/2023] [Accepted: 09/05/2023] [Indexed: 10/05/2023] Open
Abstract
Objectives The aim of this paper is to assess the association of demografic and socioeconomic determinants with utilization of dental services among Serbian adults. Materials and methods The study is a part of the population health research of Serbia, conducted in the period from October to December 2019 by the Institute of Statistics of the Republic of Serbia in cooperation with the Institute of Public Health of Serbia "Dr. Milan JovanovićBatut" and the Ministry of Health of the Republic of Serbia. The research was conducted as a descriptive, cross-sectional analytical study on a representative sample of the population of Serbia. For the purposes of this study, data on the adult population aged 20 years and older were used. Results Men were approximately 1.8 times more likely than women to not utilize dental healthcare services (OR = 1.81). The likelihood of not utilizing dental healthcare protection rises with increasing age, reaching its peak within the 65-74 age range (OR = 0.441), after which it declines. Individuals who have experienced marital dissolution due to divorce or the death of a spouse exhibit a higher probability of not utilizing health protection (OR = 1.868). As the level of education and wealth diminishes, the probability of abstaining from health protection increases by 5.8 times among respondents with an elementary school education (OR = 5.852) and 1.7 times among the most economically disadvantaged respondents (OR = 1.745). Regarding inactivity, respondents who are not employed have a 2.6-fold higher likelihood of not utilizing oral health care compared to employed respondents (OR = 2.610). Conclusion The results suggest that individual sociodemographic factors influence utilization of dental services by Serbian adults and confirmed the existence of socioeconomic disparities.
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Affiliation(s)
- Snezana Corovic
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Katarina Janicijevic
- Department of Social Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Snezana Radovanovic
- Department of Social Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Faculty of Medical Sciences, Center for Harm Reduction of Biological and Chemical Hazards, University of Kragujevac, Kragujevac, Serbia
- Institute for Public Health, Kragujevac, Serbia
| | - Ivana Simic Vukomanovic
- Department of Social Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Institute for Public Health, Kragujevac, Serbia
| | - Olgica Mihaljevic
- Department of Pathophysiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Jelena Djordjevic
- Department of Pathophysiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Milan Djordjic
- Department of Communication Skills, Ethics and Psychology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Dalibor Stajic
- Department of Hygiene and Ecology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Ognjen Djordjevic
- Institute for Public Health, Kragujevac, Serbia
- Department of Epidemiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Gordana Djordjevic
- Institute for Public Health, Kragujevac, Serbia
- Department of Epidemiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Jovana Radovanovic
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Viktor Selakovic
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Zivana Slovic
- Department of Forensic Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- University Clinical Centre Kragujevac, Forensic Medicine and Toxicology Service, Kragujevac, Serbia
| | - Vesna Milicic
- Department of Dermatovenerology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
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Kovács N, Liska O, Idara-Umoren EO, Mahrouseh N, Varga O. Trends in dental care utilisation among the elderly using longitudinal data from 14 European countries: A multilevel analysis. PLoS One 2023; 18:e0286192. [PMID: 37294829 PMCID: PMC10256212 DOI: 10.1371/journal.pone.0286192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 05/11/2023] [Indexed: 06/11/2023] Open
Abstract
BACKGROUND The use of dental care among older people is low compared to other forms of health care, with significant health consequences. However, the evidence on the extent to which countries' welfare systems and socio-economic factors influence the uptake of dental care by older people is limited. This study aimed to describe trends of dental care utilisation, and to compare use of dental care with other types of healthcare services among the elderly, considering different socio-economic factors and welfare systems in European countries. METHODS Multilevel logistic regression analysis was performed using longitudinal data from four waves (between Wave 5 and 8) of the Survey of Health, Ageing and Retirement in Europe database, with a follow-up period of 7 years. The study sample included 20,803 respondents aged 50 years or older from 14 European countries. RESULTS The annual dental care attendance was the highest in Scandinavian countries (85.7%), however, improving trends of dental attendance was recognized in Southern and Bismarckian countries (p<0.001). The difference in use of dental care services between socio-economic groups was expanding over time regarding low- and high-income level and residential area. A more marked difference was observed between social groups in dental care utilisation compared to other forms of care. Income level and unemployed status had significant effect on forgoing dental care due to cost and unavailability. CONCLUSION The observed differences between socioeconomic groups may highlight the health consequences of the different organization and financing of dental care. The elderly population could benefit from adopting policies aiming to reduce the financial barriers to dental care usage, especially in Southern and Eastern European countries.
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Affiliation(s)
- Nóra Kovács
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Orsolya Liska
- Faculty of Dentistry, Clinical Center, University of Debrecen, Debrecen, Hungary
| | | | - Nour Mahrouseh
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Orsolya Varga
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Office for Supported Research Groups, Eötvös Loránd Research Network, Budapest, Hungary
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Levy DH, Sgan-Cohen H, Solomonov M, Shemesh A, Ziv E, Glassberg E, Yavnai N. Association of Nationwide Water Fluoridation, Changes in Dental Care Legislation, and Caries-Related Treatment Needs: A 9-Year Record-Based Cross-Sectional Study. J Dent 2023; 134:104550. [PMID: 37196687 DOI: 10.1016/j.jdent.2023.104550] [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: 03/17/2023] [Revised: 05/06/2023] [Accepted: 05/15/2023] [Indexed: 05/19/2023] Open
Abstract
OBJECTIVES The implementation of nationwide water fluoridation in Israel in 2002 led to a significant reduction in caries among children. However, this practice was discontinued in 2014 due to a change in legislation. In 2010, as part of the Israeli National Health Insurance Law, free dental care for children under 10 years of age was legislated. This policy was gradually extended to include adolescents under 18 years of age in 2018. We examined the association between these efforts and changes in the caries-related treatment needs of young adults over the course of two decades. METHODS This cross-sectional study analyzed data on the need for dental restorations, root canal therapy, and extractions that were retrieved from dental records of 34,450 soldiers recruited into military service between 2012-2021. These data were cross-matched with the subjects' year of birth to determine whether the implementation of water fluoridation, dental care legislation, or both were associated with changes in the need for and provision of dental care. Sociodemographic data, including sex, age, socioeconomic cluster (SEC), intellectual capability score (ICS), body mass index, and place of birth, were also extracted. RESULTS A multivariate generalized linear model (GLM) revealed that male sex, older age, low ICS, and low SEC were significant predictors for greater caries-related treatment needs (P < 0.001). Our findings indicated that subjects exposed to fluoridated water during their childhood had significantly lower rates of caries-related treatment, regardless of access to free dental care. CONCLUSION Mandatory water fluoridation was associated with significantly lower caries-related treatment needs while national dental health legislation providing free dental care to children and adolescents was not. Therefore, we suggest that water fluoridation should be continued to maintain the observed reduction in treatment needs. CLINICAL SIGNIFICANCE Our findings provide support for the effectiveness of water fluoridation in preventing caries, whereas the impact of free dental care programs focused on clinical intervention remains to be determined.
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Affiliation(s)
- Dan Henry Levy
- Department of Endodontics, Israel Defense Forces (IDF) Medical corps, Sheba Hospital at Tel Hashomer, Israel; "Bina" Program, Faculty of Dental Medicine, Hebrew University, Jerusalem, Israel.
| | - Harold Sgan-Cohen
- Department of Community Dentistry, Faculty of Dental Medicine, Hebrew University, Jerusalem, Israel
| | - Michael Solomonov
- Department of Endodontics, Israel Defense Forces (IDF) Medical corps, Sheba Hospital at Tel Hashomer, Israel; "Bina" Program, Faculty of Dental Medicine, Hebrew University, Jerusalem, Israel
| | - Avi Shemesh
- Department of Endodontics, Israel Defense Forces (IDF) Medical corps, Sheba Hospital at Tel Hashomer, Israel; "Bina" Program, Faculty of Dental Medicine, Hebrew University, Jerusalem, Israel
| | - Eran Ziv
- Department of Endodontics, Israel Defense Forces (IDF) Medical corps, Sheba Hospital at Tel Hashomer, Israel; "Bina" Program, Faculty of Dental Medicine, Hebrew University, Jerusalem, Israel
| | | | - Nirit Yavnai
- Department of Community Dentistry, Faculty of Dental Medicine, Hebrew University, Jerusalem, Israel
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Saikia A, Aarthi J, Muthu MS, Patil SS, Anthonappa RP, Walia T, Shahwan M, Mossey P, Dominguez M. Sustainable development goals and ending ECC as a public health crisis. Front Public Health 2022; 10:931243. [PMID: 36330110 PMCID: PMC9624450 DOI: 10.3389/fpubh.2022.931243] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 09/20/2022] [Indexed: 01/24/2023] Open
Abstract
Early Childhood Caries (ECC) remains a global issue despite numerous advancements in research and interventional approaches. Nearly, 530 million children suffer from untreated dental caries of primary teeth. The consequences of such untreated dental caries not only limit the child's chewing and eating abilities but also, significantly impact the child's overall growth. Research has demonstrated that ECC is associated with nearly 123 risk factors. ECC has also been associated with local pain, infections, abscesses, and sleep pattern. Furthermore, it can affect the child's emotional status and decrease their ability to learn or perform their usual activities. In high-income countries, dental care continues to endorse a "current treatment-based approach" that involves high-technology, interventionist, and specialized approaches. While such approaches provide immediate benefit at an individual level, it fails to intercept the underlying causes of the disease at large. In low-income and middle-income countries (LMICs), the "current treatment approach" often remains limited, unaffordable, and unsuitable for the majority of the population. Rather, dentistry needs to focus on "sustainable goals" and integrate dental care with the mainstream healthcare system and primary care services. Dental care systems should promote "early first dental visits," when the child is 1 year of age or when the first tooth arrives. The serious shortages of appropriately trained oral healthcare personnel in certain regions of the world, lack of appropriate technologies and isolation of oral health services from the health system, and limited adoption of prevention and oral health promotion can pose as critical barriers. The oral health care systems must focus on three major keystones to combat the burden of ECC-1. Essential oral health services are integrated into healthcare in every country ensuring the availability of appropriate healthcare accessible and available globally, 2. Integrating oral and general healthcare to effectively prevent and manage oral disease and improve oral health, 3. Collaborating with a wide range of health workers to deliver sustainable oral health care tailored to cater to the oral health care needs of local communities.
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Affiliation(s)
- Ankita Saikia
- Department of Pediatric Dentistry, Centre for Early Childhood Caries Research (CECCRe), Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Jagadeesan Aarthi
- Department of Pediatric and Preventive Dentistry, Madha Dental College and Hospital, Chennai, India
| | - MS Muthu
- Department of Pediatric Dentistry, Centre for Early Childhood Caries Research (CECCRe), Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India,*Correspondence: MS Muthu
| | - Sneha S. Patil
- Department of Pediatric Dentistry, Centre for Early Childhood Caries Research (CECCRe), Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Robert Prashanth Anthonappa
- Dental School, Oral Developmental and Behavioural Sciences, University of Western Australia, Perth, WA, Australia
| | - Tarun Walia
- Centre of Medical and Bio allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
| | - Moayad Shahwan
- Centre of Medical and Bio allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
| | - Peter Mossey
- Dundee Dental School, University of Dundee, Dundee, United Kingdom
| | - Monica Dominguez
- Global Oral Health Programs, Smile Train Head Office, New York, NY, United States
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Elkhodary HM, Sabbagh HJ, El Meligy OAES, Talaat IM, Abdellatif EB, Mostafa MH, Khader Y, Al-Batayneh OB, Alhabli S, Al-Khanati NM, Qureshi S, Qureshi N, Yousaf MA, Marafi YF, Al Harrasi SN, Al-Rai S, Gomaa N, Mattar H, Bakhaider HA, Samodien B, Lố H, El Tantawi M. Children’s access to dental care during the COVID-19 pandemic: a multi-country survey. CHILDRENS HEALTH CARE 2022. [DOI: 10.1080/02739615.2022.2114478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Heba Mohamed Elkhodary
- Pediatric Dentistry Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Pedodontics and Oral Health, Faculty of Dental Medicine for Girls, Al Azhar University, Cairo, Egypt
| | - Heba Jafar Sabbagh
- Pediatric Dentistry Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Omar Abd El Sadek El Meligy
- Pediatric Dentistry Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
- Pediatric Dentistry and Dental Public Health Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Iman Mamdouh Talaat
- Clinical Sciences Department, College of Medicine, University of Sharjah, Sharjah, UAE
- Pathology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Enas B. Abdellatif
- Pediatric Dentistry and Dental Public Health Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Mohamed Hassan Mostafa
- Department of Pedodontics and Oral Health, Faculty of Dental Medicine for Girls, Al Azhar University, Cairo, Egypt
| | - Yousef Khader
- Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Jordan
| | - Ola B. Al-Batayneh
- Preventive Dentistry Department, Faculty of Dentistry, Jordan University of Science and Technology, Jordan
| | - Sara Alhabli
- Pediatric Dentistry Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Nuraldeen Maher Al-Khanati
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Syrian Private University, Damascus, Syria
| | - Shabnum Qureshi
- Department of Education, University of Kashmir, Srinagar, India
| | - Nafeesa Qureshi
- General Dental services NHS Tayside, NHS Tayside Scotland, DD2 2RZ, Dundee, United Kingdom
| | - Muhammad Abrar Yousaf
- Department of Biology, Faculty of Science and Technology, Virtual University of Pakistan, Lahore, Pakistan
| | | | | | - Sarah Al-Rai
- Department of Conservative and Preventive Dentistry, Faculty of Dentistry, Saba University, Yemen
| | - Noha Gomaa
- Oral Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
- Department of Oral Medicine, Children’s Health Research Institute, London, ON, Canada
| | - Hala Mattar
- Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Hanin A. Bakhaider
- Pediatric Dentistry Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Bahia Samodien
- Western Cape Education Department, Cape Town, South Africa
| | - Hanane Lố
- Department of Pediatric Dentistry, Clinique Dentaire D’Agadir, Morocco
| | - Maha El Tantawi
- Pediatric Dentistry and Dental Public Health Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
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Hoshi-Harada M, Aida J, Cooray U, Nakazawa N, Kondo K, Osaka K. Difference of income inequalities of denture use by co-payment rates: A JAGES cross-sectional study. Community Dent Oral Epidemiol 2022; 51:557-564. [PMID: 35569009 DOI: 10.1111/cdoe.12749] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 03/28/2022] [Accepted: 04/24/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Studies suggest that wearing dentures to restore missing teeth can have a positive impact on health status. However, income inequalities in denture wearing exist. The aim of this study was to investigate how differing co-payment rates under the current Japanese Universal Health Insurance Coverage System affect income inequalities in denture non-use among older adults with severe tooth loss. METHODS This cross-sectional study used data from the 2019 Japan Gerontological Evaluation Study (JAGES). Self-administered questionnaires were mailed to 345 356 independent people who did not receive long-term care insurance benefits and were aged ≥65 years. The dependent variable was denture non-use, and the independent variable was the equivalent annual household income. The Slope Index of Inequality (SII) and Relative Index of Inequality (RII) were used with regression-based approaches to determine both absolute and relative inequalities in denture non-use by co-payment rates. The covariates were sex, age, years of education, number of teeth and comorbidities. RESULTS Of the 240 889 responses received (response rate =69.9%), we analysed 21 594 participants who fulfilled the inclusion criteria. The mean age was 72.8 years (standard deviation =4.1), and 57.6% were men. For 30 per cent, 20 per cent and 10 per cent co-payment rates, the percentages of people who did not use dentures and had severe tooth loss (≤9 teeth) were 18.3%, 13.3%, and 8.5%, respectively. All analyses confirmed significant inequalities in denture non-use. The lower the co-payment rate, the smaller the inequalities. SIIs for each co-payment rate were as follows: 30 per cent =13.35% (95% confidence interval [CI] = 9.61-17.09); 20 per cent =7.85% (95% CI = 4.88-10.81); and 10 per cent =4.85% (95% CI = 2.55-7.16). Inclusion of interaction term between income and co-payment rate significantly lowered the inequalities by co-payment rate in logistic regression analysis and SII. For RII, although the interaction was not statistically significant, a similar trend was observed. CONCLUSIONS Income inequalities in denture use existed among older adults with severe tooth loss in Japan, and the inequalities appeared to be greater when the co-payment rate was higher.
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Affiliation(s)
- Manami Hoshi-Harada
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Jun Aida
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Japan
| | - Upul Cooray
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Noriko Nakazawa
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Katsunori Kondo
- Department of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University, Chiba, Japan.,Department of Gerontological Evaluation, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Ken Osaka
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan
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Winkelmann J, Gómez Rossi J, Schwendicke F, Dimova A, Atanasova E, Habicht T, Kasekamp K, Gandré C, Or Z, McAuliffe Ú, Murauskiene L, Kroneman M, de Jong J, Kowalska-Bobko I, Badora-Musiał K, Motyl S, Figueiredo Augusto G, Pažitný P, Kandilaki D, Löffler L, Lundgren C, Janlöv N, van Ginneken E, Panteli D. Exploring variation of coverage and access to dental care for adults in 11 European countries: a vignette approach. BMC Oral Health 2022; 22:65. [PMID: 35260137 PMCID: PMC8905841 DOI: 10.1186/s12903-022-02095-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 02/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Oral health, coupled with rising awareness on the impact that limited dental care coverage has on oral health and general health and well-being, has received increased attention over the past few years. The purpose of the study was to compare the statutory coverage and access to dental care for adult services in 11 European countries using a vignette approach. METHODS We used three patient vignettes to highlight the differences of the dimensions of coverage and access to dental care (coverage, cost-sharing and accessibility). The three vignettes describe typical care pathways for patients with the most common oral health conditions (caries, periodontal disease, edentulism). The vignettes were completed by health services researchers knowledgeable on dental care, dentists, or teams consisting of a health systems expert working together with dental specialists. RESULTS Completed vignettes were received from 11 countries: Bulgaria, Estonia, France, Germany, Republic of Ireland (Ireland), Lithuania, the Netherlands, Poland, Portugal, Slovakia and Sweden. While emergency dental care, tooth extraction and restorative care for acute pain due to carious lesions are covered in most responding countries, root canal treatment, periodontal care and prosthetic restoration often require cost-sharing or are entirely excluded from the benefit basket. Regular dental visits are also limited to one visit per year in many countries. Beyond financial barriers due to out-of-pocket payments, patients may experience very different physical barriers to accessing dental care. The limited availability of contracted dentists (especially in rural areas) and the unequal distribution and lack of specialised dentists are major access barriers to public dental care. CONCLUSIONS According to the results, statutory coverage of dental care varies across European countries, while access barriers are largely similar. Many dental services require substantial cost-sharing in most countries, leading to high out-of-pocket spending. Socioeconomic status is thus a main determinant for access to dental care, but other factors such as geography, age and comorbidities can also inhibit access and affect outcomes. Moreover, coverage in most oral health systems is targeted at treatment and less at preventative oral health care.
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Affiliation(s)
- Juliane Winkelmann
- Department of Healthcare Management, Technische Universität Berlin, H 80, Straße des 17. Juni 135, 10623, Berlin, Germany.
| | - Jesús Gómez Rossi
- Charité Universitätsmedizin, Department of Oral Diagnostics, Digital Health and Health Services Research, Aßmannshauser Straße 4-6, 14197, Berlin, Germany
| | - Falk Schwendicke
- Charité Universitätsmedizin, Department of Oral Diagnostics, Digital Health and Health Services Research, Aßmannshauser Straße 4-6, 14197, Berlin, Germany
| | - Antoniya Dimova
- Medical University - Varna, 55 Marin Drinov str, Varna, 9002, Bulgaria
| | - Elka Atanasova
- Medical University - Varna, 55 Marin Drinov str, Varna, 9002, Bulgaria
| | - Triin Habicht
- WHO Barcelona Office for Health Systems Financing, Sant Pau Art Nouveau Site (La Mercè pavilion), Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain
| | | | - Coralie Gandré
- Institute for Research and Information in Health Economics (IRDES), 117, bis Rue Manin, 75019, Paris, France
| | - Zeynep Or
- Institute for Research and Information in Health Economics (IRDES), 117, bis Rue Manin, 75019, Paris, France
| | - Úna McAuliffe
- Oral Health Services Research Centre and School of Public Health, University College Cork, Cork, T12K8AF, Ireland
| | - Liubove Murauskiene
- Department of Public Health, Institute of Health Sciences, Faculty of Medicine, Vilnius University, M. K. Čiurlionio g. 21/ 27, 03101, Vilnius, Lithuania
| | - Madelon Kroneman
- Nivel, Netherlands Institute for Health Services Research, Otterstraat 118, 3513 CR, Utrecht, The Netherlands
| | - Judith de Jong
- Nivel, Netherlands Institute for Health Services Research, Otterstraat 118, 3513 CR, Utrecht, The Netherlands
| | - Iwona Kowalska-Bobko
- Faculty of Health Science, Institute of Public Health, Jagiellonian University Medical College, ul. Skawińska 8, 31-066, Kraków, Poland
| | - Katarzyna Badora-Musiał
- Faculty of Health Science, Institute of Public Health, Jagiellonian University Medical College, ul. Skawińska 8, 31-066, Kraków, Poland
| | - Sylwia Motyl
- Institute of Dentistry, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Gonçalo Figueiredo Augusto
- Public Health Research Centre, National School of Public Health, Nova University Lisbon, Rua da Junqueira, 100, 1349-008, Lisbon, Portugal
| | - Peter Pažitný
- Prague University of Economics and Business, W. Churchill Sq. 1938/4, 130 67, Prague 3, Žižkov, Czech Republic
| | - Daniela Kandilaki
- Prague University of Economics and Business, W. Churchill Sq. 1938/4, 130 67, Prague 3, Žižkov, Czech Republic
| | | | - Carl Lundgren
- Vardanalys, Drottninggatan 89, 113 60, Stockholm, Sweden
| | - Nils Janlöv
- Vardanalys, Drottninggatan 89, 113 60, Stockholm, Sweden
| | - Ewout van Ginneken
- Department of Healthcare Management, Technische Universität Berlin, H 80, Straße des 17. Juni 135, 10623, Berlin, Germany.,European Observatory on Health Systems and Policies, WHO European Centre for Health Policy, Eurostation (Office 07C020), Place Victor Horta/Victor Hortaplein, 40/10, 1060, Brussels, Belgium
| | - Dimitra Panteli
- European Observatory on Health Systems and Policies, WHO European Centre for Health Policy, Eurostation (Office 07C020), Place Victor Horta/Victor Hortaplein, 40/10, 1060, Brussels, Belgium
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Cărămidă M, Țâncu AMC, Imre M, Dumitrache MA, Mihai C, Sfeatcu R. Patients' Perspective on Their Experience of Dental Treatments Covered by Public Health Insurance in Romania-A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:272. [PMID: 35010534 PMCID: PMC8744563 DOI: 10.3390/ijerph19010272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/16/2021] [Accepted: 12/23/2021] [Indexed: 06/14/2023]
Abstract
Although the aims of any public health coverage are prevention, diagnosis, treatment, rehabilitation, and maintenance, dental services are hardly ever included in services. The goal of our pilot study is to assess the perspective of a group of adult patients on their covered dental treatments. The present cross-sectional study was conducted on 140 patients who reported their perception by filling in a questionnaire. All the collected data were statistically analyzed using IBM SPSS Statistics 25. Most of the subjects (40.7%, n = 57) were treatment oriented, visiting the dentist only in an emergency situation. A total of 40.7% (n = 57) of the participants stated that all the dental treatments had coverage and 22.8% (n = 13) had to split their treatment plan because of the insurance budget limit. The subjects who had chosen covered dental services because they considered it was a right they should benefit from (53.7%, n = 22) and those who had chosen covered dental services because of financial reasons (29.3%, n = 12) were more frequently unsatisfied with the types of covered dental services. The reduced level of satisfaction was associated mainly with the list of dental procedures accepted for coverage and also with younger and highly educated patients. For a more accurate description, the present study should be completed by future studies not only on a representative population at national level, but also by assessing the perspective of dental professionals.
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Affiliation(s)
- Mariana Cărămidă
- Department of Oral Health and Community Dentistry, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 17–21 Calea Plevnei Street, Sector 1, 010221 Bucharest, Romania; (M.C.); (M.A.D.); (R.S.)
| | - Ana Maria Cristina Țâncu
- Department of Complete Denture, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 17–21 Calea Plevnei Street, Sector 1, 010221 Bucharest, Romania;
| | - Marina Imre
- Department of Complete Denture, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 17–21 Calea Plevnei Street, Sector 1, 010221 Bucharest, Romania;
| | - Mihaela Adina Dumitrache
- Department of Oral Health and Community Dentistry, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 17–21 Calea Plevnei Street, Sector 1, 010221 Bucharest, Romania; (M.C.); (M.A.D.); (R.S.)
| | - Christina Mihai
- Department of Preventive Dentistry, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 17–21 Calea Plevnei Street, Sector 1, 010221 Bucharest, Romania
| | - Ruxandra Sfeatcu
- Department of Oral Health and Community Dentistry, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 17–21 Calea Plevnei Street, Sector 1, 010221 Bucharest, Romania; (M.C.); (M.A.D.); (R.S.)
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Shirahmadi S, Khazaei S, Meschi M, Miresmaeili AF, Barkhordar S, Heidari A, Bashirian S, Jenabi E, Dadae N, Farzian S, Gafari A. Dental caries experience in primary school-age children following "Students' Oral Health Promotion Program," Iran. Int J Dent Hyg 2021; 20:453-464. [PMID: 34714594 DOI: 10.1111/idh.12561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/09/2021] [Accepted: 10/20/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study aimed at determining the changes in dental caries experience in elementary school-age children following 5 years of the Students' Oral Health Promotion Program implementation. METHODS In the present study, totally 2920 elementary school students participated and were selected by multistage cluster sampling. Based on the WHO Oral Health Survey Methods manual (4th edition), dental caries indices in primary and permanent teeth were assessed by clinical examination in schools. Data on socio-demographic characteristics and dental factors were collected through interviews based on questionnaire. The logistic and linear regression was used for data analysis. RESULTS The mean (SD) age of the elementary school children was 9.45 (1.71) years, and 1481 (50.7%) were boys. There was a significant difference between genders, age, dental pain experience and student's parent supervision with dmft, DMFT and their caries status. For 1-year increase in age, 1.67 times increase in DMFT and 0.33 decrease in dmft were predicted. Girls had higher odds of DMFT. In contrast, the odds of dmft for girls were significantly lower compared with boys. Students with dental pain experience had significantly higher odds of DMFT and dmft. The Significant Caries Index (SiC) score for permanent dentition in 12-year-old children was 5.47. Sex was significantly correlated with SiC index. The odds of developing Sic was 0.98 times lower in girls than in boys. CONCLUSIONS Dental caries was identified as a major public health problem among the elementary school students despite the implementation of the national project for oral health promotion.
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Affiliation(s)
- Samane Shirahmadi
- Department of Community Oral Health, School of Dentistry, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Salman Khazaei
- Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Marjaneh Meschi
- Department of Community Oral Health, School of Dentistry, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Amir Farhang Miresmaeili
- Department of Orthodontics, School of Dentistry, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Shagaeg Barkhordar
- Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ali Heidari
- Office of education in Hamadan, Hamadan, Iran
| | - Saeid Bashirian
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ensiyeh Jenabi
- Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Neda Dadae
- Autism Spectrum Disorders Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Shahnaz Farzian
- Departments of Oral Health, Vice Chancellor for Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Abdollah Gafari
- Departments of Oral Health, Vice Chancellor for Health, Hamadan University of Medical Sciences, Hamadan, Iran
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16
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Inequality in dental care expenditure in Iranian households: analysis of income quintiles and educational levels. BMC Oral Health 2021; 21:550. [PMID: 34702242 PMCID: PMC8549140 DOI: 10.1186/s12903-021-01912-6] [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: 07/28/2021] [Accepted: 10/18/2021] [Indexed: 11/24/2022] Open
Abstract
Background Oral health is a major public health issue which affects the human life. Access to dental care is one of the important factors in maintaining oral health. This study was aimed to investigate inequality in dental care expenditure in Iranian households. Methods The present study is a secondary analysis of a national cross-sectional survey. The data collected from the Households Income and Expenditure Survey in 2016 and 2017. The final sample consisted of 54,354 households living in rural and urban regions of all the provinces. Inequalities in household’s dental care expenditure per capita in respect to income quintiles and educational level were measured based on the Gini coefficient and concentration index. Results The results showed that about 8% of households had paid for dental care during the month before sampling. The Gini coefficient value was estimated to be 0.97 and 0.96 for dental care expenditure per capita respectively in absolute and relative measure. It indicated a significant inequality in the dental expenditure among the sample households. The values of concentration index were positive and significant for all dental care subcategories in respect to the provincial and national income quintiles as well as the educational level of the head of the household. Conclusions Income and educational inequality in the both absolute and relative dental services expenditure of the Iranian households were in favor of higher income groups as well as higher educational level of household heads. Income inequality was higher in total dental care expenditure per capita and all its subcategories than the educational inequalities of dental expenditure. In order to reduce these inequalities, the policymakers need to pay special attention to low-income households, particularly those with low-educated heads.
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17
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Pilotto LM, Celeste RK. Contextual determinants for use of dental services according to different healthcare financing systems: Andersen's model. Community Dent Oral Epidemiol 2021; 50:99-105. [PMID: 33719085 DOI: 10.1111/cdoe.12636] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/06/2021] [Accepted: 02/22/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To explore contextual factors associated with overall dental service use, and investigate whether these factors influenced choice of the type of service according to the healthcare financing alternatives (public services; out-of-pocket services; and private health insurance), by adults and older individuals, based on the most recent Andersen's behavioural model. METHODS Cross-sectional study with individual data on 17,305 adults from 177 Brazilian municipalities in the National Oral Health Survey (SBBrasil 2010). Municipal-level information was obtained from health information systems and census data. Multilevel multinomial logistic regression was carried out for multivariable analysis. RESULTS In the previous year, 38.2% of the individuals visited the dentist; of which 21.4% used out-of-pocket spending, 11.6% used public services and 5.2% private dental insurance. Municipalities with population coverage of public primary dental care >80% had higher chances of using public services (OR = 1.28, 95%CI:1.00-1.64) than those with ≤60%, but lower chances of using private insurance (OR = 0.56, 95%CI:0.38-0.83). Municipalities with population coverage of private dental insurance > 5% had lower chances of using public services (OR = 0.62, 95%CI:0.47-0.81) than those with <1% coverage, and greater chances of using private insurance (OR = 4.33, CI:95% 2.02-9.29). These factors were not associated with out-of-pocket dental services. CONCLUSIONS Municipal coverage of dental services is associated with dental care use, and this is different according to the type of financing system (public or private), as they may change the individual's choice of service. A large public healthcare system may increase public service use for those with reduced access and decrease private service use.
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Affiliation(s)
- Luciane Maria Pilotto
- Department of Social and Preventive Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Roger Keller Celeste
- Department of Social and Preventive Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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18
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Åstrøm AN, Lie SA, Mastrovito B, Sannevik J. Avoidance of dental appointment due to cost and consequences for oral health-related quality of life: 25-yr follow-up of Swedish adults. Eur J Oral Sci 2021; 129:e12778. [PMID: 33667033 DOI: 10.1111/eos.12778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/24/2021] [Accepted: 01/26/2021] [Indexed: 12/01/2022]
Abstract
We explored how socio-demographic and personal characteristics contribute to avoidance of dental appointment due to cost over time from age 55 (in 1997) to 75 (in 2017) and assessed the implications for oral health-related quality of life. In 1992, 6346 residents born in 1942 consented to participate in a prospective questionnaire survey, and 3060 (48.2%) of them completed postal follow-ups every fifth year until 2017. Oral health-related quality of life was assessed using the Oral Impact on Daily Performance inventory. The frequency of avoidance of dental appointment due to cost declined from 7.0% (in 1997) to 5.4% (in 2017), whereas the frequency of oral impacts declined from 26.0% in 2007 to 24.0% in 2017. Generalized Estimating Equation models revealed that avoidance of dental appointments due to cost was more likely reported in 1997 (OR: 1.5: 1.2-1.8) than in 2017, more likely in low educated people, and less likely in those using private dental care services. Avoidance of dental appointment due to cost was associated with impaired oral health-related quality of life. Social inequalities in avoidance of dental appointment due to cost and oral impacts did not vary across time but persisted into older ages despite the dental health care reforms that had been implemented.
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Affiliation(s)
- Anne Nordrehaug Åstrøm
- Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Stein Atle Lie
- Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Bergen, Norway
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Singh KA, Brennan DS. Use of dental services among middle-aged adults: predisposing, enabling and need variables. Aust Dent J 2021; 66:270-277. [PMID: 33521979 DOI: 10.1111/adj.12828] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/20/2021] [Accepted: 01/24/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine if making a visit, number of visits and services varied by predisposing (gender, perceived health competence, education, previous relief of pain visit), enabling (dental anxiety, income, social support) and need (perceived need, number of teeth and oral pain) characteristics. METHODS Dental visiting and services data from a sample of middle-aged South Australian adults were collected from 61% of participants at 12-months (n = 603) and 59% after 24-months (n = 583). Visiting over 2-years, mean visits and mean services were analysed by log binomial and Poison regression using the Andersen and Newman model. RESULTS The percentage having a dental visit over 2-years was lower for males than females, prevalence ratio (PR, 95% CI) 0.91 (0.84, 0.99), and for higher than lower dental anxiety, PR = 0.78 (0.62, 0.98). Number of visits was associated with higher than lower income, rate ratio (RR, 95%CI) 1.20 (1.02, 1.41) but lower for those with higher social support, RR = 0.86 (0.74, 0.99). Services were lower for those with higher perceived health competence, RR = 0.72 (0.56, 0.92) but higher for those with perceived needs, RR = 1.22 (1.01, 1.46). CONCLUSIONS While need and cost factors predict dental service use, psychosocial variables such as health competence and social support also need to be considered.
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Affiliation(s)
- K A Singh
- ARCPOH, Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia
| | - D S Brennan
- ARCPOH, Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia
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Fernández Rojas C, Emmanouil D, Dellavia C, Limeres J, Castro N, Marks LAM. Oral health needs of athletes with intellectual disability in Southern Europe: Greece, Italy and Spain. SPECIAL CARE IN DENTISTRY 2021; 41:187-194. [PMID: 33421222 DOI: 10.1111/scd.12557] [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: 07/23/2020] [Revised: 12/10/2020] [Accepted: 12/10/2020] [Indexed: 11/29/2022]
Abstract
AIMS The population with intellectual disabilities (ID) has been reported to be a vulnerable population in terms of oral health. The aims of this study were to evaluate the oral condition and treatment needs of Special Olympics (SO) athletes from Greece, Italy and Spain. METHODS AND RESULTS A cross-sectional study was performed with data collected in annual SO events held in Greece, Italy and Spain, between 2010 and 2012. The recorded parameters were the presence/absence of edentulism, untreated decay, filled or missing teeth, sealants, tooth injury and signs of gingival disease. Among the main findings, the prevalence of untreated decay was 57.0% in Greece, 48.8% in Italy and 41.7% of the Spanish athletes. The prevalence of signs of gingival disease was 61.1% in Greece, 60.6% in Italy and 66.1% in Spain. While the majority of the athletes were in need of dental treatment. CONCLUSIONS Oral disease is an unresolved problem among athletes with ID in these Mediterranean countries. Therefore efforts should be directed to meet their treatment needs and to prevent oral disease.
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Affiliation(s)
| | - Dimitris Emmanouil
- Department of Pediatric Dentistry, School of Health sciences, Faculty of Dentistry, University of Athens, Athens, Greece
| | - Claudia Dellavia
- Department of Biomedical Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
| | - Jacobo Limeres
- School of Medicine and Dentistry, Santiago de Compostela University, A Coruña, Spain
| | - Natalia Castro
- Centre of Special care in dentistry, Ghent University, Ghent, Belgium
| | - Luc A M Marks
- Centre of Special care in dentistry, Ghent University, Ghent, Belgium
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Urbanos-Garrido RM. Income-related inequalities in unmet dental care needs in Spain: traces left by the Great Recession. Int J Equity Health 2020; 19:207. [PMID: 33183287 PMCID: PMC7658913 DOI: 10.1186/s12939-020-01317-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 10/29/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Dental health is an important component of general health. Socioeconomic inequalities in unmet dental care needs have been identified in the literature, but some knowledge gaps persist. This paper tries to identify the determinants of income-related inequality in unmet need for dental care and the reasons for its recent evolution in Spain, and it inquires about the traces left by the Great Recession. METHODS Data from the EU-SILC forming a decade (2007-2017) were used. Income-related inequalities for three years were measured by calculating corrected concentration indices (CCI), which were further decomposed in order to compute the contribution of different factors to inequality. An Oaxaca-type decomposition approach was also used to analyze the origin of changes over time. Men and women were analyzed separately. RESULTS Pro-rich inequality in unmet dental care needs significantly increased over time (CCI 2007: - 0.0272 and - 0.0334 for males and females, respectively; CCI 2017: - 0.0704 and - 0.0776; p < 0.001). Inequality showed a clear "pro-cycle" pattern, growing during the Great Recession and starting to decrease just after the economic recovery began. Gender differences only were significant for 2009 (p = 0.004) and 2014 (p = 0.063). Income was the main determinant of inequality and of its variation along time -particularly for women-, followed by far by unemployment -particularly for men-; the contributions of both were mainly due to changes in elasticites. CONCLUSIONS The Great Recession left its trace in form of a higher inequality in the access to dental care. Also, unmet need for dental care, as well as its inequality, became more sensitive to the ability to pay and to unemployment along recent years. To broaden public coverage of dental care for vulnerable groups, such as low-income/unemployed people with high oral health needs, would help to prevent further growth of inequality.
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Affiliation(s)
- Rosa M Urbanos-Garrido
- Department of Applied Economics, Public Economics and Political Economy, School of Economics & Business, University Complutense of Madrid, Campus de Somosaguas, 28223, Pozuelo de Alarcón, Madrid, Spain.
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22
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van der Zande MM, Exley C, Wilson SA, Harris RV. Disentangling a web of causation: An ethnographic study of interlinked patient barriers to planned dental visiting, and strategies to overcome them. Community Dent Oral Epidemiol 2020; 49:144-157. [PMID: 33104275 DOI: 10.1111/cdoe.12586] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/07/2020] [Accepted: 10/04/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To explore barriers to planned dental visiting, investigating how barriers interlink, how they accumulate and change, and how individuals envisage overcoming their combination of barriers through personal strategies. METHODS An ethnographic study was conducted of adult urgent dental care attenders who did not have a dentist, including 155 hours of nonparticipant observations, 97 interviews and 19 follow-up interviews in six urgent dental care settings. Data were analysed using constant comparison, first identifying barriers and personal strategies to overcome them, and subsequently analysing interlinks between barriers and personal strategies. RESULTS Accounts of barriers to planned dental visiting encompassed multiple barriers, which related to socioeconomic circumstances as well as experiences of oral health care. Barriers were multi-layered and more difficult to overcome when occurring together. Personal strategies to overcome diverse barriers often hinged on increasing importance of oral health to individuals, yet this was not always sufficient. The combination of barriers participants experience was dynamic, changing due to personal, family, or employment circumstances, and with increasing severity of barriers over time. Over time, this could lead to higher cost, and additional barriers, particularly embarrassment. CONCLUSION Barriers to planned dental visiting are complex, multi-layered and change over time, constituting a 'web of causation'. This adds a novel perspective to the literature on barriers to dental visiting, and requires that researchers, dental practitioners and policy makers remain open to barriers' interlinked effects, changes in primacy among individual patients' barriers, and their accumulation over time to better support uptake of planned dental visiting.
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Affiliation(s)
- Marieke M van der Zande
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Catherine Exley
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Samantha A Wilson
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Rebecca V Harris
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, UK
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23
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Gomez-Aguilar B, Jiménez-Garcia R, Palomar-Gallego MA, Hernández-Barrera V, Carabantes-Alarcón D, López-de Andres A. Oral health status among Spanish adults with diabetes: National Health Survey, 2017. Prim Care Diabetes 2020; 14:552-557. [PMID: 32057726 DOI: 10.1016/j.pcd.2020.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/17/2020] [Accepted: 01/20/2020] [Indexed: 11/17/2022]
Abstract
AIMS We aim i) to describe self-reported oral health among patients with diabetes in Spain; ii) to recognize which variables (socio-demographic, lifestyle and health-related), were related to poor self-reported oral health in patients with diabetes. METHODS We used data from subjects of the National Health Interview Survey performed in 2017. Diabetes status was self-reported. One non-diabetes patient was matched by gender and age for each diabetes case. Poor self-reported oral health was defined using the answers "I have dental caries" to the following question: "What is the state of your teeth and molars?". Socieconomic, demographic, comorbidities, health status, health care-related were independent variables. RESULTS We found that the prevalence of dental caries was higher among subjects with diabetes than their matched controls (23.8% vs. 16.5%; P < 0.001). The OR of dental caries for people with diabetes was 1.45 (95% CI 1.12-1.30). Older age, having lower monthly income, obesity, periodontal disease, very poor/poor/ fair self-rated health and having public dental health insurance increased the probability of suffering caries. CONCLUSIONS Poor self-reported oral health was higher among people with diabetes compared to non-diabetes controls. Physicians and dentists should increase their awareness with their patients with diabetes, especially those with obesity, younger and with lower education.
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Affiliation(s)
- Belén Gomez-Aguilar
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - Rodrigo Jiménez-Garcia
- Departamento de Salud Publica y Materno-infantil, Facultad de Medicina, Complutense University, Madrid, Spain.
| | | | - Valentín Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - David Carabantes-Alarcón
- Departamento de Salud Publica y Materno-infantil, Facultad de Medicina, Complutense University, Madrid, Spain
| | - Ana López-de Andres
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain
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Xu M, Gao X, Wu H, Ding M, Zhang C, Du S, 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. Measuring and decomposing socioeconomic-related inequality in the use of oral health services among Chinese adults. Community Dent Oral Epidemiol 2020; 49:47-54. [PMID: 32959367 DOI: 10.1111/cdoe.12575] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 08/19/2020] [Accepted: 08/24/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVES This study aimed to measure socioeconomic-related inequality and horizontal inequity in the use of oral health services and decompose this inequality among adults of different age groups in China. METHODS In total, 10 973 adults (3669 aged 35-44 years, 3767 aged 55-64 years and 3537 aged 65-74 years) who participated in the 4th National Oral Health Survey (2015-2016) in China were included. Concentration curves and the Erreygers-corrected concentration index (EI) were employed to measure socioeconomic-related inequality in the use of oral health services. Then, inequity in this utilization was measured by the horizontal inequity index (HI). Furthermore, decomposition analyses were conducted for the three groups to explain the contributions of income level, need factors (ie self-assessed oral health and evaluated oral health status), other factors (ie sex, residential location, educational attainment level and type of basic insurance) and a residual term to overall inequality in oral health service utilization. RESULTS The significant positive EI and HI values indicated that pro-rich inequality and inequity in oral health service utilization exist among Chinese adults. Income and type of basic medical insurance contributed the most to socioeconomic-related inequality in the use of oral health services among adults aged 55-64 and 65-74 years. However, the main driving factors of socioeconomic inequality among adults aged 35-44 years in dental care use included income, educational achievement, type of basic medical insurance and residential location. The need variables accounted for a very small proportion of overall socioeconomic-related inequality in oral health service use in all three groups. CONCLUSIONS Oral healthcare service utilization was disproportionately concentrated among better-off Chinese adults. The primary determinants of inequality in dental care use in different age groups provide information for policymakers to create more targeted policies to achieve equity in the oral healthcare system in China.
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Affiliation(s)
- Mengru Xu
- Department of Preventive Dentistry, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xiaoli Gao
- Department of Preventive Dentistry, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Huijing Wu
- Department of Preventive Dentistry, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Min Ding
- Department of Preventive Dentistry, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Chunzi Zhang
- Department of Preventive Dentistry, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Shuo Du
- Department of Preventive Dentistry, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xing Wang
- Chinese Stomatological Association, Beijing, China
| | - Xiping Feng
- Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Baojun Tai
- School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Deyu Hu
- West China School of Stomatology, Sichuan University, Chengdu, China
| | - Huancai Lin
- Guanghua School of Stomatology, Hospital of Stomatology, Sun Yetsen University, Guangzhou, China
| | - Bo Wang
- Chinese Stomatological Association, Beijing, China
| | - Chunxiao Wang
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shuguo Zheng
- Department of Preventive Dentistry, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xuenan Liu
- Department of Preventive Dentistry, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Wensheng Rong
- Department of Preventive Dentistry, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Weijian Wang
- Department of Preventive Dentistry, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Tao Xu
- Department of Preventive Dentistry, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yan Si
- Department of Preventive Dentistry, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
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Horizontal inequity in the utilisation of healthcare services in Australia. Health Policy 2020; 124:1263-1271. [PMID: 32950284 DOI: 10.1016/j.healthpol.2020.08.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 06/03/2020] [Accepted: 08/26/2020] [Indexed: 11/22/2022]
Abstract
The Australian universal healthcare system aims to ensure affordable and equitable use of healthcare services based on individual health needs. This paper presents empirical evidence on the extent of horizontal inequity (HI) in healthcare services (unequal utilisation by income for equal need) in Australia during the period of promoting reliance on private healthcare financing. Using data from the most recent Australian National Health Survey of 2011-12 and 2014-15, we examined and measured the extent of HI in eight indicators of out-of-hospital services and hospital-related care. Contrary to earlier studies, our results show a small but pro-rich inequity in the probability of general practitioner visits. Inequity in the distribution of specialist and dentist visits was in favour of richer people, a result that is commonly found in other developed countries and is also consistent with existing Australian evidence. Hospital-related care was equitably distributed compared to the pro-poor pattern found in earlier studies. Despite the universal health insurance system in Australia, there was inequity in the utilisation of needed healthcare services. Our evidence is relevant to similar health systems as governments move to higher out-of-pocket payments and other private sources to reduce pressure on public healthcare expenditure.
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Fardal Ø, Skau I, Rongen G, Heasman P, Grytten J. Provision of treatment for periodontitis in Norway in 2013 – a national profile. Int Dent J 2020; 70:266-276. [DOI: 10.1111/idj.12565] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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Andrade FBD, Antunes JLF, Andrade FCD, Lima-Costa MFF, Macinko J. Education-Related Inequalities in Dental Services Use among Older Adults in 23 Countries. J Dent Res 2020; 99:1341-1347. [PMID: 32623932 DOI: 10.1177/0022034520935854] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study aimed to measure the magnitude of education-related inequalities in the use of dental services among older adults (aged 50 y or older) from a sizable multicountry sample of 23 upper-middle- and high-income countries. This study used cross-sectional data from nationally representative surveys of people aged 50 y and over. Countries included in the Health and Retirement Study surveys were the following: Brazil, China, South Korea, Mexico, United States, Austria, Belgium, Croatia, Czech Republic, Denmark, Estonia, France, Germany, Greece, Italy, Israel, Luxembourg, Poland, Portugal, Slovenia, Spain, Sweden, and Switzerland. The dependent variable was the use of dental services, based on the self-report of having had a dental visit within the previous year, except for the United States and South Korea, which used 2-y recall periods. Educational level was used as the measure of socioeconomic position and was standardized across countries. Multivariate logistic regression modeling was used to evaluate the factors associated with the use of dental services, and the magnitude of education inequalities in the use of dental services was assessed using the slope index of inequality (SII) to measure absolute inequalities and the relative index of inequality for relative inequalities. The pooled prevalence of the use of dental services was 31.7% and ranged from 18.7% in China to 81.2% in Sweden. In the overall sample, the absolute difference in the prevalence of use between the lowest and highest educational groups was 20 percentage points. SII was significant for all countries except Portugal. Relative educational inequalities were significant for all countries and ranged from 3.2 in Poland to 1.2 in Sweden. There were significant education-related inequalities in the use of dental care by older adults in all countries. Monitoring these inequalities is critical to the planning and delivery of dental services.
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Affiliation(s)
- F Bof de Andrade
- Oswaldo Cruz Foundation, Rene Rachou Institute, Belo Horizonte, Brazil
| | - J L F Antunes
- Department of Epidemiology, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - F C D Andrade
- School of Social Work, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - M F F Lima-Costa
- Oswaldo Cruz Foundation, Rene Rachou Institute, Belo Horizonte, Brazil
| | - J Macinko
- Departments of Health Policy and Management and Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
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Grytten J, Skau I. Educational inequalities in access to fixed prosthodontic treatment in Norway. Causal effects using the introduction of a school reform as an instrumental variable. Soc Sci Med 2020; 260:113105. [PMID: 32653812 DOI: 10.1016/j.socscimed.2020.113105] [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] [Revised: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Equality in access to dental services, independent of level of education, is an important aim of Scandinavian welfare policy. In Norway, this policy is the main justification for a dental public subsidy scheme for adults. An important part of the subsidy scheme is to cover the cost of fixed prosthodontic treatment, including implant-based crowns and bridges for premolars, canines and incisors. A stated policy goal is to secure equal access to everybody in need of these services, independent of their level of education. The aim of this study was to estimate the causal effect of education on the probability of receiving fixed prosthodontic treatment in the adult Norwegian population. METHODS During the period 1960-1972, all municipalities in Norway were required to increase the number of compulsory years of education from seven to nine years. We used this education reform as the instrumental variable to create exogenous variation in the individual's number of years of education. The education data were combined with data from the Norwegian Health Economics Administration, which contained our outcome variable. Our sample included individuals with 9 years education or less. Altogether 113 237 individuals were included in the study. RESULTS For men, the first stage regression coefficient was 0.87 (confidence interval: 0.82-0.92). This means that the reform resulted in 0.87 additional years of education. For men, the probability of receiving fixed prosthodontic treatment increased by 0.67 percentage points per additional year of schooling. For women, the first stage regression coefficient was 0.84 (confidence interval: 0.79-0.88). The second stage regression coefficient was small (= 0.0022) and not statistically significant at a conventional level. CONCLUSION From a welfare policy point of view, for men, the subsidy scheme has not succeeded to redistribute resources so that dental services are accessible independent of their social status.
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Affiliation(s)
- Jostein Grytten
- Department of Community Dentistry, Dental Faculty, University of Oslo, Norway; Department of Obstetrics and Gynecology, Institute of Clinical Medicine, Akershus University Hospital, Lørenskog, Norway.
| | - Irene Skau
- Department of Community Dentistry, Dental Faculty, University of Oslo, Norway
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Allin S, Farmer J, Quiñonez C, Peckham A, Marchildon G, Panteli D, Henschke C, Fattore G, Lamloum D, Holden ACL, Rice T. Do health systems cover the mouth? Comparing dental care coverage for older adults in eight jurisdictions. Health Policy 2020; 124:998-1007. [PMID: 32712013 DOI: 10.1016/j.healthpol.2020.06.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 06/17/2020] [Accepted: 06/26/2020] [Indexed: 11/30/2022]
Abstract
Oral health is an important component of general health, yet there is limited financial protection for the costs of oral health care in many countries. This study compares public dental care coverage in a selection of jurisdictions: Australia (New South Wales), Canada (Alberta), England, France, Germany, Italy, Sweden, and the United States. Drawing on the WHO Universal Coverage Cube, we compare breadth (who is covered), depth (share of total costs covered), and scope (services covered), with a focus on adults aged 65 and older. We worked with local experts to populate templates to provide detailed and comparable descriptions of dental care coverage in their jurisdictions. Overall most jurisdictions offer public dental coverage for basic services (exams, x-rays, simple fillings) within four general types of coverage models: 1) deep public coverage for a subset of the older adult population based on strict eligibility criteria: Canada (Alberta), Australia (New South Wales) and Italy; 2) universal but shallow coverage of the older adult population: England, France, Sweden; 3) universal, and predominantly deep coverage for older adults: Germany; and 4) shallow coverage available only to some subgroups of older adults in the United States. Due to the limited availability of comparable data within and across jurisdictions, further research would benefit from standardized data collection initiatives for oral health measures.
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Affiliation(s)
- Sara Allin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Canada; North American Observatory on Health Systems and Policies.
| | - Julie Farmer
- North American Observatory on Health Systems and Policies; Faculty of Dentistry, University of Toronto, Canada
| | | | - Allie Peckham
- North American Observatory on Health Systems and Policies; Edson College of Nursing and Health Innovation, Arizona State University
| | - Gregory Marchildon
- Institute of Health Policy, Management and Evaluation, University of Toronto, Canada; North American Observatory on Health Systems and Policies
| | - Dimitra Panteli
- Department of Health Care Management, Technische Universität Berlin, Germany
| | - Cornelia Henschke
- Department of Health Care Management, Technische Universität Berlin, Germany; Faculty of Health Sciences Brandenburg, Brandenburg University of Technology Cottbus -Senftenberg, Germany
| | - Giovanni Fattore
- Department of Social and Political Sciences, Bocconi University, Italy
| | - Demetrio Lamloum
- Department of Social and Political Sciences, Bocconi University, Italy
| | - Alexander C L Holden
- The University of Sydney School of Dentistry, Faculty of Medicine and Health, Australia
| | - Thomas Rice
- North American Observatory on Health Systems and Policies; Fielding School of Public Health, Department of Health Policy and Management, University of California, Los Angeles, United States
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Piotrowska DE, Jankowska D, Huzarska D, Szpak AS, Pędziński B. Socioeconomic inequalities in use and non-use of dental services in Poland. Int J Public Health 2020; 65:637-647. [PMID: 32388573 PMCID: PMC7360667 DOI: 10.1007/s00038-020-01379-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 04/25/2020] [Accepted: 04/27/2020] [Indexed: 12/11/2022] Open
Abstract
Objectives To assess the impact of classical socioeconomic factors on the use and non-use of dental services on a representative sample of Polish population. Methods The study was based on face-to-face surveys conducted by GUS (Statistics Poland) on 13,376 respondents in 2010 and 12,532 individuals in 2013. Results The percentage of people using dental services in the highest income group was approximately twice as high as that in the lowest one (Q1: 7.0% vs. Q5: 16.4%), with the same being true for education (the lowest education group: 8.3% vs. the highest education group: 18.0%), and place of residence (inhabitants of rural areas: 9.2% vs. inhabitants of largest cities: 15.9%) in 2013. The analysis has shown the disparities in not using dental services when in need to be less clear-cut. Conclusions The conducted research, based on two independent periods, a representative population sample, univariate analysis and the multivariate regression model has revealed pronounced social inequalities in dental care use. It is a challenge to determine the factors which contribute most to health inequalities and the interventions which are most effective in reducing them.
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Affiliation(s)
- Dorota Elżbieta Piotrowska
- Department of Public Health, Medical University of Bialystok, ul. Szpitalna 37, 15-295, Białystok, Poland.
| | - Dorota Jankowska
- Department of Statistics and Medical Informatics, Medical University of Bialystok, ul.Szpitalna 37, Białystok, 15-295, Poland
| | - Dorota Huzarska
- Department of Public Health, Medical University of Bialystok, ul. Szpitalna 37, 15-295, Białystok, Poland
| | - Andrzej Stanisław Szpak
- Department of Public Health, Medical University of Bialystok, ul. Szpitalna 37, 15-295, Białystok, Poland.,Institute of Rural Health, ul.Jaczewskiego 2, Lublin, 20-090, Poland
| | - Bartosz Pędziński
- Department of Public Health, Medical University of Bialystok, ul. Szpitalna 37, 15-295, Białystok, Poland.,Lomza Medical Center Ltd., ul.Ks.Kardynała Wyszyńskiego 9, Lomza, 18-400, Poland
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Estimating Lifetime Dental Care Expenditure in South Korea: An Abridged Life Table Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17093308. [PMID: 32397465 PMCID: PMC7246729 DOI: 10.3390/ijerph17093308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/05/2020] [Accepted: 05/07/2020] [Indexed: 12/14/2022]
Abstract
The aim of this study was to measure the magnitude and distribution of a Korean’s lifetime dental expenses depending on age and sex, by constructing a hypothetical lifetime and life table of survival. Additionally, we estimated the difference in life expectancy between men and women and its impact on dental expenses. We used the 2015 Korea Health Panel Survey to calculate the total dental expenditure, including expenses paid directly by patients and those paid by insurers. We generated survival profiles to simulate dental expenses during a typical lifetime (from birth to age 95) using the abridged life table (five-year intervals for age groups) in 2015 from the South Korean Statistical Information Service. We independently calculated the remaining dental expenses for survivors of all ages. The results showed that an estimate of average lifetime dental expenditure was $31,851 per capita: $31,587 for men and $32,318 for women. Nearly 33% of the average per capita lifetime dental expenditure was attributable to the longer life expectancy of women, with no statistically significant difference in lifetime dental expenditure between men and women. Many survivors incurred 70% of their lifetime dental expenses before age 65. The results highlighted the need for policymakers to address spending on age-specific dental care owing to extended life expectancy, given the disproportionate share of healthcare resources supporting the elderly.
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Rezaei S, Pulok MH, Zahirian Moghadam T, Zandian H. Socioeconomic-Related Inequalities in Dental Care Utilization in Northwestern Iran. Clin Cosmet Investig Dent 2020; 12:181-189. [PMID: 32425612 PMCID: PMC7196241 DOI: 10.2147/ccide.s253242] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 04/17/2020] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION There have been multiple studies on socioeconomic-related inequalities in the use of dental services in Iran, but the evidence is still limited. This study measured inequality in dental care utilization by socioeconomic status and examined factors explaining this inequality among households in Ardabil, Iran in 2019. METHODS A total of 436 household heads participated in this cross-sectional study. Using a validated questionnaire, face-to-face interviews were conducted to collect data on dental care utilization, unmet needs, sociodemographic characteristics, economic status, health insurance, and oral health status of the participants. We used the concentration curve and relative concentration index (RCI) to visualize and quantify the level of inequality in dental care utilization by income. Regression-based decomposition was also applied to understand the causes of inequality. RESULTS About 59.2% (95% CI 54.4%-63.7%) and 14.7% (95% CI 11.6%-18.4%) of participants had visited a dentist for dental treatment in the previous 12 months and for 6-month dental checkups, respectively. The RCI for the probability of visiting a dentist in the last 12 months was 0.243 (95% CI 0.140-0.346). This suggests that dental care utilization was more concentrated among the rich. The RCI for unmet dental care needs was negative, which indicates more prevalence among the poor. Monthly household income (20.9%), self-rated oral health (6.9%), regular brushing (3.2%), and dental health insurance (2.5%) were the main factors in socioeconomic inequality in dental care utilization. CONCLUSION This study reveals that dental care-service utilization did not match the need for dental care, due to differences in socioeconomic status in Ardabil, Iran. Policies could be implemented to increase the coverage of dental care services among socioeconomically disadvantaged groups to tackle socioeconomic-related inequality in dental care utilization.
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Affiliation(s)
- Satar Rezaei
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Telma Zahirian Moghadam
- Social Determinants of Health Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Hamed Zandian
- Social Determinants of Health Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
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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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Kim ES, Kim BI, Jung HI. Does the national dental scaling policy reduce inequalities in dental scaling usage? A population-based quasi-experimental study. BMC Oral Health 2019; 19:185. [PMID: 31412821 PMCID: PMC6694626 DOI: 10.1186/s12903-019-0881-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 08/07/2019] [Indexed: 12/01/2022] Open
Abstract
Background In 2013, the national dental scaling insurance policy was introduced in South Korea. The purpose of this study is to determine the impact of the policy on inequalities in dental scaling usage. Methods Data of a nationally representative sample of 1,517,097 people over the age of 20 were obtained from the 2010–2016 Community Health Survey. Respondents who reported that they had not received dental scaling in the past year were defined as dental scaling non-users. The excess prevalence and relative prevalence ratio of dental scaling non-users were calculated for the pre-policy (2010–2012) and post-policy periods (2014–2016) using monthly household income levels. Additionally, trends of dental scaling inequalities were shown as concentration indexes. Results The prevalence of dental scaling non-users declined from 58.0 to 48.7% in the highest income group and from 86.3 to 78.8% in the lowest income group. However, the adjusted excess prevalence for the lowest income group compared with the highest had increased from 11.9 (95% CI: 11.9–11.9) to 15.5 (95% CI: 15.5–15.5)%, and the adjusted prevalence ratio increased from 1.19 (95% CI: 1.19–1.20) to 1.29 (95% CI: 1.29–1.30). Absolute and relative concentration indexes of dental scaling non-users increased after policy implementation. Conclusions The national dental scaling insurance policy has increased socioeconomic inequalities in dental scaling usage. Because dental care access generally requires high individual agency, expanded dental coverage may have had limited effects in attenuating inequalities and inadvertently widened the gap. To reduce dental care inequalities, universal access with universal dental coverage should be considered. Electronic supplementary material The online version of this article (10.1186/s12903-019-0881-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eun-Soo Kim
- Department of Preventive Dentistry & Public Oral Health, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Baek-Il Kim
- Department of Preventive Dentistry & Public Oral Health, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.,BK21 PLUS Project, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Hoi In Jung
- Department of Preventive Dentistry & Public Oral Health, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Pilotto LM, Celeste RK. The relationship between private health plans and use of medical and dental health services in the Brazilian health system. CIENCIA & SAUDE COLETIVA 2019; 24:2727-2736. [PMID: 31340289 DOI: 10.1590/1413-81232018247.24112017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 10/24/2017] [Indexed: 11/22/2022] Open
Abstract
To describe the last place of medical and dental health service used in relation to private health plans, and examine the effect of being registered in the primary healthcare system through the Family Health Strategy (FHS). This was a cross-sectional study using data from Brazil's 2008 National Household Survey. Multinomial logistic regression was performed to analyze how a private health plan and enrollment in the FHS influenced the use of health services. Results showed that individuals with a private health plan tend to use medical and dental services more than individuals without such a plan. However, many individuals with a private health plan used public services or paid out-of-pocket services, mainly for dental care. Among individuals without a private plan, being enrolled in the FHS reduced the use of out-of-pocket private services, regardless of age, income or educational level. Enrollment in the FHS increased the chances of using public services, and the effect of this enrollment is greater among those who have a private plan. Policies to strengthen public primary healthcare and to expand the FHS should be encouraged within the universal health system.
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Affiliation(s)
- Luciane Maria Pilotto
- Centro Universitário Univates. Av. Avelino Talini 171, Bairro Universitário. 95900-000 Lajeado RS Brasil. lutipilotto @yahoo.com.br
| | - Roger Keller Celeste
- Faculdade de Odontologia, Universidade Federal do Rio Grande do Sul Porto Alegre RS Brasil
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Che X, Sohn M, Park HJ. Unmet dental care needs in South Korea: how do they differ by insurance system? J Health Serv Res Policy 2019; 24:164-171. [DOI: 10.1177/1355819619835260] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objectives This study aimed to analyse and compare the influence of National Health Insurance and Medical Aid coverage on the persistency of unmet dental care needs in South Korea. Methods This study was based on a longitudinal sample of 4461 adults aged 19 years and older who participated in the South Korea Health Panel from 2011 to 2014, using weights to make the data nationally representative. Propensity score matching was used to adjust the demographic, socioeconomic and health status information of National Health Insurance and Medical Aid groups. Panel logistic regression analyses were conducted to examine the association between health insurance type and unmet dental needs for three consecutive years. Results The odds of the lowest income group reporting unmet dental care needs compared with the highest income group was 6.75 (confidence interval 5.94−7.67), which reduced to 4.19 (confidence interval 3.76−4.67) in the models including health insurance schemes. Additionally, Medical Aid recipients (odds ratio 2.49; 95% confidence interval 2.18−2.48) were more likely to have unmet needs than those covered by National Health Insurance. Conclusions The dental care needs of Medical Aid beneficiaries were not being met, unlike those of the National Health Insurance beneficiaries. Such evidence suggests that increasing health insurance coverage to include several essential dental services would improve the accessibility of dental care services for Medical Aid beneficiaries.
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Affiliation(s)
- Xianhua Che
- Researcher, BK21PLUS Program in ‘Embodiment: Health-Society Interaction’, Department of Public Health Sciences, Graduate School, Korea University, Republic of Korea
| | - Minsung Sohn
- Professor, Department of Health and Care Administration, The Cyber University of Korea, Seoul, Republic of Korea
| | - Hee-Jung Park
- Professor, Department of Dental Hygiene, College of Health Science, Kangwon National University, Republic of Korea
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Rodriguez-Alvarez E, Lanborena N, Borrell LN. Place of Birth Inequalities in Dental Care Use before and after the Economic Crisis in Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16101691. [PMID: 31091780 PMCID: PMC6572320 DOI: 10.3390/ijerph16101691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 04/30/2019] [Accepted: 05/12/2019] [Indexed: 12/20/2022]
Abstract
This study evaluates inequalities in the use of dental services according to place of birth before and after the economic crisis in Spain. A cross-sectional study was performed in adults aged 18 to 65 years in Spain. We used data from three Spanish National Health Surveys for the years 2006 (before the crisis), 2014, and 2017 (after the crisis). Log-binomial regression was used to quantify the association between place of birth and use of dental care services before and after controlling for the selected covariates. In 2006, we found a greater probability of not using dental care services in immigrants from Asia (PR: 1.36, 95% CI: 1.10-1.67) and Africa (PR: 1.16, 95% CI: 1.05-1.28) compared to the natives. For 2014, the probability of not using dental care services was greater for all immigrants relative to natives, with the greatest probability for those from Africa (PR: 1.71, 95% CI: 1.46-2.01) and Asia (PR: 1.3, 95% CI: 1.23-1.47). The associations for 2017 were weaker in magnitude than the ones observed for 2014, although stronger than for 2006. This study suggests that the economic recovery did not have the same impact for natives and immigrants regardless of regions of origin, given the observed inequalities in use of dental services.
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Affiliation(s)
- Elena Rodriguez-Alvarez
- Department of Nursing I, University of the Basque Country (UPV/EHU), 48940 Leioa, Bizkaia, Spain.
- OPIK-Research Group for Social Determinants of Health and Demographic Change, University of the Basque Country (UPV/EHU) 48940 Leioa, Bizkaia, Spain.
| | - Nerea Lanborena
- Department of Nursing I, University of the Basque Country (UPV/EHU), 48940 Leioa, Bizkaia, Spain.
- OPIK-Research Group for Social Determinants of Health and Demographic Change, University of the Basque Country (UPV/EHU) 48940 Leioa, Bizkaia, Spain.
| | - Luisa N Borrell
- OPIK-Research Group for Social Determinants of Health and Demographic Change, University of the Basque Country (UPV/EHU) 48940 Leioa, Bizkaia, Spain.
- Department of Epidemiology & Biostatistics, Graduate School of Public Health & Health Policy, City University of New York, New York, NY 10027, USA.
- Department of Surgery, Medical and Social Science. University of Alcalá, 28871 Madrid, Spain.
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Sekundo C, Stock C, Jürges H, Listl S. Patients' self‐reported measures of oral health—A validation study on basis of oral health questions used in a large multi‐country survey for populations aged 50+. Gerodontology 2019; 36:171-179. [DOI: 10.1111/ger.12398] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 02/04/2019] [Accepted: 02/09/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Caroline Sekundo
- Department of Conservative Dentistry, Translational Health Economics Group (THE Group) Heidelberg University Heidelberg Germany
| | - Christian Stock
- Division of Clinical Epidemiology and Aging Research German Cancer Research Center (DKFZ) Heidelberg Germany
- Institute of Medical Biometry and Informatics (IMBI) Heidelberg University Hospital Heidelberg Germany
| | - Hendrik Jürges
- Schumpeter School of Business and Economics University of Wuppertal Wuppertal Germany
| | - Stefan Listl
- Department of Conservative Dentistry, Translational Health Economics Group (THE Group) Heidelberg University Heidelberg Germany
- Department of Quality and Safety of Oral Health Care Radboud University Nijmegen Nijmegen The Netherlands
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Teixeira AKM, Roncalli AG, Noro LRA. Income Trajectories and Oral Health of Young People in a Life Course Study. Caries Res 2019; 53:347-356. [PMID: 30650428 DOI: 10.1159/000495038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 10/31/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To investigate the impact of the family's socioeconomic trajectory on the oral health status of young people in the city of Sobral, Ceará, Brazil, and test the hypotheses of the life course theory. METHODS This is a cohort study conducted in 2000, 2006, and 2012. In the third wave, 482 individuals between 17 and 21 years of age were examined and interviewed. The outcomes analyzed were the trajectory of tooth decay (decayed teeth in 2012 and cavity reoccurrence) and the trajectory of dental assistance (immediate dental assistance and untreated caries). The socioeconomic trajectory was measured by the mobility of the family's income between childhood and youth and the number of episodes of poverty throughout life. RESULTS The risk of developing decayed teeth in 2012 was greater for those who had always remained poor. Young people who were never poor had fewer decayed teeth in 2012, but more cavity reoccurrence. Downward mobility resulted in less access to immediate dental assistance. More experience of poverty throughout life implied more decayed teeth in 2012 and less immediate dental assistance. CONCLUSION The life course hypotheses regarding an influence of socioeconomic mobility and cumulative risk on oral health outcomes in youth were confirmed.
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Macroeconomic changes and trends in dental care utilization in Estonia and Lithuania in 2004-2012: a repeated cross-sectional study. BMC Oral Health 2018; 18:199. [PMID: 30509245 PMCID: PMC6276228 DOI: 10.1186/s12903-018-0665-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 11/16/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to assess trends and inequalities in dental care utilization in Estonia and Lithuania in relation to large-scale macroeconomic changes in 2004-2012. METHODS Data on 22,784 individuals in the 20-64 age group were retrieved from nationally representative cross-sectional surveys in 2004, 2006, 2008, 2010 and 2012. Age- and sex-standardized prevalence estimates of past 12-month dental visits were calculated for each study year, stratified by gender, age group, ethnicity, educational level and economic activity. Multivariable logistic regression analysis was used to assess the independent effect of study year and socioeconomic status on dental visits. RESULTS The age- and sex-standardized prevalence of dental visits in the past 12 months was 46-52% in Estonia and 61-67% in Lithuania. In 2004-2008, the prevalence of dental visits increased by 5.9 percentage points in both countries and fell in 2008-2010 by 3.8 percentage points in Estonia and 4.6 percentage points in Lithuania. In both countries the prevalence of dental care utilization had increased slightly by 2012, although the increase was statistically insignificant. Results from a logistic regression analysis showed that these differences between study years were not explained by differences in socioeconomic status or oral health conditions. Women, the main ethnic group (only in Estonia), and higher educated and employed persons had significantly higher odds of dental visits in both countries, but the odds were lower for 50-64 year olds in Lithuania. CONCLUSIONS In European Union countries with lower national wealth, the use of dental services is sensitive to macroeconomic changes regardless of the extent of public coverage, at the same time, higher public coverage may not relate to lower inequalities in dental care use.
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Rebelo Vieira JM, Rebelo MAB, Martins NMDO, Gomes JFF, Vettore MV. Contextual and individual determinants of non-utilization of dental services among Brazilian adults. J Public Health Dent 2018; 79:60-70. [PMID: 30468261 DOI: 10.1111/jphd.12295] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 09/03/2018] [Accepted: 10/08/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To examine the association of contextual and individual determinants with non-utilization of dental services among Brazilian adults. METHODS Data were from adults aged 35-44 years (N = 7,265) from the 2010 Brazilian Oral Health Survey (SB Brasil Project). Non-utilization of dental services was assessed whether the individual has never had a dental visit over the whole life time. Independent variables were selected according to Andersen's behavioral model. Contextual variables included Human Development Index-longevity (HDI-Longevity) (predisposing demographic), HDI-Education and Gini index (predisposing social), integration of oral health teams into Primary Care (enabling health policy), and HDI-Income (enabling financing). Individual data were age and sex (predisposing demographic), ethnicity and schooling (predisposing social), family monthly income (predisposing enabling), perceived dental treatment (perceived need), and decayed teeth (evaluated need). The relationship of contextual and individual variables with non-utilization of dental services was assessed through multilevel logistic regression analysis to estimate odds ratios (ORs) and 95% confidence intervals (95% CI). RESULTS The prevalence of non-utilization of dental services was 4.7 percent. Adults living in cities with high HDI-Income were less likely to never have a dental visit. The odds of non-utilization of dental services were lower for adults living in cities with high HDI-Longevity. Sex, skin color, dental treatment needs, poor socioeconomic characteristics, perceived dental treatment needs, and decayed teeth were also associated with non-utilization of dental services. CONCLUSIONS The results suggest that contextual enabling and predisposing factors, individual sociodemographic, and needs-related characteristics influence non-utilization of dental services by Brazilian adults.
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Affiliation(s)
| | | | | | | | - Mario Vianna Vettore
- Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
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Lopez-de-Andrés A, Vazquez-Vazquez L, Martinez-Huedo MA, Hernández-Barrera V, Jimenez-Trujillo I, Tapias-Ledesma MA, de Miguel-Diez J, Jiménez-García R. Is COPD associated with periodontal disease? A population-based study in Spain. Int J Chron Obstruct Pulmon Dis 2018; 13:3435-3445. [PMID: 30425473 PMCID: PMC6203114 DOI: 10.2147/copd.s174898] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background Periodontal disease is more prevalent and more severe among men and women suffering from chronic obstructive pulmonary disease (COPD) compared with healthy adults. The objectives of this paper were to assess the association between periodontal disease and COPD, controlling the effect of sociodemographic characteristics, oral health status, lifestyle variables, and comorbidities. Second, we identified which of the variables analyzed were independently associated with periodontal disease among COPD sufferers. Methods This descriptive study was done with data from the National/European Health Interview Surveys, conducted in years 2006, 2011/12, and 2014 in Spain. We included subjects ≥40 years of age. COPD status was self-reported. One non-COPD patient was matched by age, gender, and the year of survey for each COPD case. The presence of periodontal disease was defined using the answers "my teeth bleed spontaneously or while brushing" or/and "my teeth move" to the question: "Do you suffer of any of these dental and oral disorders or diseases?" Independent variables included demographic, socioeconomic, and health care-related variables, oral health status, and presence of comorbidities. Results The prevalence of periodontal disease was higher among COPD patients than their matched non-COPD controls (26.5% vs 22.2%; P<0.001). Adjusted odds ratio (AOR) of periodontal disease for subjects with COPD was 1.21 (95% CI: 1.12-1.30). Suffering mental disorders (AOR: 1.61; 95% CI: 1.32-1.97) was positively associated with higher risk of periodontal disease. Older age, having a private dental health insurance, and university education were variables associated with lower rates of periodontal disease. Conclusion Prevalence of periodontal disease was higher among those with COPD compared to non-COPD controls. Dentists and physicians should increase their awareness with their COPD patients, especially those who are younger, with lower education, and suffer depression and/or anxiety.
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Affiliation(s)
- Ana Lopez-de-Andrés
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Spain,
| | - Luis Vazquez-Vazquez
- Human Anatomy and Embryology Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Spain
| | | | - Valentín Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Spain,
| | - Isabel Jimenez-Trujillo
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Spain,
| | - Miguel A Tapias-Ledesma
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Spain,
| | - Javier de Miguel-Diez
- Respiratory Department, Gregorio Marañon General University Hospital, Medical School, Complutense University, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Rodrigo Jiménez-García
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Spain,
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Li C, Yao NA, Yin A. Disparities in dental healthcare utilization in China. Community Dent Oral Epidemiol 2018; 46:576-585. [PMID: 29968253 DOI: 10.1111/cdoe.12394] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 05/24/2018] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The goal of this study was to investigate inequality in dental service utilization in Chinese middle-aged and senior adults and changes in inequality over time and to determine the sources of inequality. METHODS The data included 17 648 individuals aged 45 years and older in 2013 and 15 450 individuals in 2015 who participated in the China Health and Retirement Longitudinal Study (CHARLS). The concentration index was used to quantify the degree of inequality. A decomposition method was employed to determine the sources of inequality, including need variables (demographic characteristics, self-reported health status, and presence of chronic diseases), living standard (measured by household consumption expenditure per capita), other non-need variables (education level, marital status, region of residence, urban-rural difference and type of health insurance plans). RESULTS The better-off not only had a higher likelihood of using dental care services than did the worse-off but also used them more often than the worse-off. The concentration index for probability of dental care utilization increased from 0.074 to 0.112 between 2013 and 2015, and the concentration index for total number of dental visits increased from 0.085 to 0.127. Living standard, education, health insurance plans and urban-rural disparities showed a pro-rich contribution to the inequality. The living standard contributed about 70% to the pro-rich inequality. CONCLUSIONS Dental care utilization in the Chinese middle-aged and older adults was concentrated in the better-off. Inequality in dental care utilization widened from 2013 to 2015. Achieving equity in dental care utilization remains a challenge for the healthcare system in China.
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Affiliation(s)
- Chaofan Li
- School of Health Care Management, Key Laboratory of Health Economics and Policy Research, NHFPC, Shandong University, Jinan, China
| | - Nengliang Aaron Yao
- School of Health Care Management, Key Laboratory of Health Economics and Policy Research, NHFPC, Shandong University, Jinan, China.,Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Aitian Yin
- School of Health Care Management, Key Laboratory of Health Economics and Policy Research, NHFPC, Shandong University, Jinan, China
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El Tantawi M, Folayan MO, Mehaina M, Vukovic A, Castillo JL, Gaffar BO, Arheiam A, Al-Batayneh OB, Kemoli AM, Schroth RJ, Lee GHM. Prevalence and Data Availability of Early Childhood Caries in 193 United Nations Countries, 2007-2017. Am J Public Health 2018; 108:1066-1072. [PMID: 29927650 DOI: 10.2105/ajph.2018.304466] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess the relationship between health care system and economic factors and early childhood caries (ECC) data availability and prevalence. METHODS We estimated ECC data for 193 United Nations countries from studies published between 2007 and 2017. We obtained other variables from the World Health Organization and the World Bank databases. We assessed association with ECC data availability by using logistic regression and with ECC prevalence by using linear regression. RESULTS We included 190 publications from 88 (45.6%) countries. The mean ECC prevalence was 23.8% and 57.3% in children younger than 36 months and children aged 36 to 71 months, respectively. The odds of ECC data availability were significantly higher for countries with more physicians and more dentists. In children younger than 36 months, ECC prevalence was associated with universal health coverage (B = -6.56). In children aged 36 to 71 months, it was associated with growth of gross national income (B = 0.27). CONCLUSIONS Countries with more physicians and more dentists were more likely to have ECC data. Among those with data, countries with higher economic growth had higher ECC prevalence.
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Affiliation(s)
- Maha El Tantawi
- Maha El Tantawi and Balgis O. Gaffar are with the Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia. Morenike O. Folayan is with the Faculty of Dentistry, Obafemi Awolowo University, Ile-Ife, Nigeria. Mohamed Mehaina is with Bibliotheca Alexandrina, Alexandria, Egypt. Ana Vukovic is with the Department of Pediatric and Preventive Dentistry, School of Dental Medicine, University of Belgrade, Belgrade, Republic of Serbia. Jorge L. Castillo is with the Department of Paediatric Dentistry and Orthodontics, Universidad Peruana Cayetano Heredia, Lima, Peru. Arheiam Arheiam is with the Department of Community and Preventive Dentistry, Faculty of Dentistry, University of Benghazi, Libya. Ola B. Al-Batayneh is with the Department of Preventive Dentistry, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan. Arthur M. Kemoli is with the Department of Paediatric Dentistry and Orthodontics, College of Health Sciences, University of Nairobi, Kenya. Robert J. Schroth is with the Department of Preventive Dental Science, Dr Gerald Niznick College of Dentistry, and Departments of Pediatrics and Child Health and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba. Gillian H. M. Lee is with Paediatric Dentistry, Faculty of Dentistry, University of Hong Kong, Hong Kong
| | - Morenike O Folayan
- Maha El Tantawi and Balgis O. Gaffar are with the Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia. Morenike O. Folayan is with the Faculty of Dentistry, Obafemi Awolowo University, Ile-Ife, Nigeria. Mohamed Mehaina is with Bibliotheca Alexandrina, Alexandria, Egypt. Ana Vukovic is with the Department of Pediatric and Preventive Dentistry, School of Dental Medicine, University of Belgrade, Belgrade, Republic of Serbia. Jorge L. Castillo is with the Department of Paediatric Dentistry and Orthodontics, Universidad Peruana Cayetano Heredia, Lima, Peru. Arheiam Arheiam is with the Department of Community and Preventive Dentistry, Faculty of Dentistry, University of Benghazi, Libya. Ola B. Al-Batayneh is with the Department of Preventive Dentistry, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan. Arthur M. Kemoli is with the Department of Paediatric Dentistry and Orthodontics, College of Health Sciences, University of Nairobi, Kenya. Robert J. Schroth is with the Department of Preventive Dental Science, Dr Gerald Niznick College of Dentistry, and Departments of Pediatrics and Child Health and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba. Gillian H. M. Lee is with Paediatric Dentistry, Faculty of Dentistry, University of Hong Kong, Hong Kong
| | - Mohamed Mehaina
- Maha El Tantawi and Balgis O. Gaffar are with the Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia. Morenike O. Folayan is with the Faculty of Dentistry, Obafemi Awolowo University, Ile-Ife, Nigeria. Mohamed Mehaina is with Bibliotheca Alexandrina, Alexandria, Egypt. Ana Vukovic is with the Department of Pediatric and Preventive Dentistry, School of Dental Medicine, University of Belgrade, Belgrade, Republic of Serbia. Jorge L. Castillo is with the Department of Paediatric Dentistry and Orthodontics, Universidad Peruana Cayetano Heredia, Lima, Peru. Arheiam Arheiam is with the Department of Community and Preventive Dentistry, Faculty of Dentistry, University of Benghazi, Libya. Ola B. Al-Batayneh is with the Department of Preventive Dentistry, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan. Arthur M. Kemoli is with the Department of Paediatric Dentistry and Orthodontics, College of Health Sciences, University of Nairobi, Kenya. Robert J. Schroth is with the Department of Preventive Dental Science, Dr Gerald Niznick College of Dentistry, and Departments of Pediatrics and Child Health and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba. Gillian H. M. Lee is with Paediatric Dentistry, Faculty of Dentistry, University of Hong Kong, Hong Kong
| | - Ana Vukovic
- Maha El Tantawi and Balgis O. Gaffar are with the Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia. Morenike O. Folayan is with the Faculty of Dentistry, Obafemi Awolowo University, Ile-Ife, Nigeria. Mohamed Mehaina is with Bibliotheca Alexandrina, Alexandria, Egypt. Ana Vukovic is with the Department of Pediatric and Preventive Dentistry, School of Dental Medicine, University of Belgrade, Belgrade, Republic of Serbia. Jorge L. Castillo is with the Department of Paediatric Dentistry and Orthodontics, Universidad Peruana Cayetano Heredia, Lima, Peru. Arheiam Arheiam is with the Department of Community and Preventive Dentistry, Faculty of Dentistry, University of Benghazi, Libya. Ola B. Al-Batayneh is with the Department of Preventive Dentistry, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan. Arthur M. Kemoli is with the Department of Paediatric Dentistry and Orthodontics, College of Health Sciences, University of Nairobi, Kenya. Robert J. Schroth is with the Department of Preventive Dental Science, Dr Gerald Niznick College of Dentistry, and Departments of Pediatrics and Child Health and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba. Gillian H. M. Lee is with Paediatric Dentistry, Faculty of Dentistry, University of Hong Kong, Hong Kong
| | - Jorge L Castillo
- Maha El Tantawi and Balgis O. Gaffar are with the Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia. Morenike O. Folayan is with the Faculty of Dentistry, Obafemi Awolowo University, Ile-Ife, Nigeria. Mohamed Mehaina is with Bibliotheca Alexandrina, Alexandria, Egypt. Ana Vukovic is with the Department of Pediatric and Preventive Dentistry, School of Dental Medicine, University of Belgrade, Belgrade, Republic of Serbia. Jorge L. Castillo is with the Department of Paediatric Dentistry and Orthodontics, Universidad Peruana Cayetano Heredia, Lima, Peru. Arheiam Arheiam is with the Department of Community and Preventive Dentistry, Faculty of Dentistry, University of Benghazi, Libya. Ola B. Al-Batayneh is with the Department of Preventive Dentistry, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan. Arthur M. Kemoli is with the Department of Paediatric Dentistry and Orthodontics, College of Health Sciences, University of Nairobi, Kenya. Robert J. Schroth is with the Department of Preventive Dental Science, Dr Gerald Niznick College of Dentistry, and Departments of Pediatrics and Child Health and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba. Gillian H. M. Lee is with Paediatric Dentistry, Faculty of Dentistry, University of Hong Kong, Hong Kong
| | - Balgis O Gaffar
- Maha El Tantawi and Balgis O. Gaffar are with the Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia. Morenike O. Folayan is with the Faculty of Dentistry, Obafemi Awolowo University, Ile-Ife, Nigeria. Mohamed Mehaina is with Bibliotheca Alexandrina, Alexandria, Egypt. Ana Vukovic is with the Department of Pediatric and Preventive Dentistry, School of Dental Medicine, University of Belgrade, Belgrade, Republic of Serbia. Jorge L. Castillo is with the Department of Paediatric Dentistry and Orthodontics, Universidad Peruana Cayetano Heredia, Lima, Peru. Arheiam Arheiam is with the Department of Community and Preventive Dentistry, Faculty of Dentistry, University of Benghazi, Libya. Ola B. Al-Batayneh is with the Department of Preventive Dentistry, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan. Arthur M. Kemoli is with the Department of Paediatric Dentistry and Orthodontics, College of Health Sciences, University of Nairobi, Kenya. Robert J. Schroth is with the Department of Preventive Dental Science, Dr Gerald Niznick College of Dentistry, and Departments of Pediatrics and Child Health and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba. Gillian H. M. Lee is with Paediatric Dentistry, Faculty of Dentistry, University of Hong Kong, Hong Kong
| | - Arheiam Arheiam
- Maha El Tantawi and Balgis O. Gaffar are with the Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia. Morenike O. Folayan is with the Faculty of Dentistry, Obafemi Awolowo University, Ile-Ife, Nigeria. Mohamed Mehaina is with Bibliotheca Alexandrina, Alexandria, Egypt. Ana Vukovic is with the Department of Pediatric and Preventive Dentistry, School of Dental Medicine, University of Belgrade, Belgrade, Republic of Serbia. Jorge L. Castillo is with the Department of Paediatric Dentistry and Orthodontics, Universidad Peruana Cayetano Heredia, Lima, Peru. Arheiam Arheiam is with the Department of Community and Preventive Dentistry, Faculty of Dentistry, University of Benghazi, Libya. Ola B. Al-Batayneh is with the Department of Preventive Dentistry, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan. Arthur M. Kemoli is with the Department of Paediatric Dentistry and Orthodontics, College of Health Sciences, University of Nairobi, Kenya. Robert J. Schroth is with the Department of Preventive Dental Science, Dr Gerald Niznick College of Dentistry, and Departments of Pediatrics and Child Health and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba. Gillian H. M. Lee is with Paediatric Dentistry, Faculty of Dentistry, University of Hong Kong, Hong Kong
| | - Ola B Al-Batayneh
- Maha El Tantawi and Balgis O. Gaffar are with the Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia. Morenike O. Folayan is with the Faculty of Dentistry, Obafemi Awolowo University, Ile-Ife, Nigeria. Mohamed Mehaina is with Bibliotheca Alexandrina, Alexandria, Egypt. Ana Vukovic is with the Department of Pediatric and Preventive Dentistry, School of Dental Medicine, University of Belgrade, Belgrade, Republic of Serbia. Jorge L. Castillo is with the Department of Paediatric Dentistry and Orthodontics, Universidad Peruana Cayetano Heredia, Lima, Peru. Arheiam Arheiam is with the Department of Community and Preventive Dentistry, Faculty of Dentistry, University of Benghazi, Libya. Ola B. Al-Batayneh is with the Department of Preventive Dentistry, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan. Arthur M. Kemoli is with the Department of Paediatric Dentistry and Orthodontics, College of Health Sciences, University of Nairobi, Kenya. Robert J. Schroth is with the Department of Preventive Dental Science, Dr Gerald Niznick College of Dentistry, and Departments of Pediatrics and Child Health and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba. Gillian H. M. Lee is with Paediatric Dentistry, Faculty of Dentistry, University of Hong Kong, Hong Kong
| | - Arthur M Kemoli
- Maha El Tantawi and Balgis O. Gaffar are with the Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia. Morenike O. Folayan is with the Faculty of Dentistry, Obafemi Awolowo University, Ile-Ife, Nigeria. Mohamed Mehaina is with Bibliotheca Alexandrina, Alexandria, Egypt. Ana Vukovic is with the Department of Pediatric and Preventive Dentistry, School of Dental Medicine, University of Belgrade, Belgrade, Republic of Serbia. Jorge L. Castillo is with the Department of Paediatric Dentistry and Orthodontics, Universidad Peruana Cayetano Heredia, Lima, Peru. Arheiam Arheiam is with the Department of Community and Preventive Dentistry, Faculty of Dentistry, University of Benghazi, Libya. Ola B. Al-Batayneh is with the Department of Preventive Dentistry, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan. Arthur M. Kemoli is with the Department of Paediatric Dentistry and Orthodontics, College of Health Sciences, University of Nairobi, Kenya. Robert J. Schroth is with the Department of Preventive Dental Science, Dr Gerald Niznick College of Dentistry, and Departments of Pediatrics and Child Health and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba. Gillian H. M. Lee is with Paediatric Dentistry, Faculty of Dentistry, University of Hong Kong, Hong Kong
| | - Robert J Schroth
- Maha El Tantawi and Balgis O. Gaffar are with the Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia. Morenike O. Folayan is with the Faculty of Dentistry, Obafemi Awolowo University, Ile-Ife, Nigeria. Mohamed Mehaina is with Bibliotheca Alexandrina, Alexandria, Egypt. Ana Vukovic is with the Department of Pediatric and Preventive Dentistry, School of Dental Medicine, University of Belgrade, Belgrade, Republic of Serbia. Jorge L. Castillo is with the Department of Paediatric Dentistry and Orthodontics, Universidad Peruana Cayetano Heredia, Lima, Peru. Arheiam Arheiam is with the Department of Community and Preventive Dentistry, Faculty of Dentistry, University of Benghazi, Libya. Ola B. Al-Batayneh is with the Department of Preventive Dentistry, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan. Arthur M. Kemoli is with the Department of Paediatric Dentistry and Orthodontics, College of Health Sciences, University of Nairobi, Kenya. Robert J. Schroth is with the Department of Preventive Dental Science, Dr Gerald Niznick College of Dentistry, and Departments of Pediatrics and Child Health and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba. Gillian H. M. Lee is with Paediatric Dentistry, Faculty of Dentistry, University of Hong Kong, Hong Kong
| | - Gillian H M Lee
- Maha El Tantawi and Balgis O. Gaffar are with the Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia. Morenike O. Folayan is with the Faculty of Dentistry, Obafemi Awolowo University, Ile-Ife, Nigeria. Mohamed Mehaina is with Bibliotheca Alexandrina, Alexandria, Egypt. Ana Vukovic is with the Department of Pediatric and Preventive Dentistry, School of Dental Medicine, University of Belgrade, Belgrade, Republic of Serbia. Jorge L. Castillo is with the Department of Paediatric Dentistry and Orthodontics, Universidad Peruana Cayetano Heredia, Lima, Peru. Arheiam Arheiam is with the Department of Community and Preventive Dentistry, Faculty of Dentistry, University of Benghazi, Libya. Ola B. Al-Batayneh is with the Department of Preventive Dentistry, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan. Arthur M. Kemoli is with the Department of Paediatric Dentistry and Orthodontics, College of Health Sciences, University of Nairobi, Kenya. Robert J. Schroth is with the Department of Preventive Dental Science, Dr Gerald Niznick College of Dentistry, and Departments of Pediatrics and Child Health and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba. Gillian H. M. Lee is with Paediatric Dentistry, Faculty of Dentistry, University of Hong Kong, Hong Kong
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Herkrath FJ, Vettore MV, Werneck GL. Contextual and individual factors associated with dental services utilisation by Brazilian adults: A multilevel analysis. PLoS One 2018; 13:e0192771. [PMID: 29420660 PMCID: PMC5805334 DOI: 10.1371/journal.pone.0192771] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 01/30/2018] [Indexed: 11/29/2022] Open
Abstract
Background Inequalities in the utilisation of dental services in Brazil are remarkable. The aim of this study was to evaluate the association of contextual and individual factors with the utilisation of dental services by Brazilian adults using the Andersen’s behavioural model. Methods Individual-level data from 27,017 adults residents in the State capitals who were interviewed in the 2013 Brazilian National Health Survey were pooled with contextual city-level data. The outcomes were non-utilisation of dental services and last dental visit over 12 months ago. Individual predisposing variables were age, sex, race/skin colour, schooling and social network. Individual enabling variables included income, health insurance and registration in primary health care. Individual need variables were self-perceived dental health and self-reported missing teeth. Multilevel logistic regression models were performed to estimate odds ratio (OR) and 95% confidence intervals (95% CIs) of the association of contextual and individual predisposing, enabling and need-related variables with dental services outcomes. Results Predisposing (OR = 0.89; 95% CI 0.81–0.97) and enabling (OR = 0.90; 95% CI 0.85–0.96) contextual factors were associated with non-utilisation of dental services. Individual predisposing (sex, race/skin colour, schooling), enabling (income, health insurance) and need (self-perceived oral health, missing teeth) were associated with non-utilisation of dental services and last dental visit over 12 months ago. The latter was also associated with other individual predisposing (age, social network) and need (eating difficulties due to oral problems) characteristics. Conclusions Individual and contextual determinants influenced dental services utilisation in Brazilian adults. These factors should be on the policy agenda and considered in the organisation of health services aiming to reduce oral health inequalities related to access and utilisation of dental services.
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Affiliation(s)
- Fernando José Herkrath
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
- Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Manaus, Amazonas, Brazil
- * E-mail:
| | - Mario Vianna Vettore
- Academic Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, Sheffield, United Kingdom
| | - Guilherme Loureiro Werneck
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
- Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
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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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Inequalities in Health Services Usage in a National Health System Scheme: The Case of a Southern Social European Region. Nurs Res 2017; 67:26-34. [PMID: 29240657 DOI: 10.1097/nnr.0000000000000256] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Health services can reduce inequalities caused by other determinants of health or increase them due to the effect of the inverse care law-the principle that the availability of good quality care tends to vary inversely with the need for it in the population served. OBJECTIVE The purpose of the research was to describe inequalities in the use of nursing services, medical services in primary care, specialist care, and services not fully covered by the Basque public health system in Spain. METHODS A cross-sectional study of adults aged at least 25 years who completed the 2013 Basque Health Survey (N = 10,454) was conducted. Age-standardized prevalence and prevalence ratios for use of services that are covered and noncovered in the health system were computed. The association of health services usage with socioeconomic variables was estimated using a Poisson regression model with robust variance. The relative index of inequality (RII) was used to measure the magnitude of socioeconomic status inequalities in health service use. All analyses were carried out separately for men and women. RESULTS Individuals with lower socioeconomic status were more likely to use primary care (RII = 0.87, 95% CI [0.79, 0.97]) and less likely to use specialist services (RII = 0.82, 95% CI [0.75, 0.89]). Across noncovered health services, inequalities between the highest and lowest social groups were significant in all cases and especially marked in men's use of physiotherapists (RII = 0.46, 95% CI [0.35, 0.61]) and podiatrists (RII = 0.24, 95%CI [0.15, 0.38]). DISCUSSION There are significant inequalities in primary and specialist health service use based on individual socioeconomic status, particularly for services that are not provided free of charge within the existing health system. This suggests that health service systems that are not explicitly designed to provide universal access may actually amplify preexisting social and health inequalities within their target populations.
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Demarco FF, Collares K, Correa MB, Cenci MS, Moraes RRD, Opdam NJ. Should my composite restorations last forever? Why are they failing? Braz Oral Res 2017; 31:e56. [PMID: 28902236 DOI: 10.1590/1807-3107bor-2017.vol31.0056] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 05/22/2017] [Indexed: 11/22/2022] Open
Abstract
Composites resins have become the first choice for direct anterior and posterior restorations. The great popularity is related to their esthetic appearance and reduced need of sound tissue removal as compared with former treatments. Several studies have demonstrated that composite restorations may last long in clinical service. In this review we discuss the factors playing a role on the long-term longevity. Composite restorations have demonstrated a good clinical performance with annual failure rates varying from 1% to 3% in posterior teeth and 1% to 5% in anterior teeth. Factors related to the patients such as caries risk and occlusal stress risk, in addition to socioeconomic factors, may affect the survival significantly. Characteristics of the clinical operators, particularly their decision making when it comes to observing or approaching an existing restoration, are decisive for longevity. Cavity features such as the number of restored walls, composite volume, and presence of endodontic treatment are of major importance and may dictate the service time of the restorative approach. The choice of restorative composite seems to have a minor effect on longevity provided that appropriate technical procedures are used. The main reasons for failure in posterior teeth are secondary caries and fracture (restoration or tooth/restoration), while in anterior teeth esthetic concerns are the main reasons leading to restoration failures. Composite resin restorations can be considered a reliable treatment as long as both the professional and the patient are aware of the factors involved in restoration failures.
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Affiliation(s)
- Flávio Fernando Demarco
- Universidade Federal de Pelotas - Unipel, School of Dentistry, Graduate Program in Dentistry, Pelotas, RS, Brazil
| | - Kauê Collares
- Universidade Federal de Pelotas - Unipel, School of Dentistry, Graduate Program in Dentistry, Pelotas, RS, Brazil
| | - Marcos Britto Correa
- Universidade Federal de Pelotas - Unipel, School of Dentistry, Graduate Program in Dentistry, Pelotas, RS, Brazil
| | - Maximiliano Sergio Cenci
- Universidade Federal de Pelotas - Unipel, School of Dentistry, Graduate Program in Dentistry, Pelotas, RS, Brazil
| | - Rafael Ratto de Moraes
- Universidade Federal de Pelotas - Unipel, School of Dentistry, Graduate Program in Dentistry, Pelotas, RS, Brazil
| | - Niek Johannes Opdam
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Dentistry, Nijmegen, The Netherlands
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Olofsson H, Ulander EL, Gustafson Y, Hörnsten C. Association between socioeconomic and health factors and edentulism in people aged 65 and older – a population-based survey. Scand J Public Health 2017; 46:690-698. [DOI: 10.1177/1403494817717406] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims: To study edentulism and use of dental services in a population-based sample of people aged 65 years and older from northern Sweden and western Finland. Methods: In 2010, people aged 65, 70, 75 and 80 years who were living in one of 32 municipalities in northern Sweden and western Finland were invited to answer a questionnaire as part of the Gerontological Regional Database (GERDA) study ( n = 6099). The questionnaire contained items related to socioeconomic status, general health and edentulism. Results: The prevalence of edentulism was 34.9% in Finland, compared with 20.6% in Sweden ( p < 0.001), 31.9% in rural areas, compared with 20.9% in urban areas ( p < 0.001), and 25% overall. The prevalence of edentulism rose from 17.8% in 65-year-olds, 23.8% in 70-year-olds, 33.5% in 75-year-olds and 37.3% in 80-year-olds ( p < 0.001), and was 23.8% in women, compared with 27% in men ( p < 0.001). In multivariate models, edentulism was associated with lower educational level (odds ratio (OR) 2.87, 95% confidence interval (CI) 2.31–3.58), low income level (OR 1.7, CI 1.09–1.47), residence in a rural area (OR 1.43, CI 1.23–1.66), male sex (OR 1.30, CI 1.12–1.52), dependence in instrumental activities of daily living (OR 1.48, CI 1.25–1.74), social isolation (OR 1.52, CI 1.17–1.98) and poor self-experienced health (OR 1.38, CI 1.17–1.62). Conclusions: One-quarter of the total sample was edentulous, with a higher prevalence of edentulism in Finland than in Sweden and in rural than in urban areas. Edentulism was associated with socioeconomic, psychological and health-related factors. These findings could be used to inform preventive measures and identify people aged 65 years and older who are in need of oral care.
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Affiliation(s)
- Hanna Olofsson
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Sweden
| | - Eva Lena Ulander
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Sweden
| | - Yngve Gustafson
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Sweden
| | - Carl Hörnsten
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Sweden
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Bof de Andrade F, Drumond Andrade FC, Noronha K. Measuring socioeconomic inequalities in the use of dental care services among older adults in Brazil. Community Dent Oral Epidemiol 2017; 45:559-566. [PMID: 28745803 DOI: 10.1111/cdoe.12323] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/09/2016] [Accepted: 06/18/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The primary objectives are to assess socioeconomic inequality in the use of dental care among older Brazilian adults and to analyse the extent to which certain determinants contribute to that inequality. METHODS A cross-sectional study using data from the National Oral Health Survey conducted in 2010. All individuals answered a structured questionnaire containing questions on their use of dental care and socioeconomic conditions and underwent a clinical oral examination by a dentist. Concentration indices were decomposed to determine the contribution of socioeconomic factors to inequalities. RESULTS Being in the fifth wealth, quintile was associated with higher odds of having recently visited a dentist (reference: 1st quintile, odds-ratio (OR) 2.26, 95% confidence interval (CI) 1.51-3.38). In addition, being in the top two quintiles of wealth was negatively associated with the use of public dental services. Having eight or more years of schooling was associated with higher odds of both having a recent dental visit and receiving preventive care (relative to having 0-3 years of education), and negatively associated with using public dental services. Results indicate pro-rich inequalities in recent dental visits and preventive dental care. Further, there was a pro-poor inequality in the use of public dental care services. CONCLUSIONS The recent use of dental care and the use of preventive care are disproportionately concentrated among wealthier older adults, whereas the use of public services is more common among poorer individuals. Wealth inequalities in dental care use were mainly explained by socioeconomic factors, such as wealth and education, rather than oral health factors, such as needing treatment or a dental prosthesis.
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Affiliation(s)
| | | | - Kenya Noronha
- Center for Development and Regional Planning, Federal University of Minas Gerais, Belo Horizonte, Brazil
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