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Chaffee BW. Self-perceived quality of social roles, activities and relationships predicts incident gingivitis. Community Dent Oral Epidemiol 2024. [PMID: 38654403 DOI: 10.1111/cdoe.12966] [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: 01/04/2024] [Revised: 03/21/2024] [Accepted: 04/12/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVES While physical health status is known to impact social functioning, a growing literature suggests that social well-being may affect oral health. This investigation evaluated whether self-perceived quality of social roles, activities and relationships (social well-being) influences gingival inflammation. METHODS Data were from the Population Assessment of Tobacco and Health Study, a nationally representative cohort of US adults, biennial waves 4 (2017) to 6 (2021). Social well-being was derived from the validated PROMIS Global-10 survey instrument, categorized for this longitudinal analysis as high, moderate or low. The main outcome was incident self-reported gum bleeding (dichotomous, proxy for gingivitis). Survey-weighted logistic regression modelling adjusted for overall health status, sociodemographic (e.g. age, sex, race/ethnicity), socioeconomic (e.g. income, education) and behavioural (e.g. tobacco, alcohol) confounders and was used to predict marginal mean gum bleeding incidence. RESULTS Cross-sectionally at wave 4 (N = 23 679), gum bleeding prevalence was higher along a stepwise gradient of decreasing satisfaction with social activities and relationships (extremely satisfied: 20.4%; not at all: 40.1%). Longitudinally, among participants who had never reported gum bleeding through wave 4 (N = 9695), marginal predicted new gum bleeding at wave 6 was greater with each category of lower wave 4-5 social well-being (high: 7.6%; moderate: 8.6%; low: 12.4%). Findings were robust to alternative model specifications. Results should be interpreted considering study limitations (e.g. potential unmeasured confounding; outcome by self-report). CONCLUSIONS Social functioning may affect physical health. Specifically, social roles, activities and relationships may influence inflammatory oral conditions, like gingivitis. Confirmatory research is warranted, along with policies and interventions that promote social well-being.
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Affiliation(s)
- Benjamin W Chaffee
- University of California San Francisco School of Dentistry, San Francisco, California, USA
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Ticku S, Watrous O, Burgess D, Luo YL, DSouza S, Simpson C, King K, Riedy CA, Seymour B. A Three Delays theoretical framework to describe social determinants as barriers to dental care. Community Dent Oral Epidemiol 2024. [PMID: 38425183 DOI: 10.1111/cdoe.12949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/19/2024] [Accepted: 02/05/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVES The Three Delays model is a well-established global public health framework for the utilization of obstetric services where each delay represents a series of factors affecting utilization: (1) Delay #1-Deciding to seek care, (2) Delay #2-Reaching an appropriate facility and (3) Delay #3-Receiving adequate care. The aim of this qualitative study was to explore the application of the Three Delays model to dental service utilization and describe factors attributed to delayed utilization within this framework. METHODS This study utilized a framework analysis, underpinned by the Three Delays model, to examine delays in dental care utilization. A criterion purposive sample of English-speaking adults (18+ years) in Massachusetts and Florida, USA with limited dental care access was recruited. Data were collected via semi-structured interviews conducted in two phases: 17 individual interviews, followed by interviews with a subset of five participants over 3 months (a total of 18 interviews). The analysis involved inductive thematic coding and systematic organization within the framework. RESULTS Major themes and subthemes were constructed from the participants' narratives, identified and categorized as factors in the Three Delays framework. Each of the delays was interrelated to the other two, and Delay #1 was the most common delay based on the participants' interviews. The themes and subthemes contributing to one or more delays included interpersonal communication, prior dental experience, financial considerations, childcare costs, social connection, technology literacy, time constraints, competing priorities, stressors such as eviction and immigration status and microaggressions including racism and stigma. CONCLUSION The Three Delays model was applicable to the study of dental care utilization and factors that impact the decision to seek dental care, reaching an appropriate dental facility and receiving adequate dental care in this study context.
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Affiliation(s)
- Shenam Ticku
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Olivia Watrous
- Department of Developmental Biology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Danielle Burgess
- Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Yuanyuan Laura Luo
- Department of Pediatric Dentistry, New York University College of Dentistry, New York, New York, USA
| | - Sabina DSouza
- The University of Chicago College, Chicago, Illinois, USA
| | | | - Kareem King
- Harvard College, Cambridge, Massachusetts, USA
| | - Christine A Riedy
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Brittany Seymour
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
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Völker S, van der Zee-Neuen A, Rinnert A, Hanneken J, Johansson T. Detecting high-risk neighborhoods and socioeconomic determinants for common oral diseases in Germany. BMC Oral Health 2024; 24:205. [PMID: 38331748 DOI: 10.1186/s12903-024-03897-4] [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: 05/03/2023] [Accepted: 01/15/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Ideally, health services and interventions to improve dental health should be tailored to local target populations. But this is not the standard. Little is known about risk clusters in dental health care and their evaluation based on small-scale, spatial data, particularly among under-represented groups in health surveys. Our study aims to investigate the incidence rates of major oral diseases among privately insured and self-paying individuals in Germany, explore the spatial clustering of these diseases, and evaluate the influence of social determinants on oral disease risk clusters using advanced data analysis techniques, i.e. machine learning. METHODS A retrospective cohort study was performed to calculate the age- and sex-standardized incidence rate of oral diseases in a study population of privately insured and self-pay patients in Germany who received dental treatment between 2016 and 2021. This was based on anonymized claims data from BFS health finance, Bertelsmann, Dortmund, Germany. The disease history of individuals was recorded and aggregated at the ZIP code 5 level (n = 8871). RESULTS Statistically significant, spatially compact clusters and relative risks (RR) of incidence rates were identified. By linking disease and socioeconomic databases on the ZIP-5 level, local risk models for each disease were estimated based on spatial-neighborhood variables using different machine learning models. We found that dental diseases were spatially clustered among privately insured and self-payer patients in Germany. Incidence rates within clusters were significantly elevated compared to incidence rates outside clusters. The relative risks (RR) for a new dental disease in primary risk clusters were min = 1.3 (irreversible pulpitis; 95%-CI = 1.3-1.3) and max = 2.7 (periodontitis; 95%-CI = 2.6-2.8), depending on the disease. Despite some similarity in the importance of variables from machine learning models across different clusters, each cluster is unique and must be treated as such when addressing oral public health threats. CONCLUSIONS Our study analyzed the incidence of major oral diseases in Germany and employed spatial methods to identify and characterize high-risk clusters for targeted interventions. We found that private claims data, combined with a network-based, data-driven approach, can effectively pinpoint areas and factors relevant to oral healthcare, including socioeconomic determinants like income and occupational status. The methodology presented here enables the identification of disease clusters of greatest demand, which would allow implementing more targeted approaches and improve access to quality care where they can have the most impact.
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Affiliation(s)
- Sebastian Völker
- Data Science Center of Excellence, BFS health finance, Bertelsmann, Dortmund, Germany.
- Center for Public Health and Healthcare Research, Institute of General Practice, Family Medicine and Preventive Medicine, Program Medical Science, Paracelsus Medical University, Salzburg, Austria.
| | - Antje van der Zee-Neuen
- Center for Physiology, Pathophysiology and Biophysics, Institute for Physiology and Pathophysiology/Gastein Research Institute/Center for Public Health and Healthcare Research, Paracelsus Medical University, Salzburg, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Salzburg, Austria
| | - Alexander Rinnert
- Healthcare & Politics, BFS health finance, Bertelsmann, Dortmund, Germany
| | - Jessica Hanneken
- Healthcare & Politics, BFS health finance, Bertelsmann, Dortmund, Germany
| | - Tim Johansson
- Center for Public Health and Healthcare Research, Institute of General Practice, Family Medicine and Preventive Medicine, Program Medical Science, Paracelsus Medical University, Salzburg, Austria
- Salzburg Regional Health Fund, SAGES, Salzburg, Austria
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Hensel ALJ, Gomaa N. Social and economic capital as effect modifiers of the association between psychosocial stress and oral health. PLoS One 2023; 18:e0286006. [PMID: 37200290 DOI: 10.1371/journal.pone.0286006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/06/2023] [Indexed: 05/20/2023] Open
Abstract
OBJECTIVES To assess the extent of the association of psychosocial stress with oral health in an Ontario population stratified by age groups, and whether any association is modified by indicators of social and economic capital. METHODS We retrieved data of 21,320 Ontario adults, aged 30-74 years old, from the Canadian Community Health Survey (CCHS: 2017-2018), which is a Canada-wide, cross-sectional survey. Using binomial logistic regression models that adjusted for age, sex, education, and country of birth, we examined the association of psychosocial stress (indicated by perceived life stress) with inadequate oral health (indicated as having at least one of the following: bleeding gums, fair/poor self-perceived oral health, persistent oral pain). We assessed the effect measure modification of indicators of social (sense of belonging to the local community, living/family arrangements) and economic capital (household income, dental insurance, dwelling ownership) on the perceived life stress-oral health relationship, stratified by age (30-44, 45-59, 60-74 yrs). We then calculated the Relative Excess Risk due to Interaction (RERI) which indicates the risk that is above what would be expected if the combination of low capital (social or economic) and high psychosocial stress was entirely additive. RESULTS Respondents with higher perceived life stress were at a significantly higher risk of having inadequate oral health (PR = 1.39; 95% CI: 1.34, 1.44). Adults with low social and economic capital were also at an increased risk of inadequate oral health. Effect measure modification showed an additive effect of indicators of social capital on the perceived life stress-oral health relationship. This effect was evident across all three age groups (30-44, 45-59, 60-74 yrs), with the highest attributable proportion of social and economic capital indicators in the psychosocial stress-oral health relationship in older adults (60-74 yrs). CONCLUSION Our findings suggest an exacerbating effect for low social and economic capital in the relationship of perceived life stress with inadequate oral health among older adults.
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Affiliation(s)
- Abby L J Hensel
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Noha Gomaa
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
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Pang M, Wang J, Tian T, Zhao J, Jiang X, Li H, Kong F. The mediating effect of social support on the association between socioeconomic status and self-reported oral health status among the migrant elderly following children in Weifang, China: a cross-sectional study. BMC Oral Health 2022; 22:619. [PMID: 36529752 PMCID: PMC9760054 DOI: 10.1186/s12903-022-02649-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Driven by population aging and the rapid urbanization in China, many migrant elderly following children (MEFC) moved to big cities to care for their grandchildren. The purpose of this study is to clarify the mediating effect of social support on the relationship between socioeconomic status (SES) and self-reported oral health status among the MEFC in Weifang, China. METHODS Multistage cluster random sampling was used to select the participants and finally 613 MEFC were included in the survey. The Social Support Rating Scale (SSRS) and the Chinese version of the Geriatric Oral Health Assessment Index (GOHAI) scale were used for data collection. Descriptive analysis, Rao-Scott test, t-test and structural equation modeling (SEM) were conducted in this study. RESULTS Mean score of GOHAI of the MEFC was 54.95 ± 6.47. The SES of MEFC exerted positive direct effect both on social support (standardized coefficient = 0.15) and self-reported oral health status (standardized coefficient = 0.22); social support exerted positive direct effect on self-reported oral health status (standardized coefficient = 0.17). Social support partially mediated the association between SES and self-reported oral health status [95% confidence interval (CI) 0.003-0.064, P < 0.05], and the mediating effect of social support accounted for 12.0% of the total effect. CONCLUSIONS Higher GOHAI score of MEFC indicated their better self-reported oral health status. MEFCs' SES could exert positive effect both on social support and self-reported oral health status, while the mediating effect of social support between SES and self-reported oral health status of MEFC was established.
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Affiliation(s)
- Mingli Pang
- grid.27255.370000 0004 1761 1174Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012 China ,grid.27255.370000 0004 1761 1174NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012 China
| | - Jieru Wang
- grid.27255.370000 0004 1761 1174Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012 China ,grid.27255.370000 0004 1761 1174NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012 China
| | - Tingting Tian
- grid.27255.370000 0004 1761 1174Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012 China ,grid.27255.370000 0004 1761 1174NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012 China
| | - Jinfeng Zhao
- grid.27255.370000 0004 1761 1174Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012 China ,grid.27255.370000 0004 1761 1174NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012 China
| | - Xiaoxu Jiang
- grid.27255.370000 0004 1761 1174Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012 China ,grid.27255.370000 0004 1761 1174NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012 China
| | - Hexian Li
- grid.27255.370000 0004 1761 1174Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012 China ,grid.27255.370000 0004 1761 1174NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012 China
| | - Fanlei Kong
- grid.27255.370000 0004 1761 1174Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012 China ,grid.27255.370000 0004 1761 1174NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012 China
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