Early life-course socioeconomic position, adult work-related factors and oral health disparities: cross-sectional analysis of the J-SHINE study

Trends in Self-Rated Oral Health and Its Associations with Oral Health Status and Oral Health Behaviors in Japanese University Students: A Cross-Sectional Study from 2011 to 2019

Self-rated oral health (SROH) is a valid, comprehensive indicator of oral health status. The purpose of this cross-sectional study was to analyze how oral health behaviors and clinical oral status were associated with SROH and how they had changed over the course of nine years in Japanese university students. Data were obtained from 17,996 students who underwent oral examinations and completed self-questionnaires from 2011 to 2019. Oral status was assessed using the decayed and filled teeth scores, bleeding on probing (BOP), probing pocket depth, the Oral Hygiene Index-Simplified (OHI-S), oral health behaviors, and related factors. SROH improved from 2011 to 2019. The logistic regression model showed that university students who were female and had a high daily frequency of tooth brushing, no BOP, no decayed teeth, no filled teeth, and a low OHI-S score and were significantly more likely to report very good, good, or fair SROH. An interaction effect was observed between survey year and regular dental check-ups (year × regular dental check-ups). The improvement trend in SROH might be associated with changes in oral health behaviors and oral health status.

[Influence of social gradient on the oral health of formally employed womenInfluencia do gradiente social na saúde bucal de mulheres trabalhadoras formáis]

Introduction

Oral diseases are associated with unfavorable social, material, and socioeconomic conditions. Women's oral health is affected by social aspects, which increase health inequalities when compared to men.

Objective

To evaluate the social gradient's influence on the oral health of working women at a university in Santander, Colombia.

Materials and methods

Analytical cross-sectional observational cross-sectional study involving 84 working women. Sociodemographic variables, oral health condition variables (presence of dental caries, periodontal disease, and edentulism), and social status variables were used to establish relationships. Chi-square test or Fisher's Exact test, Student's t-test or Wilcoxon rank test were used, with a significance a<0.05.

Results

The prevalence of dental caries was 85.7%, periodontal disease 79.8%, and edentulism 40.5%. Age, ethnicity, marital status, educational level, work carried out daily, socioeconomic status, and responsibility for household finances were the social factors most frequently related to oral conditions.

Conclusion

The social gradient did not register statistically significant differences when analyzed with oral diseases. However, it was established that women with a high social status had a lower burden of oral diseases, while women with a low social status had a higher prevalence of dental caries, periodontal disease, and edentulism.

Oral health inequality among Indonesian workers in South Korea: role of health insurance and discrimination factors

Background

The health of migrant workers is becoming an important public health issue. Although there are an increasing number of migrant workers in Korea, the health status in migrant populations remains unknown. The aims of this study were (1) to evaluate the association between income and self-rated oral health (SROH), and (2) to assess the role of health insurance and self-perceived discrimination in the association between income and SROH among Indonesian migrant workers in Korea.

Methods

Information about self-reported income, SROH, coverage/utilization of health insurance (HI), living difficulties related to oral health (LDROH), oral health literacy (OHL), and discrimination were obtained from Indonesian migrant workers in Korea (n = 248). The main explanatory variable was income, and SROH was an outcome variable. Logistic regression analyses were performed controlling for age, gender, HI, LDROH, OHL, and discrimination. The paths from income to SROH were analyzed using the Partial Least Square-Structural Equation Model (PLS-SEM).

Results

Among Indonesian migrant workers, the lower income group had the highest probability of a poor SROH compared to the higher income group. The variables showing a high explanatory power were discrimination among the low income group and HI among the middle income group. In PLS-SEM, the variables such as HI, LDROH, OHL, and discrimination contributed 11% to explaining the association between income and SROH.

Conclusion

A monotonic gradient was revealed among migrant workers according to the association between income and SROH. Discrimination and HI contributed to oral health inequalities.

Effectiveness of message-framing to improve oral health behaviors and dental plaque among pregnant women

BACKGROUND

Oral health is considered a prominent factor that contributes to quality of life. Hormonal changes during pregnancy can influence oral health. Message framing can play an important role in oral health. The aim of the present study was to investigate the effect of message framing on oral health and dental plaque among pregnant women.

METHODS

The study was conducted in 2017 on 108 pregnant women in Izeh county, Iran. Participants were randomly assigned to gain-framed, loss-framed, and control groups. The research instrument included a two part questionnaire containing demographic information and oral health knowledge, attitude, behavioral intention, self-efficacy, practice, and dental plaque index. Gain-and loss-framed messages were sent to the intervention groups via cell phone texts, but the control group did not receive any messages. Participant dental plaque was clinically assessed. Analysis of covariance with follow-up tests were performed using SPSS version, 23.0 with p-value set at 0.01 for significance.

RESULTS

Intervention groups had better oral health (knowledge, atttitude, intention, efficacy, practices and plaque) scores compared to the control group (p < 0.001), but intervention (gain- vs loss-framed) groups did not differ on outcomes.

CONCLUSION

Text message intervention improved knowledge, attitude, behavioral intention, self-efficacy, practice, and dental plaque among pregnant women. While differences between control and both intervention groups indicated text messaging had an impact on oral health outcomes, message framing (i.e., gain vs loss) had no discernable impact on oral health outcomes.

Effort-reward imbalance at work and tooth loss: a cross-sectional study from the J-SHINE project

Oral diseases produce enormous productivity loss. However, epidemiological evidence of work stress and tooth loss is scarce. The aim of this study was to examine the association of work stress, according to effort-reward imbalance (ERI), with tooth loss. We conducted a cross-sectional study using data obtained between 2010 and 2011 in Japan. This study included 1,195 employees aged 25-50 years old (response rate=32%). The dependent variable was self-reported tooth loss (having or not). The independent variable was a dichotomized ERI ratio (>1.4 and ≤1.4). Age, sex, sociodemographic variables, work-related factors, and health-related variables were adjusted. Psychological distress was used as a potential mediator. We also examined an additive interaction between support from supervisors and ERI. The median age was 37, and 48% were women. After adjusting for the covariates, ERI was still associated with tooth loss (prevalence ratio=1.20 [95% confidence interval=1.01, 1.42] from Poisson regression models with a robust error variance). Psychological distress partially explained the association, and support from supervisors significantly attenuated the association. In conclusion, high ERI ratio was still associated with an increased risk of tooth loss among working adults.

Posição socioeconômica e autoavaliação da saúde bucal no Brasil: resultados da Pesquisa Nacional de Saúde

Resumo: Analisou-se a autoavaliação da saúde bucal da população adulta brasileira segundo a posição socioeconômica (região de residência, escolaridade, renda e classe social), explorando as variáveis com maior sensibilidade para medir tal associação. Estudaram-se 59.758 indivíduos com 18 anos ou mais de idade, que participaram da Pesquisa Nacional de Saúde 2013, um inquérito domiciliar de base populacional. A autoavaliação da saúde bucal (dentes e gengivas) foi analisada como positiva, regular e negativa. Com base na regressão logística multinomial, estimaram-se odds ratio (OR) brutos e ajustados e os respectivos intervalos de 95% de confiança (IC95%). Foram calculados os percentuais de concordância e o valor de kappa para comparar os valores obtidos pelos modelos de regressão e os valores esperados. A prevalência da autoavaliação da saúde bucal positiva foi 67,4%, 26,7% para regular e 5,9% para negativa. Após ajuste, a chance de autoavaliar a saúde bucal como negativa foi significativamente mais elevada entre os indivíduos com renda domiciliar per capita de até um salário mínimo (OR = 4,71; IC95%: 2,84-7,83), sem nível de escolaridade completo (OR = 3,28; IC95%: 2,34-4,61), da classe social destituídos de ativos (OR = 3,03; IC95%: 2,12-4,32) e residentes na Região Nordeste (OR = 1,50; IC95%: 1,19-1,89). Diversos indicadores de posição socioeconômica influenciam a percepção sobre a saúde bucal, mas a renda domiciliar per capita, a escolaridade e a classe social foram as responsáveis pelo maior gradiente na autoavaliação da saúde bucal de adultos no Brasil em 2013.

Neo-Marxian social class inequalities in oral health among the South Korean population

AIM

The aims of this study were to examine inequalities in periodontitis and tooth loss among South Korean adults using the Wright's Neo-Marxian social class (NMSC) indicator and to assess the impact of material, psychosocial, health behavioural and workplace environmental factors in the association of social class with oral health.

METHODS

This study used the data from the 4th Korea National Health and Nutrition Examination Survey with 6710 participants aged 19-54 years old. Participants were classified into 12 social class positions based on the Wright's social class map. Healthy gum and absence of tooth loss were the health outcomes. Mediating factors were material (M), psychosocial (PS), health behavioural (HB) and workplace environmental (WPE) factors. A series of logistic regressions were performed to analyse the data. Odds ratio (OR) and 95% confidence interval (CI) were used to report the results.

RESULTS

For the absence of periodontal pockets status, expert supervisors were the healthiest periodontal group among the social classes (OR = 2.15 95% CI 1.59-2.90) in the age and gender adjusted model. For the absence of tooth loss, skilled workers had the highest OR for absence of tooth loss (OR = 1.64 95% CI 1.31-2.05) in the age- and gender-adjusted model. For absence of periodontal pockets, the explanatory power of the M factor was the highest in all social class positions except for nonskilled supervisors followed by the HB factor. Additionally, the absence of tooth loss had a fairly similar pattern. The explanatory power of the M factor was the highest in all social class positions except for the petty bourgeoisie (highest: HB) and nonskilled supervisors (highest: WPE) followed by the HB and WPE factors.

CONCLUSION

There were nongradient oral health inequalities among the South Korean population according to the NMSC. Oral health promotion programmes that focus on changing the socioeconomic environment and health behaviours should be implemented.

Life course socioeconomic inequalities and oral health status in later life: ELSI-Brazil

OBJECTIVE

To investigate the association between life course socioeconomic conditions and two oral health outcomes (edentulism and use of dental prostheses among individuals with severe tooth loss) among older Brazilian adults.

METHODS

This was a cross-sectional study with data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil) which includes information on persons aged 50 years or older residing in 70 municipalities across the five great Brazilian regions. Regression models using life history information were used to investigate the relation between childhood (parental education) and adulthood (own education and wealth) socioeconomic circumstances and edentulism and use of dental prostheses. Slope index of inequality and relative index of inequality for edentulism and use of dental prostheses assessed socioeconomic inequalities in both outcomes.

RESULTS

Approximately 28.8% of the individuals were edentulous and among those with severe tooth loss 80% used dental prostheses. Significant absolute and relative inequalities were found for edentulism and use of dental prostheses. The magnitude of edentulism was higher among individuals with lower levels of socioeconomic position during childhood, irrespective of their current socioeconomic position. Absolute and relative inequalities related to the use of dental prostheses were not related to childhood socioeconomic position.

CONCLUSIONS

These findings substantiate the association between life course socioeconomic circumstances and oral health in older adulthood, although use of dental prostheses was not related to childhood socioeconomic position. The study also highlights the long-lasting relation between childhood socioeconomic inequalities and oral health through the life course.

Temporary employment and tooth loss: a cross-sectional study from the J-SHINE study

Background

Temporary employment leads to psychological distress and higher mortality, but data on its associations with oral health is limited. We examined whether having the experience of temporary employment was associated with tooth loss among working adults in Japan.

Methods

We conducted a cross-sectional study from the 2010–2011 Japanese Study on Stratification, Health, Income, and Neighborhood study that analyzed 2652 participants aged 25–50 years (men = 1394; women = 1258). Independent variable was changes in employment status (continuous regular employment and the experience of temporary employment). Dependent variable was self-reported tooth loss (none, 1 tooth, 2 teeth, 3 teeth, 4 teeth, and more than 4 teeth). Covariates were sex, age, years of education, self-rated household economic status in early life at 5 years old, marital status, number of family members in the household, history of diabetes, and body mass index. We conducted a negative binomial regression analysis to estimate prevalence rate ratios (PRRs) and 95% confidence intervals (95%CIs) for tooth loss. We also confirmed the interaction term between changes in employment status and sex.

Results

The median age of the participants was 37 years. The percentages of men and women who experienced temporary employment were 14.5% and 61.3%, respectively. Compared with continuous regular employment, the experience of temporary employment was significantly associated with tooth loss in both sexes after adjusting for the covariates (men: PRR = 1.50 [95%CI = 1.13, 2.00]; women: PRR = 1.42 [95%CI = 1.14, 1.76]). The interaction term between employment status and sex was not significant (p = 0.71).

Conclusions

Temporary employment is adversely associated with oral health.

Labor factor barriers to seeking medical services among metropolitan workers: a cross-sectional analysis by sex using the J-SHINE study

OBJECTIVES

There is limited evidence on the relationship between labor factors and the decision to refrain from seeking medical services. This study aimed to examine how labor factors are related to medical service access among male and female workers in Tokyo and surrounding areas.

METHODS

We used data from 4,385 respondents to the survey in the Japanese Study on Stratification, Health, Income, and Neighborhood (J-SHINE), an ongoing epidemiologic household panel study. Surveys from 2010 to 2011 were analyzed. The outcome variable was whether or not an individual refrained from seeking medical services. Labor factors included employment type (permanent, temporary, or self-employed), company size (<100, 100-1,000, or >1,000 employees) and occupation type (white-collar, blue-collar).

RESULTS

We included a total of 2,013 people after excluding those with missing data (analysis utilization: 45.9%). After adjusting covariates, we found that men working in small companies were more likely to refrain from seeking medical services than were those in medium or large companies (adjusted prevalence ratio [PR]: 1.19, 95% confidence interval [CI]: 1.04-1.37). Among women, however, those in self-employment (PR: 1.38, 95% CI: 1.08-1.77) and blue-collar employment (PR: 1.24, 95% CI: 1.04-1.47) were more likely to refrain than were those classified as permanent or white-collar workers.

CONCLUSIONS

The relationship between labor factors and refraining from seeking medical services differed among men by company size, and among women by employment type and occupation type.

Socioeconomic inequalities in dental health among middle-aged adults and the role of behavioral and psychosocial factors: evidence from the Spanish National Health Survey

BACKGROUND

The goal of this analysis was to describe socioeconomic inequalities in dental health among Spanish middle-aged adults, and the role of behavioral and psychosocial factors in explaining these inequalities.

METHODS

This cross-sectional study used survey data from the 2006 Spanish National Health Survey and focused on adults ages 30 - 64. The outcome was dental health status based on the presence of self-reported dental problems. We used education, income, and occupational class as indicators of socioeconomic position and applied logistic regression analysis to estimate associations. We included behavioral and psychosocial variables in the models and compared non-adjusted to adjusted estimates to assess their potential role in explaining socioeconomic gradients.

RESULTS

Results showed clear socioeconomic gradients in dental health among middle-aged adults. The percentage of people who reported more dental problems increased among those with lower levels of education, income, and occupation. These gradients were statistically significant (p < .001). Logistic regression showed that groups with lower education, income, and occupation had higher odds of reporting the outcome (p < .001). Associations were stronger when considering education as the indicator of socioeconomic position. Substantial unexplained associations remained significant after adjusting the model by behavioral and psychosocial variables.

CONCLUSIONS

This study shows significant socioeconomic gradients in dental health among middle-aged adults in Spain. Behavioral and psychosocial variables were insufficient to explain the inequalities described, suggesting the intervention of other factors. Further research should incorporate additional explanations to better understand and comprehensively address socioeconomic inequalities in dental health.