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Azañedo D, Visconti-Lopez FJ, Hernández-Vásquez A. Oral Health Service Use in Older Peruvians Before and During the COVID-19 Pandemic. Int Dent J 2024; 74:473-481. [PMID: 38225185 PMCID: PMC11123544 DOI: 10.1016/j.identj.2023.12.003] [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: 05/09/2023] [Revised: 11/14/2023] [Accepted: 12/09/2023] [Indexed: 01/17/2024] Open
Abstract
OBJECTIVES The aim of this work was to analyse inequalities in oral health services utilisation (OHSU) in older Peruvian adults through comparative analysis of the years 2019 and 2021. METHODS We conducted a secondary analysis of data from the 2019 and 2021 Demographic and Health Survey (ENDES). The outcome variable was OHSU by older Peruvian adults in the past year. We used Poisson generalised linear models adjusted for age and sex to assess changes in OHSU by sociodemographic characteristics. The Erreygers concentration index was used to describe the socioeconomic inequalities in OHSU. The contribution of each variable to inequalities was estimated by a decomposition analysis. RESULTS In 2021, OHSU probability amongst older Peruvian adults decreased by 37% compared to 2019. The decline was greatest in those aged 80 or older (51%), the lowest wealth quintile (47%), those with functional limitations (53%), and those whose native language is Quechua or other indigenous languages (47%). Surprisingly, we observed a reduction in OHSU inequalities (difference: -0.1074; P = .003) during the COVID-19 pandemic, particularly amongst rural residents (difference: -0.0771; P = .030), the lowest wealth quintile (difference: -0.0764; P = .020), and those with functional limitations (difference: -0.3665; P < .001). Poverty accounted for 73% of the inequality in 2021. CONCLUSIONS The probability of OHSU has significantly decreased likely due to the COVID-19 pandemic. Paradoxically, we observed a reduction in OHSU inequalities during the pandemic, despite the known socioeconomic impact. However, further research is required to gain deeper understanding of this phenomenon.
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Affiliation(s)
| | | | - Akram Hernández-Vásquez
- Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru.
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Jashni YK, Emari F, Morris M, Allison P. Indicators of integrating oral health care within universal health coverage and general health care in low-, middle-, and high-income countries: a scoping review. BMC Oral Health 2023; 23:251. [PMID: 37120527 PMCID: PMC10149008 DOI: 10.1186/s12903-023-02906-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 03/21/2023] [Indexed: 05/01/2023] Open
Abstract
BACKGROUND The World Health Organization (WHO) has recently devoted special attention to oral health and oral health care recommending the latter becoming part of universal health coverage (UHC) so as to reduce oral health inequalities across the globe. In this context, as countries consider acting on this recommendation, it is essential to develop a monitoring framework to measure the progress of integrating oral health/health care into UHC. This study aimed to identify existing measures in the literature that could be used to indicate oral health/health care integration within UHC across a range of low-, middle- and high-income countries. METHODS A scoping review was conducted by searching MEDLINE via Ovid, CINAHL, and Ovid Global Health databases. There were no quality or publication date restrictions in the search strategy. An initial search by an academic librarian was followed by the independent reviewing of all identified articles by two authors for inclusion or exclusion based on the relevance of the work in the articles to the review topic. The included articles were all published in English. Articles concerning which the reviewers disagreed on inclusion or exclusion were reviewed by a third author, and subsequent discussion resulted in agreement on which articles were to be included and excluded. The included articles were reviewed to identify relevant indicators and the results were descriptively mapped using a simple frequency count of the indicators. RESULTS The 83 included articles included work from a wide range of 32 countries and were published between 1995 and 2021. The review identified 54 indicators divided into 15 categories. The most frequently reported indicators were in the following categories: dental service utilization, oral health status, cost/service/population coverage, finances, health facility access, and workforce and human resources. This study was limited by the databases searched and the use of English-language publications only. CONCLUSIONS This scoping review identified 54 indicators in a wide range of 15 categories of indicators that have the potential to be used to evaluate the integration of oral health/health care into UHC across a wide range of countries.
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Affiliation(s)
- Yassaman Karimi Jashni
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montréal, Canada
| | - Fatemeh Emari
- Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada
| | - Martin Morris
- Schulich Library of Physical Sciences, Life Sciences and Engineering, McGill University, Montréal, Canada
| | - Paul Allison
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montréal, Canada.
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Felgner S, Henschke C. Patients' preferences in dental care: A discrete-choice experiment and an analysis of willingness-to-pay. PLoS One 2023; 18:e0280441. [PMID: 36848356 PMCID: PMC9970100 DOI: 10.1371/journal.pone.0280441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 12/31/2022] [Indexed: 03/01/2023] Open
Abstract
INTRODUCTION Dental diseases are a major problem worldwide. Costs are a burden on healthcare systems and patients. Missed treatments can have health and financial consequences. Compared to other health services, dental treatments are only covered in parts by statutory health insurance (SHI). Using the example of dental crowns for a cost-intensive treatment, our study aims to investigate whether (1) certain treatment attributes determine patients' treatment choice, and (2) out-of-pocket payments represent a barrier to access dental care. METHODS We conducted a discrete-choice-experiment by mailing questionnaires to 10,752 people in Germany. In presented scenarios the participants could choose between treatment options (A, B, or none) composed of treatment attribute levels (e.g., color of teeth) for posterior (PT) and anterior teeth (AT). Considering interaction effects, we used a D-efficient fractional factorial design. Choice analysis was performed using different models. Furthermore, we analyzed willingness-to-pay (WTP), preference of choosing no and SHI standard care treatment, and influence of socioeconomic characteristics on individual WTP. RESULTS Out of n = 762 returned questionnaires (response rate of r = 7.1), n = 380 were included in the analysis. Most of the participants are in age group "50 to 59 years" (n = 103, 27.1%) and female (n = 249, 65.5%). The participants' benefit allocations varied across treatment attributes. Aesthetics and durability of dental crowns play most important roles in decision-making. WTP regarding natural color teeth is higher than standard SHI out-of-pocket payment. Estimations for AT dominate. For both tooth areas, "no treatment" was a frequent choice (PT: 25.7%, AT: 37.2%). Especially for AT, treatment beyond SHI standard care was often chosen (49.8%, PT: 31.3%). Age, gender, and incentive measures (bonus booklet) influenced WTP per participant. CONCLUSION This study provides important insights into patient preferences for dental crown treatment in Germany. For our participants, aesthetic for AT and PT as well as out-of-pocket payments for PT play an important role in decision-making. Overall, they are willing to pay more than the current out-of-pockt payments for what they consider to be better crown treatments. Findings may be valuable for policy makers in developing measures that better match patient preferences.
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Affiliation(s)
- Susanne Felgner
- Department of Health Care Management, Berlin Centre of Health Economics Research (BerlinHECOR), Technische Universität Berlin, Berlin, Germany
| | - Cornelia Henschke
- Department of Health Care Management, Berlin Centre of Health Economics Research (BerlinHECOR), Technische Universität Berlin, Berlin, Germany
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Jiang N, Grytten J, Kinge JM. Inequality in access to dental services in a market-based dental care system: A population study from Norway 1975-2018. Community Dent Oral Epidemiol 2022; 50:548-558. [PMID: 34806803 DOI: 10.1111/cdoe.12709] [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: 05/03/2021] [Revised: 11/10/2021] [Accepted: 11/12/2021] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To examine income-related inequalities in access to dental services from 1975 to 2018. In Norway, dental care services for adults are privately financed. This may lead to income-related inequalities in access. In the early 1970s, that is, at the beginning of the study period, there were marked inequalities in access to dental services according to personal income. However, from the beginning of the 1970s, there has been a large increase in gross national income per capita in Norway as a result of the growth of the oil and gas industry. This increase in income also meant that people with a low income in 1975 had a rise in their level of income. According to the law of diminishing utility, an increase in income leads to higher consumption of dental services for people with a low level of income compared to people with a high level of income. The study hypothesis is that the inequalities in access to dental services that existed in 1975 became less over time. METHODS Statistics Norway collected samples of cross-sectional health survey data for the following years: 1975, 1985, 1995, 2002, 2008, 2012 and 2018. For each sample, individuals 21 years and older were drawn randomly from the non-institutionalized adult population using a two-stage stratified cluster sample technique. Inequalities were measured using the concentration index. The dependent variable was the use of dental services during the last year, and the key independent variable was equivalized household income. RESULTS The concentration index for inequalities in use of dental services according to income decreased from 0.10 (95% CI = 0.09, 0.11) in 1975 to 0.04 (95% CI = 0.03, 0.05) in 2018. The decrease was particularly large from 2002 to 2012. This was a period with a large growth in gross national income. CONCLUSION People with a low income had a marked increase in their purchasing power from 1975 to 2018. This coincided with an increase in demand for dental care for this low-income group.
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Affiliation(s)
- Nan Jiang
- Department of Community Dentistry, University of Oslo, Oslo, Norway
| | - Jostein Grytten
- Department of Community Dentistry, University of Oslo, Oslo, Norway.,Department of Obstetrics and Gynecology, Institute of Clinical Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Jonas Minet Kinge
- Department of Community Dentistry, University of Oslo, Oslo, Norway.,Norwegian Institute of Public Health, Oslo, Norway
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Ou X, Zeng L, Zeng Y, Pei Y, Zhang X, Wu W, Siamdoust S, Wu B. Health behaviors and tooth retention among older adults in China: findings from the 4th Chinese national oral health survey. BMC Oral Health 2022; 22:285. [PMID: 35836158 PMCID: PMC9281058 DOI: 10.1186/s12903-022-02283-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 06/08/2022] [Indexed: 11/10/2022] Open
Abstract
Background This study aimed to examine the association between oral health behaviors and tooth retention among Chinese older adults.
Methods Data were used from the 4th Chinese National Oral Health Survey, a nationally representative sample. The sample included 9054 older adults aged 55 to 74. Control variables and oral health behaviors were measured through a questionnaire interview, and the number of remaining teeth and periodontal health were obtained from an oral health examination. A chi-square test was used for univariate analysis. Multivariate Logistic regression was used to explore the association between health behaviors and the number of remaining teeth. Results The average number of remaining teeth in the sample was 24.4 ± 7.7. There was a higher proportion of older adults living in urban areas with 20 or more teeth than those living in rural areas (83.2% vs. 79.4%, P < 0.001); and a higher proportion of individuals with high education levels with 20 or more teeth compared to those with low education levels (P < 0.001). Logistic regression models showed that older adults who used toothpicks `(OR = 3.37, 95% CI 2.94–3.85), dental floss (OR = 1.93, 95% CI 1.05–3.53), toothpaste (OR = 3.89, 95% CI 3.14–4.83); and never smoked (OR = 1.43 95% CI 1.20–1.70) were more likely to retain 20 or more natural teeth; whereas older adults who had a dental visit were less likely to retain 20 or more natural teeth (OR = 0.45, 95% CI 0.39–052). Conclusion Good oral hygiene practices, never smoking, and regular dental visits focusing on prevention are significantly associated with teeth retention. It is critical to promote a healthy lifestyle and improve prevention-oriented oral health care systems.
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Affiliation(s)
- Xiaoyan Ou
- Key Laboratory of Oral Biomedicine, Jiangxi Province, Jiangxi Province Clinical Research Center for Oral Diseases, Affiliated Stomatological Hospital of Nanchang University, 49 Fuzhou Road, Nanchang, 330006, Jiangxi Province, China
| | - Liwei Zeng
- Key Laboratory of Oral Biomedicine, Jiangxi Province, Jiangxi Province Clinical Research Center for Oral Diseases, Affiliated Stomatological Hospital of Nanchang University, 49 Fuzhou Road, Nanchang, 330006, Jiangxi Province, China.
| | - Yixuan Zeng
- Key Laboratory of Oral Biomedicine, Jiangxi Province, Jiangxi Province Clinical Research Center for Oral Diseases, Affiliated Stomatological Hospital of Nanchang University, 49 Fuzhou Road, Nanchang, 330006, Jiangxi Province, China
| | - Yaolin Pei
- Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY, 10010, USA
| | - Xiujuan Zhang
- Key Laboratory of Oral Biomedicine, Jiangxi Province, Jiangxi Province Clinical Research Center for Oral Diseases, Affiliated Stomatological Hospital of Nanchang University, 49 Fuzhou Road, Nanchang, 330006, Jiangxi Province, China
| | - Wei Wu
- Key Laboratory of Oral Biomedicine, Jiangxi Province, Jiangxi Province Clinical Research Center for Oral Diseases, Affiliated Stomatological Hospital of Nanchang University, 49 Fuzhou Road, Nanchang, 330006, Jiangxi Province, China
| | - Shahrzad Siamdoust
- Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY, 10010, USA
| | - Bei Wu
- Rory Meyers College of Nursing and NYU Aging Incubator, New York University, 433 First Avenue, New York, NY, 10010, USA.
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Kataoka S, Kimura M, Yamaguchi T, Egashira K, Yamamoto Y, Koike Y, Ogawa Y, Fujiharu C, Namai T, Taguchi K, Takahashi M, Kameda A, Kasen T, Hano A, Kubota K, Sato M, Yamaga H, Nohara K, Shirasawa M, Sekine C, Fukuda M, Aoki A, Takeuchi Y, Mugiyama M, Mori K, Sawada K, Kashiwagi Y, Kitamura M, Hayashi T, Nakagawa T, Murakami S. A cross-sectional study of relationships between periodontal disease and general health: The Hitachi Oral Healthcare Survey. BMC Oral Health 2021; 21:644. [PMID: 34911523 PMCID: PMC8672581 DOI: 10.1186/s12903-021-01990-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 11/22/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND This cross-sectional study performed to clarify the relationship between periodontal disease and non-communicable diseases (NCDs), such as obesity, diabetes mellitus, impaired glucose tolerance (IGT), chronic obstructive pulmonary disease (COPD), and atherosclerotic cardiovascular disease (ASCVD) by introducing dental examinations into the annual health examinations conducted by Japanese companies, and to highlights the importance of a medical system that connects dental and medical professionals. METHODS A total of 1.022 Hitachi Ltd. employees were enrolled in this cross-sectional study. We examined correlations and odds ratios (ORs) between the dental and overall health of employees using stratification and multiple logistic regression analyses based on the periodontal health indicators, general health indicators, and occlusal force. RESULTS The adjusted OR of PPD for obesity (OR, 1.42; 95% confidence interval [CI], 1.09-1.84; p = 0.009), IGT (OR, 1.48; 95% CI, 1.00-2.20; p = 0.049), and COPD (OR, 1.38; 95% CI, 1.02-1.88; p = 0.038) significantly differed. The adjusted OR of body mass index (OR, 1.28; 95% CI 1.15-1.42; p < 0.001), haemoglobin A1C (HbA1c) (OR, 4.34; 95% CI, 1.89-9.98; p < 0.001), fasting blood glucose (FBG) levels (OR, 1.08; 95% CI 1.04-1.11; p < 0.001), postbronchodilator forced expiratory volume in one second/forced vital capacity ratio (%FEV1) (OR, 0.95; 95% CI 0.91-1.00; p = 0.031) and smoking (OR, 2.32; 95% CI 1.62-3.33; p < 0.001) for severe periodontal disease also significantly differed. Occlusal force was significantly reduced in employees aged 50-59 years compared to those aged 40-49 years. Both PPD, HbA1c, FBG levels were significantly associated with occlusal force among employees with moderate/severe periodontitis. PPD was significantly associated with occlusal force among employees with and moderate COPD, and ASCVD. %FEV1 was significantly associated with occlusal force among employees with IGT. CONCLUSIONS This cross-sectional study revealed mutual relationships among periodontal disease, NCDs, and occlusal force on Japanese corporate workers. We demonstrated that a comprehensive, regional healthcare system centred on annual integrated dental and physical health examinations in the workplace will benefit employees and positively impact corporate health insurance.
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Affiliation(s)
- Shinsuke Kataoka
- Research and Development Head Quarters, LION Corporation, Odawara, Kanagawa, Japan
| | - Mitsuo Kimura
- Research and Development Head Quarters, LION Corporation, Odawara, Kanagawa, Japan
| | - Tsuguno Yamaguchi
- Research and Development Head Quarters, LION Corporation, Odawara, Kanagawa, Japan
| | - Kenji Egashira
- Research and Development Head Quarters, LION Corporation, Odawara, Kanagawa, Japan
| | - Yu Yamamoto
- Research and Development Head Quarters, LION Corporation, Odawara, Kanagawa, Japan
| | - Yasushi Koike
- Research and Development Head Quarters, LION Corporation, Odawara, Kanagawa, Japan
| | - Yuki Ogawa
- Research and Development Head Quarters, LION Corporation, Odawara, Kanagawa, Japan
| | - Chika Fujiharu
- The LION Foundation for Dental Health (Public Interest Incorporated Foundation), Sumida, Tokyo, Japan
| | - Toshiko Namai
- The LION Foundation for Dental Health (Public Interest Incorporated Foundation), Sumida, Tokyo, Japan
| | - Kanako Taguchi
- The LION Foundation for Dental Health (Public Interest Incorporated Foundation), Sumida, Tokyo, Japan
| | - Momoko Takahashi
- The LION Foundation for Dental Health (Public Interest Incorporated Foundation), Sumida, Tokyo, Japan
| | - Asami Kameda
- The LION Foundation for Dental Health (Public Interest Incorporated Foundation), Sumida, Tokyo, Japan
| | - Tomoka Kasen
- The LION Foundation for Dental Health (Public Interest Incorporated Foundation), Sumida, Tokyo, Japan
| | - Asami Hano
- The LION Foundation for Dental Health (Public Interest Incorporated Foundation), Sumida, Tokyo, Japan
| | - Konomi Kubota
- The LION Foundation for Dental Health (Public Interest Incorporated Foundation), Sumida, Tokyo, Japan
| | - Masayuki Sato
- Research and Development Head Quarters, LION Corporation, Odawara, Kanagawa, Japan
| | - Hiroaki Yamaga
- Research and Development Head Quarters, LION Corporation, Odawara, Kanagawa, Japan
| | - Kaori Nohara
- The LION Foundation for Dental Health (Public Interest Incorporated Foundation), Sumida, Tokyo, Japan
| | - Mikiko Shirasawa
- The LION Foundation for Dental Health (Public Interest Incorporated Foundation), Sumida, Tokyo, Japan
| | - Chika Sekine
- The LION Foundation for Dental Health (Public Interest Incorporated Foundation), Sumida, Tokyo, Japan
| | - Maki Fukuda
- The LION Foundation for Dental Health (Public Interest Incorporated Foundation), Sumida, Tokyo, Japan
| | - Arisa Aoki
- The LION Foundation for Dental Health (Public Interest Incorporated Foundation), Sumida, Tokyo, Japan
| | - Yurina Takeuchi
- The LION Foundation for Dental Health (Public Interest Incorporated Foundation), Sumida, Tokyo, Japan
| | - Misaki Mugiyama
- The LION Foundation for Dental Health (Public Interest Incorporated Foundation), Sumida, Tokyo, Japan
| | - Kenta Mori
- Faculty of Dentistry, Osaka University, Suita, Osaka, Japan
| | - Keigo Sawada
- Faculty of Dentistry, Osaka University, Suita, Osaka, Japan
| | | | | | - Takeshi Hayashi
- Hitachi Health Care Center, Hitachi Limited, Hitachi, Ibaraki, Japan
| | - Tohru Nakagawa
- Hitachi Health Care Center, Hitachi Limited, Hitachi, Ibaraki, Japan
| | - Shinya Murakami
- Faculty of Dentistry, Osaka University, Suita, Osaka, Japan.
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Okamoto E. Japan's Dental Care Facing Population Aging: How Universal Coverage Responds to the Changing Needs of the Elderly. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179359. [PMID: 34501951 PMCID: PMC8430920 DOI: 10.3390/ijerph18179359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 08/29/2021] [Accepted: 08/31/2021] [Indexed: 11/30/2022]
Abstract
Although universal health coverage (UHC) is pursued by many countries, not all countries with UHC include dental care in their benefits. Japan, with its long-held tradition of UHC, covers dental care as an essential benefit, and the majority of dental care services are provided to all patients with minimal copayment. Being under UHC, the scope of services as well as prices are regulated by the uniform fee schedule, and dentists submit claims according to the uniform format and fee schedule. The author analyzed the publicly available dental health insurance claims data as well as a sampling survey on dental hygiene to illustrate how Japan’s dental care is responding to the challenges from population aging. A marked improvement was found in dental health status in the elderly population as measured by improved tooth-specific survival. The improvement may be attributable to the universal coverage of dental care, as evidenced by the steady increase in home visits by dentists/dental hygienists as well as home oral rehabilitation services.
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Affiliation(s)
- Etsuji Okamoto
- Department of Health & Welfare Management, University of Fukuchiyama, Kyoto 620-0886, Japan
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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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Andrade FBD, Antunes JLF. Trends in socioeconomic inequalities in the prevalence of functional dentition among older people in Brazil. CAD SAUDE PUBLICA 2018; 34:e00202017. [DOI: 10.1590/0102-311x00202017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 05/18/2018] [Indexed: 01/13/2023] Open
Abstract
The objective of this research was to evaluate trends in socioeconomic inequalities in the prevalence of functional dentition among community-dwelling older adults in Brazil. This was a cross-sectional study with data from the last two SBBrasil Project surveys conducted in 2003 and 2010. Functional dentition was defined as the presence of 20 or more natural teeth and was assessed during the clinical examination of dentition status. Schooling was used as the socioeconomic position measure. Socioeconomic inequality was measured using two complex measures; the slope index of inequality (SII) and the relative index of inequality (RII). The prevalence of functional dentition was 10.8% (95%CI: 8.1-14.2) in 2003 and 13.6% (95%CI: 11.1-16.5) in 2010. The prevalence of functional dentition increased significantly over the educational rank in both years. Absolute inequalities were significant for both years and remained unaltered between 2003 and 2010. Significant relative inequality in the prevalence of functional dentition was found in both years of the survey. Socioeconomic inequalities in the prevalence of functional dentition among older adults in Brazil persisted significantly between both national oral health surveys.
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Kailembo A, Quiñonez C, Lopez Mitnik GV, Weintraub JA, Stewart Williams J, Preet R, Iafolla T, Dye BA. Income and wealth as correlates of socioeconomic disparity in dentist visits among adults aged 20 years and over in the United States, 2011-2014. BMC Oral Health 2018; 18:147. [PMID: 30139349 PMCID: PMC6108097 DOI: 10.1186/s12903-018-0613-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 08/13/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most studies in the United States (US) have used income and education as socioeconomic indicators but there is limited information on other indicators, such as wealth. We aimed to assess how two socioeconomic status measures, income and wealth, compare as correlates of socioeconomic disparity in dentist visits among adults in the US. METHODS Data from the National Health and Nutrition Examination Survey (NHANES) 2011-2014 were used to calculate self-reported dental visit prevalence for adults aged 20 years and over living in the US. Prevalence ratios using Poisson regressions were conducted separately with income and wealth as independent variables. The dependent variable was not having a dentist visit in the past 12 months. Covariates included sociodemographic factors and untreated dental caries. Parsimonious models, including only statistically significant (p < 0.05) covariates, were derived. The Akaike Information Criterion (AIC) measured the relative statistical quality of the income and wealth models. Analyses were additionally stratified by race/ethnicity in response to statistically significant interactions. RESULTS The prevalence of not having a dentist visit in the past 12 months among adults aged 20 years and over was 39%. Prevalence was highest in the poorest (58%) and lowest wealth (57%) groups. In the parsimonious models, adults in the poorest and lowest wealth groups were close to twice as likely to not have a dentist visit (RR 1.69; 95%CI: 1.51-1.90) and (RR 1.68; 95%CI: 1.52-1.85) respectively. In the income model the risk of not having a dentist visit were 16% higher in the age group 20-44 years compared with the 65+ year age group (RR 1.16; 95%CI: 1.04-1.30) but age was not statistically significant in the wealth model. The AIC scores were lower (better) for the income model. After stratifying by race/ethnicity, age remained a significant indicator for dentist visits for non-Hispanic whites, blacks, and Asians whereas age was not associated with dentist visits in the wealth model. CONCLUSIONS Income and wealth are both indicators of socioeconomic disparities in dentist visits in the US, but both do not have the same impact in some populations in the US.
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Affiliation(s)
- Alexander Kailembo
- National Institutes of Health, National Institute of Dental and Craniofacial Research, Bethesda, USA.
| | | | - Gabriela V Lopez Mitnik
- National Institutes of Health, National Institute of Dental and Craniofacial Research, Bethesda, USA
| | | | - Jennifer Stewart Williams
- Umeå University, Umea, Sweden.,Research Centre for Generational Health and Ageing, University of Newcastle, Callaghan, Australia
| | | | - Timothy Iafolla
- National Institutes of Health, National Institute of Dental and Craniofacial Research, Bethesda, USA
| | - Bruce A Dye
- National Institutes of Health, National Institute of Dental and Craniofacial Research, Bethesda, USA
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