Political factors and oral health inequalities: a cross-national analysis

Background: Macro-level factors (related to the economic and political context) have been considered as determinants of health inequalities. In particular, the role of political factors (such as welfare state regimes) has recently received increasing attention. However, very little is known in that respect for oral health inequalities. Aim: To examine the relationship between oral health inequalities and political factors (welfare state regimes) in Europe and the US. Methods: The project involved three stages. First, oral health inequalities were compared across 21 European countries grouped into different welfare state regimes (Scandinavian, Anglo-Saxon, Bismarckian, Southern, and Eastern). Second, a multilevel approach was employed to assess the influence of welfare regimes on the variation in oral health between European countries. Third, inequalities were compared between two countries classified in the same welfare regime, but with different health care systems: England and the US. In stages one and three, relative and absolute socioeconomic inequalities were examined using the relative and slope indices of inequality (RII and SII, respectively). Results: The Scandinavian welfare regime showed consistently lower prevalence rates of edentulousness, no functional dentition and oral impacts than the other regimes. Significant educational and occupational inequalities on edentulousness and no functional dentition were observed in all welfare regimes. The comparison on the magnitude of inequalities across regimes showed a complex picture with different findings according to the outcome, socioeconomic indicator and nature of the inequalities (absolute and relative). Overall, results of this comparison did not support the hypothesis of lower inequalities in the Scandinavian regime. When using a multilevel approach, results revealed that grouping countries into welfare regimes contributed to explaining the variation in oral health among European countries. In the England-US comparison, significant relative (RII) and absolute (SII) inequalities were found in the two countries in all oral health measures. These inequalities were consistently higher in the US compared to England. Conclusions: Oral health inequalities exist in all European welfare state regimes. The Scandinavian regime exhibited better oral health, but not lower inequalities compared to the other regimes. The US showed consistently larger inequalities than England. Overall, results suggest that political factors influence socioeconomic inequalities in oral health

Explaining time changes in oral health-related quality of life in England: a decomposition analysis

BACKGROUND: Oral diseases are highly prevalent and impact on oral health-related quality of life (OHRQoL). However, time changes in OHRQoL have been scarcely investigated in the current context of general improvement in clinical oral health. This study aims to examine changes in OHRQoL between 1998 and 2009 among adults in England, and to analyse the contribution of demographics, socioeconomic characteristics and clinical oral health measures. METHODS: Using data from two nationally representative surveys in England, we assessed changes in the Oral Health Impact Profile-14 (OHIP-14), in both the sample overall (n=12 027) and by quasi-cohorts. We calculated the prevalence and extent of oral impacts and summary OHIP-14 scores. An Oaxaca-Blinder type decomposition analysis was used to assess the contribution of demographics (age, gender, marital status), socioeconomic position (education, occupation) and clinical measures (presence of decay, number of missing teeth, having advanced periodontitis). RESULTS: There were significant improvements in OHRQoL, predominantly among those that experienced oral impacts occasionally, but no difference in the proportion with frequent oral impacts. The decomposition model showed that 43% (–4.07/–9.47) of the decrease in prevalence of oral impacts reported occasionally or more often was accounted by the model explanatory variables. Improvements in clinical oral health and the effect of ageing itself accounted for most of the explained change in OHRQoL, but the effect of these factors varied substantially across the lifecourse and quasi-cohorts. CONCLUSIONS: These decomposition findings indicate that broader determinants could be primarily targeted to influence OHRQoL in different age groups or across different adult cohorts

Early-life course factors and oral health among young Norwegian adults

Objective Using a national sample of young Norwegian adults, we examined whether unpleasant experience with dental care during childhood is associated with tooth loss and oral health–related quality of life in adulthood after accounting for early- and later-life socio-behavioural circumstances and dental avoidance behaviour. Methods 2433 individuals aged 25-35 years participated in an electronic survey. Oral quality of life was measured using the oral impact of daily performance (OIDP) inventory. Generalized linear models and negative binomial regression models were used to estimate the association of early unpleasant experiences with dental care and tooth loss and OIDP scores. Incidence rate ratio (IRR) and 95% confidence intervals (CI) were used to estimate the relative differences in prevalence of tooth loss and OIDP scores. Results Adjusting for early-life characteristics only, the prevalence of tooth loss was 1.42 (IRR = 1.42, 95% CI: 1.24-1.64) and 1.96 (IRR = 1.96, 95% CI: 1.70-2.26) times higher among individuals who reported unpleasant experiences a few times or several times, than in individuals who did not report unpleasant experiences with dental care in childhood. Adjusting further for educational level, smoking and tooth brushing attenuated the relative differences (IRR = 1.40, 95% CI: 1.22-1.62 and IRR = 1.88, 95% CI: 1.62-2.17, respectively). Lastly, when adjusting for dental avoidance behaviour, the prevalence of tooth loss was 1.29 (IRR = 1.29, 95% CI: 1.11-1.50) and 1.58 (IRR = 1.58, 95% CI: 1.32-1.88) times higher among individuals who reported unpleasant experiences a few times or several times than in those who did not. Corresponding associations of early unpleasant experience with OIDP were (IRR = 1.41 95% CI: 1.22-1.63) and (IRR = 1.69, 95% CI: 1.42-2.01) when adjusting for early-life characteristics, and (IRR = 1.39, 95% CI: 1.20-1.60) and (IRR = 1.51, 95% CI: 1.27-1.80) when adjusting for education, smoking and tooth brushing. When adjusting for dental avoidance behaviour, the association of early unpleasant experience with OIDP became nonsignificant. Conclusion Unpleasant dental care experiences during childhood are associated with poor oral health in adulthood, independent of later-life socio-behavioural characteristics including negative dental care seeking. This highlights the importance of tailoring regular contacts with dental healthcare services in childhood to build confidence in children and thus has implications for healthcare policy.publishedVersio