Inequality in oral health related to early and later life social conditions: a study of elderly in Norway and Sweden

Abstract Background: A life course perspective recognizes influences of socially patterned exposures on oral health across the life span. This study assessed the influence of early and later life social conditions on tooth loss and oral impacts on daily performances (OIDP) of people aged 65 and 70 years. Whether social inequalities in oral health changed after the usual age of retirement was also examined. In accordance with "the latent effect life course model", it was hypothesized that adverse early-life social conditions increase the risk of subsequent tooth loss and impaired OIDP, independent of later-life social conditions. Methods: Data were obtained from two cohorts studies conducted in Sweden and Norway. The 2007 and 2012 waves of the surveys were used for the present study. Early-life social conditions were measured in terms of gender, education and country of birth, and later-life social conditions were assessed by working status, marital status and size of social network. Logistic regression and Generalized Estimating Equations (GEE) were used to analyse the data. Inverse probability weighting (IPW) was used to adjust estimates for missing responses and loss to follow-up. Results: Early-life social conditions contributed to tooth loss and OIDP in each survey year and both countries independent of later-life social conditions. Lower education correlated positively with tooth loss, but did not influence OIDP. Foreign country of birth correlated positively with oral impacts in Sweden only. Later-life social conditions were the strongest predictors of tooth loss and OIDP across survey years and countries. GEE revealed significant interactions between social network and survey year, and between marital status and survey year on tooth loss. Conclusion: The results confirmed the latent effect life course model in that early and later life social conditions had independent effects on tooth loss and OIDP among the elderly in Norway and Sweden. Between age 65 and 70, inequalities in tooth loss related to marital status declined, and inequalities related to social network increased

Oral health-related quality of life, tooth loss and utilization of dental services among older people in Norway and Sweden. A prospective and comparative perspective

Background: Globally, the proportion of older people is increasing. There is a need to address issues related to oral health and oral health-related quality of life of elderly. There is scarce information on how oral health and dental care utilization as well as the social distribution of those oral indicators develop across time and by ageing in Norway and Sweden. The overall aim was to provide new information about oral health, dental care utilization and associated life-course factors among older people using comparative data generated by Norwegian and Swedish 1942 birth cohorts of elderly. Methods: The thesis is based on data from two cohort studies. All persons born in 1942 in three counties of Norway and two counties of Sweden were defined as the study cohorts. The 2007 and 2012 waves were used in the present thesis. In Norway, the response rates were 58.0% (n=4211) in 2007 and 54.5% (n=3733) in 2012. A total of 2947 (follow-up rate of 70.0%) participated in both waves. The corresponding rates in Sweden were 73.1% (n=6078) and 72.2% (n=5697), respectively. A total of 4862 (follow-up rate of 80.0%) participated in 2007 and 2012. Data were collected using self-administered questionnaire and analysed separately by country. Results: The prevalence of reporting any oral impacts (OIDP>0) was 29.0% in 2007 and 28.4% in 2012 in Norway, whereas corresponding figures in Sweden were 27.3% in 2007 and 20.4% in 2012. Altogether, 63.6% of the Norwegian and 68.1% of the Swedish participants reported no change regarding OIDP (Oral Impacts on Daily Performances) scores across time. The percentage of persons reporting tooth loss (defined as extensive tooth loss or being edentulous) increased from 21.8% to 23.2% in Norway and from 25.9% to 27.3% in Sweden. Less frequent dental attendance decreased from 14.5% to 12.2% in Norway and from 13.6% to 12.9% in Sweden. Early and later life social conditions contributed independently on tooth loss and OIDP. Participants in socially disadvantaged groups were more likely to report oral impacts (OIDP), tooth loss and less frequent dental attendance. Marginal and random intercept models were applied to take account into clustered structure of data due to repeated observations. Using Andersen’s behavioural model, predisposing, enabling, and need related factors and dental care utilization indicators were associated with OIDP. Conclusions: The OIDP frequency inventory demonstrated acceptable longitudinal validity, reproducibility and responsiveness. OIDP (reporting any oral impacts) and less frequent dental attendance declined while tooth loss increased from age 65 to 70 in both countries investigated. Social inequalities were confirmed and shown to be persistent in Norwegian and Swedish older people from age 65 to 70 years. Support for the latent effect life-course model was obtained. This thesis provides support to Andersen’s model as a satisfactory model to explain oral health in older people

Applying the theory of planned behavior to self-report dental attendance in Norwegian adults through structural equation modelling approach

Abstract Background Understanding factors that affect dental attendance behavior helps in constructing effective oral health campaigns. A socio-cognitive model that adequately explains variance in regular dental attendance has yet to be validated among younger adults in Norway. Focusing a representative sample of younger Norwegian adults, this cross-sectional study provided an empirical test of the Theory of Planned Behavior (TPB) augmented with descriptive norm and action planning and estimated direct and indirect effects of attitudes, subjective norms, descriptive norms, perceived behavioral control and action planning on intended and self-reported regular dental attendance. Method Self-administered questionnaires provided by 2551, 25–35 year olds, randomly selected from the Norwegian national population registry were used to assess socio-demographic factors, dental attendance as well as the constructs of the augmented TPB model (attitudes, subjective norms, descriptive norms, intention, action planning). A two-stage process of structural equation modelling (SEM) was used to test the augmented TPB model. Results Confirmatory factor analysis, CFA, confirmed the proposed correlated 6-factor measurement model after re-specification. SEM revealed that attitudes, perceived behavioral control, subjective norms and descriptive norms explained intention. The corresponding standardized regression coefficients were respectively (β = 0.70), (β =0.18), (β = − 0.17) and (β =0.11) (p < 0.001). Intention (β =0.46) predicted action planning and action planning (β =0.19) predicted dental attendance behavior (p < 0.001). The model revealed indirect effects of intention and perceived behavioral control on behavior through action planning and through intention and action planning, respectively. The final model explained 64 and 41% of the total variance in intention and dental attendance behavior. Conclusion The findings support the utility of the TPB, the expanded normative component and action planning in predicting younger adults’ intended- and self-reported dental attendance. Interventions targeting young adults’ dental attendance might usefully focus on positive consequences following this behavior accompanied with modeling and group performance