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

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