The association between area level socio-economic position and oral health-related quality of life in the South African adult population

Objective: To investigate the association between arealevel socio-economic position (SEP) and oral health-related quality of life (OHRQoL). Methods: Data collected from a nationally representative sample of the South African population ?16 years old (n=3,003) included demographics, individual-level SEP measures and self-reported oral health status. OHRQoL was measured using the Oral Health Impact Profile-14 (OHIP-14). The General Household Survey (n=25,653 households) and Quarterly Labour Force Surveys (n~30,000 households/ quarter) were used to determine area-level SEP. Data analysis included a random-effect negative binomial regression model and Blinder-Oaxaca decomposition analysis. Results: Area-level deprivation was associated with more negative oral impacts, independent of an individual's SEP. Other significant predictors of oral impacts included having experienced oral pain and reporting previous dental visits. Area differences in dental attendance contributed the most (37.5%) to the observed gap in OHRQoL, explained by differences in area-level SEP, whereas individual-level SEP contributed the least (18.8%). In the more affluent areas, satisfaction with life in general and individuals' SEP were significantly positively associated with OHRQoL.DHE

The role of socio-economic position on satisfaction with oral health services among South African adults : a structural equation model

OBJECTIVE : To investigate how differences in socio-economic position (SEP) influence satisfaction with dental services among South Africans. METHODS : Data collected from a nationally representative sample of the South African population ≥16 years old (n=3,112) included socio-demographics, health insurance enrolment, past-year dental visit and facility type (public or private), satisfaction and reason(s) for dissatisfaction with the dental services received. Using structural equation modelling, a pathway to satisfaction with dental services was tested using a number of model fit statistics. RESULT : Of the 15.1% (n=540) who had visited a dentist in the past-year, 54.1% (n=312) were satisfied with the services received. Reasons for dissatisfaction included long waiting time (33.1%), painful procedure (13%) and rude staff (10.4%). Being of higher SEP was associated with reporting using private facility. Those who visited public facilities were more likely to have encountered a long waiting time, which in turn was associated with being more likely to report treatment as having been painful and reporting dissatisfaction. Long waiting times had the greatest direct effect on dental service dissatisfaction (β = -0.31). CONCLUSION : Improving waiting time is likely to be the major factor to help reduce socio-economic disparities in the quality of dental services experienced by South Africans.http://www.sada.co.zaam2017Dental Management Science

Oral health and subjective psychological well-being among South African adults : findings from a national household survey

OBJECTIVE : To determine the association between oral health and socioeconomic status with subjective psychological well-being. METHODS : An interviewer-administered questionnaire was conducted during 2011 on a nationally representative sample of South African adults >16 years (n=2,971) who reported on socio-demographic data, past dental visit patterns, number of remaining teeth and oral and general health status. Subjective well-being was computed as the sum of scores obtained from participants' estimates of level of happiness (scale 0-6) and rating of level of satisfaction with life (scale 0-4). Analyses included t-tests and multivariable-adjusted Poisson regression. RESULTS : The average score on a scale of 0-10 for subjective well-being was 6.31 (95%CI=6.17-6.44), which decreased with age, but increased with level of education and frequency of dental visits. Even after controlling for socioeconomic status, those who rated their oral health as good were more likely to report a higher subjective well-being (Prevalence Rate ratio (PRR) =1.14; 95% CI=1.03-1.27). Those who reported visiting a dentist at least every 6 months reported higher subjective well-being (PRR=1.10; 1.04-1.16. CONCLUSIONS : Good oral health is independently associated with greater subjective well-being. This highlights the need to prioritise oral health promotion as an integral part of promoting general health and improving the quality of life of South Africans.http://www.sada.co.zaam201

Social gradient in the cost of oral pain and related dental service utilisation among South African adults

Background: Oral pain affects people's daily activities and quality of life. The burden of oral pain may vary across socio-economic positions. Currently, little is known about the social gradient in the cost of oral pain among South Africans. This study therefore assessed the social gradient in the cost of oral pain and the related dental service utilisation pattern among South African adults. Methods: Data were obtained from a nationally representative cross-sectional survey of South African adults ?16 year-old (n = 2651) as part of the South African Social Attitudes Survey conducted by the South African Human Sciences Research Council. The survey included demographic data, individual-level socio-economic position (SEP), self-reported oral health status, past six months' oral pain experience and cost. The area-level SEP was obtained from the 2010 General Household Survey (n = 25,653 households) and the 2010/2011Quarterly Labour Force Survey conducted in South Africa. The composite indices used for individual-level SEP (? = 0.76) and area-level SEP (? = 0. 88) were divided into tertiles. Data analysis was done using t-tests and ANOVA. Significance was set at p < 0.05. Results: The prevalence of oral pain among the adult South Africans was 19.4 % (95 % CI = 17.2-21.9). The most commonly reported form of oral pain was 'toothache' (78.9 %). The majority of the wealthiest participants sought care from private dental clinics (64.7 %), or from public dental clinics (19.7 %), while the poorest tended to visit a public dental clinic (45 %) or nurse/general medical practitioner (17.4 %). In the poorest areas, 21 % responded to pain by 'doing nothing'. The individual expenditure for oral pain showed a social gradient from an average of ZAR61.44 spent by those of lowest SEP to ZAR433.83 by the wealthiest (national average ZAR170.92). Average time lost from school/work was two days over the six-month period, but days lost was highest for those living in middle class neighbourhoods (3.41), while those from the richest neighbourhood had lost significantly fewer days from oral pain (0.64). Conclusions: There is a significant social gradient in the burden of oral pain. Improved access to dental care, possibly through carefully planned universal National Health Insurance (NHI), may reduce oral health disparities in South Africa.Scopus 201

Association of tooth loss with hypertension

Please refer to abstract in articl

Prevalence and socio-economic disparities in fissure sealant placement among adolescents in the Limpopo Province, South Africa

OBJECTIVES: This study investigated socio-economic factors associated with the placement of fissure sealants in a population of South African adolescents. METHOD: The study participants were high school students aged 12 to layers who provided baseline data during 2005 in a tobaccouse prevention trial, and consented to oral examination (n=1103). Information was obtained using a self-administered survey questionnaire, including demographic data, data on oral health behaviour, the employment status of parents/guardians, and the family structure of the household and on health insurance enrolment. The main outcome measure was the presence of a fissure sealant on any tooth, recorded using the WHO oral examination protocol. Data were analysed using chi-square statistics and multiple logistic regression analysis (p<0.05). RESULTS: Overall, only 3.5% (n=37) of the study participants had a fissure sealant, and only 31.3% (n=345) had ever made a dental visit. Those who had attended seeking mostly preventive care were significantly more likely to have a fissure sealant than those who had visited mostly when they were in pain (14.2% vs. 2.9%; p<0.001). In the multi-variable adjusted analysis, those reporting to have parents who are both employed (OR = 2.76; 2.26 – 3.38), and reporting regular preventive dental visits (OR = 3.55; 2.28 – 5.58) were positively associated with receiving fissure sealant, while those who self-identified as black (OR = 0.04; 0.01 – 0.13), were significantly less likely to present with a fissure sealant as compared with other ethnicity/race groups. CONCLUSIONS: Higher socio-economic status and regular access to preventive care were significantly associated with the placement of fissure sealants in the studied population.http://www.sada.co.z

Socio-economic inequities in dental caries experience of 12-year-old South Africans : policy implications for prevention

Please refer to abstract in articl

Health Insurance, Socio-Economic Position and Racial Disparities in Preventive Dental Visits in South Africa

This study sought to determine the contributions of socio-economic position and health insurance enrollment in explaining racial disparities in preventive dental visits (PDVs) among South Africans. Data on the dentate adult population participating in the last South African Demographic and Health Survey conducted during 2003–2004 (n = 6,312) was used. Main outcome measure: Reporting making routine yearly PDVs as a preventive measure. Education, material wealth index and nutritional status indicated socio-economic position. Multi-level logistic regression analysis was conducted to determine the predictors of PDVs. A variant of Blinder-Oaxaca decomposition analysis was also conducted. Health insurance coverage was most common among Whites (70%) and least common among black Africans (10.1%) in South Africa. Similarly, a yearly PDV was most frequently reported by Whites (27.8%) and least frequently reported among black Africans (3.1%). Lower education and lower material wealth were associated with lower odds of making PDVs. There was significant interaction between location (urban/rural) and education (p = 0.010). The racial and socio-economic differences in PDVs observed in urban areas were not observed in rural areas. In the general dentate population, having health insurance significantly increased the odds of making PDVs (OR = 4.32; 3.04–6.14) and accounted for 40.3% of the White/non-White gap in the probability of making PDVs. Overall, socio-economic position and health insurance enrollments together accounted for 55.9% (95% CI = 44.9–67.8) of the White/non-White gap in PDVs. Interventions directed at improving both socio-economic position and insurance coverage of non-White South Africans are likely to significantly reduce racial disparities in PDVs