DOI QR코드

DOI QR Code

Socioeconomic Inequalities in the Oral Health of People Aged 15-40 Years in Kurdistan, Iran in 2015: A Cross-sectional Study

  • Moradi, Ghobad (Social Determinants of Health Research Center, Kurdistan University of Medical Sciences) ;
  • Moinafshar, Ardavan (Student Research Committee, Kurdistan University of Medical Sciences) ;
  • Adabi, Hemen (Student Research Committee, Kurdistan University of Medical Sciences) ;
  • Sharafi, Mona (Student Research Committee, Kurdistan University of Medical Sciences) ;
  • Mostafavi, Farideh (Social Determinants of Health Research Center, Kurdistan University of Medical Sciences) ;
  • Bolbanabad, Amjad Mohamadi (Social Determinants of Health Research Center, Kurdistan University of Medical Sciences)
  • Received : 2017.03.02
  • Accepted : 2017.07.14
  • Published : 2017.09.30

Abstract

Objectives: The aim of this study was to evaluate socioeconomic inequalities in the prevalence of dental caries among an urban population. Methods: This study was conducted among 2000 people 15-40 years of age living in Kurdistan, Iran in 2015. Using a questionnaire, data were collected by 4 trained dental students. The dependent variable was the decayed, missing, and filled teeth (DMF) index. Using principal component analysis, the socioeconomic status (SES) of families was determined based on their household assets. Inequality was measured using the concentration index; in addition, the Oaxaca analytical method was used to determine the contribution of various determinants to the observed inequality. Results: The concentration index for poor scores on the DMF index was -0.32 (95% confidence interval [CI], -0.40 to -0.36); thus, poor DMF indices had a greater concentration in groups with a low SES (p<0.001). Decomposition analysis showed that the mean prevalence of a poor DMF index was 43.7% (95% CI, 40.4 to 46.9%) in the least privileged group and 14.4% (95% CI, 9.5 to 9.2%) in the most privileged group. It was found that 85.8% of the gap observed between these groups was due to differences in sex, parents' education, and the district of residence. A poor DMF index was less prevalent among people with higher SES than among those with lower SES (odds ratio, 0.31; 95% CI, 0.19 to 0.52). Conclusions: An alarming degree of SES inequality in oral health status was found in the studied community. Hence, it is suggested that inequalities in oral health status be reduced via adopting appropriate policies such as the delivery of oral health services to poorer groups and covering such services in insurance programs.

Keywords

References

  1. Roberts M, Hsiao W, Berman P, Reich M. Getting health reform right: a guide to improving performance and equity. New York: Oxford University Press; 2008, p. 352.
  2. Vandenheede H, Vikhireva O, Pikhart H, Kubinova R, Malyutina S, Pajak A, et al. Socioeconomic inequalities in all-cause mortality in the Czech Republic, Russia, Poland and Lithuania in the 2000s: findings from the HAPIEE Study. J Epidemiol Community Health 2014;68(4):297-303. https://doi.org/10.1136/jech-2013-203057
  3. Hu Y, van Lenthe FJ, Borsboom GJ, Looman CW, Bopp M, Burstrom B, et al. Trends in socioeconomic inequalities in self-assessed health in 17 European countries between 1990 and 2010. J Epidemiol Community Health 2016;70(7):644-652. https://doi.org/10.1136/jech-2015-206780
  4. Braveman P. Health disparities and health equity: concepts and measurement. Annu Rev Public Health 2006;27:167-194. https://doi.org/10.1146/annurev.publhealth.27.021405.102103
  5. Culyer AJ, Wagstaff A. Equity and equality in health and health care. J Health Econ 1993;12(4):431-457. https://doi.org/10.1016/0167-6296(93)90004-X
  6. Braveman P, Gruskin S. Defining equity in health. J Epidemiol Community Health 2003;57(4):254-258. https://doi.org/10.1136/jech.57.4.254
  7. Roland E, Gueguen G, Longis MJ, Boiselle J. Validation of the reproducibility of the DMF Index used in bucco-dental epidemiology and evaluation of its 2 clinical forms. World Health Stat Q 1994;47(2):44-61 (French).
  8. Tsakos G, Demakakos P, Breeze E, Watt RG. Social gradients in oral health in older adults: findings from the English longitudinal survey of aging. Am J Public Health 2011;101(10):1892-1899. https://doi.org/10.2105/AJPH.2011.300215
  9. Elani HW, Harper S, Allison PJ, Bedos C, Kaufman JS. Socio-economic inequalities and oral health in Canada and the United States. J Dent Res 2012;91(9):865-870. https://doi.org/10.1177/0022034512455062
  10. Turrell G, Sanders AE, Slade GD, Spencer AJ, Marcenes W. The independent contribution of neighborhood disadvantage and individual-level socioeconomic position to self-reported oral health: a multilevel analysis. Community Dent Oral Epidemiol 2007;35(3):195-206. https://doi.org/10.1111/j.1600-0528.2006.00311.x
  11. Cohen-Carneiro F, Souza-Santos R, Rebelo MA. Quality of life related to oral health: contribution from social factors. Cien Saude Colet 2011;16 Suppl 1:1007-1015. https://doi.org/10.1590/S1413-81232011000700033
  12. Marin GH, Urdampilleta P, Zurriaga O. Determinants of dental care utilization by the adult population in Buenos Aires. Med Oral Patol Oral Cir Bucal 2010;15(2):e316-e321.
  13. Broadbent JM, Thomson WM. For debate: problems with the DMF index pertinent to dental caries data analysis. Community Dent Oral Epidemiol 2005;33(6):400-409. https://doi.org/10.1111/j.1600-0528.2005.00259.x
  14. Marthaler TM. Changes in dental caries 1953-2003. Caries Res 2004;38(3):173-181. https://doi.org/10.1159/000077752
  15. Nadanovsky P, Sheiham A. Relative contribution of dental services to the changes in caries levels of 12-year-old children in 18 industrialized countries in the 1970s and early 1980s. Community Dent Oral Epidemiol 1995;23(6):331-339. https://doi.org/10.1111/j.1600-0528.1995.tb00258.x
  16. Homaie Rad E, Kavosi Z, Arefnezhad M. Economic inequalities in dental care utilizations in Iran: evidence from an urban region. Med J Islam Repub Iran 2016;30:383.
  17. Kiadaliri AA, Hosseinpour R, Haghparast-Bidgoli H, Gerdtham UG. Pure and social disparities in distribution of dentists: a cross-sectional province-based study in Iran. Int J Environ Res Public Health 2013;10(5):1882-1894. https://doi.org/10.3390/ijerph10051882
  18. Pakshir HR. Oral health in Iran. Int Dent J 2004;54(6 Suppl 1):367-372. https://doi.org/10.1111/j.1875-595X.2004.tb00013.x
  19. Asgari F, Majidi A, Koohpayehzadeh J, Etemad K, Rafei A. Oral hygiene status in a general population of Iran, 2011: a key lifestyle marker in relation to common risk factors of non-communicable diseases. Int J Health Policy Manag 2015;4(6):343-352. https://doi.org/10.15171/ijhpm.2015.18
  20. ur Rehman MM, Mahmood N, ur Rehman B. The relationship of caries with oral hygiene status and extra-oral risk factors. J Ayub Med Coll Abbottabad 2008;20(1):103-108.
  21. World Health Organization. Oral health surveys: basic methods. 5th ed. Geneva: World Health Organization; 2013, p. 74.
  22. O'Donnell O, Van Doorslaer E, Wagstaff A, Lindelow M. Analyzing health equity using household survey data a guide to techniques and their implementation. Washington, DC: World Bank; 2008, p. 71, 150.
  23. Moradi G, Mohammad K, Majdzadeh R, Ardakani HM, Naieni KH. Socioeconomic inequality of non-communicable risk factors among people living in Kurdistan Province, Islamic Republic of Iran. Int J Prev Med 2013;4(6):671-683.
  24. Moradi G, Majdzadeh R, Mohammad K, Malekafzali H, Jafari S, Holakouie-Naieni K. Is the status of diabetes socioeconomic inequality changing in Kurdistan Province, west of Iran? A comparison of two surveys. Med J Islam Repub Iran 2016;30:375.
  25. Bammann K, Gwozdz W, Lanfer A, Barba G, De Henauw S, Eiben G, et al. Socioeconomic factors and childhood overweight in Europe: results from the multi-centre IDEFICS study. Pediatr Obes 2013;8(1):1-12. https://doi.org/10.1111/j.2047-6310.2012.00075.x
  26. Raittio E, Lahti S, Kiiskinen U, Helminen S, Aromaa A, Suominen AL. Inequality in oral health-related quality of life before and after a major subsidization reform. Eur J Oral Sci 2015;123(4):267-275. https://doi.org/10.1111/eos.12192
  27. Raittio E, Aromaa A, Kiiskinen U, Helminen S, Suominen AL. Income-related inequality in perceived oral health among adult Finns before and after a major dental subsidization reform. Acta Odontol Scand 2016;74(5):348-354. https://doi.org/10.3109/00016357.2016.1142113
  28. Moeller J, Quinonez C. The association between income inequality and oral health in Canada: a cross-sectional study. Int J Health Serv 2016;46(4):790-809. https://doi.org/10.1177/0020731416635078
  29. Do LG, Scott JA, Thomson WM, Stamm JW, Rugg-Gunn AJ, Levy SM, et al. Common risk factor approach to address socioeconomic inequality in the oral health of preschool children: a prospective cohort study. BMC Public Health 2014;14:429. https://doi.org/10.1186/1471-2458-14-429
  30. Somkotra T. Inequality in oral health-care utilisation exists among older Thais despite a universal coverage policy. Australas J Ageing 2013;32(2):110-114. https://doi.org/10.1111/j.1741-6612.2012.00617.x
  31. Celeste RK, Nadanovsky P. How much of the income inequality effect can be explained by public policy? Evidence from oral health in Brazil. Health Policy 2010;97(2-3):250-258. https://doi.org/10.1016/j.healthpol.2010.05.015
  32. Gulcan F, Ekback G, Ordell S, Lie SA, Astrom AN. Inequality in oral health related to early and later life social conditions: a study of elderly in Norway and Sweden. BMC Oral Health 2015;15:20. https://doi.org/10.1186/s12903-015-0005-y
  33. Jamieson LM, Thomson WM. Adult oral health inequalities described using area-based and household-based socioeconomic status measures. J Public Health Dent 2006;66(2):104-109. https://doi.org/10.1111/j.1752-7325.2006.tb02564.x
  34. Ha DH, Do LG, Luzzi L, Mejia GC, Jamieson L. Changes in area-level socioeconomic status and oral health of indigenous Australian children. J Health Care Poor Underserved 2016;27(1 Suppl):110-124. https://doi.org/10.1353/hpu.2016.0034
  35. Inglehart MR, Patel MH, Widmalm SE, Briskie DM. Self-reported temporomandibular joint disorder symptoms, oral health, and quality of life of children in kindergarten through grade 5: do sex, race, and socioeconomic background matter? J Am Dent Assoc 2016;147(2):131-141. https://doi.org/10.1016/j.adaj.2015.10.001
  36. Furuta M, Ekuni D, Irie K, Azuma T, Tomofuji T, Ogura T, et al. Sex differences in gingivitis relate to interaction of oral health behaviors in young people. J Periodontol 2011;82(4):558-565. https://doi.org/10.1902/jop.2010.100444
  37. Hernandez-Palacios RD, Ramirez-Amador V, Jarillo-Soto EC, Irigoyen-Camacho ME, Mendoza-Nunez VM. Relationship between gender, income and education and self-perceived oral health among elderly Mexicans. An exploratory study. Cien Saude Colet 2015;20(4):997-1004. https://doi.org/10.1590/1413-81232015204.00702014

Cited by

  1. Socioeconomic status, oral health and dental disease in Australia, Canada, New Zealand and the United States vol.18, pp.None, 2017, https://doi.org/10.1186/s12903-018-0630-3
  2. Reducing social inequalities in the oral health of an adult population vol.33, pp.None, 2017, https://doi.org/10.1590/1807-3107bor-2019.vol33.0102
  3. Catastrophic health expenditure and its determinants in households with gastrointestinal cancer patients: evidence from new health system reform in Iran vol.12, pp.4, 2017, https://doi.org/10.1108/ijhrh-01-2019-0008
  4. Decomposing socioeconomic inequality in dental caries in Iran: cross-sectional results from the PERSIAN cohort study vol.78, pp.1, 2017, https://doi.org/10.1186/s13690-020-00457-4
  5. Evaluating the quality of care for patients with type 2 diabetes mellitus based on the HbA1c: A national survey in Iran vol.7, pp.3, 2017, https://doi.org/10.1016/j.heliyon.2021.e06485
  6. Catastrophic health expenditures for children with disabilities in Iran: A national survey vol.36, pp.5, 2021, https://doi.org/10.1002/hpm.3273