Sanders Anne E, Slade Gary D, Turrell Gavin, John Spencer A, Marcenes Wagner
Australian Research Centre for Population Oral Health (ARCPOH), The University of Adelaide, Adelaide, SA, Australia.
Community Dent Oral Epidemiol. 2006 Aug;34(4):310-9. doi: 10.1111/j.1600-0528.2006.00286.x.
The nature of the relationship between status and health has theoretical and applied significance. To compare the shape of the socioeconomic -oral health relationship using a measure of relative social status (MacArthur Scale of Subjective Social Status) and a measure of absolute material resource (equivalised household income); to investigate the contribution of behaviour in attenuating the socioeconomic gradient in oral health status; and to comment on three hypothesised explanatory mechanisms for this relationship (material, psychosocial, behavioural).
In 2003, cross-sectional self-report data were collected from 2,915 adults aged 43-57 years in Adelaide, Australia using a stratified cluster design. Oral conditions were (1) < 24 teeth, (2) 1+ impact/s reported fairly often or very often on the 14-item Oral Health Impact Profile; (3) fair or poor self-rated oral health, and (4) low satisfaction with chewing ability. Prevalence ratios and 95% confidence intervals (PR, 95%CI) were calculated from a logistic regression model. Covariates were age, sex, country of birth, smoking, alcohol use, body mass index, frequencies of toothbrushing and interdental cleaning.
There was an approximately linear relationship of decreasing prevalence for each oral condition across quintiles of increasing relative social status. In the fully adjusted model the gradient was steepest for low satisfaction with chewing (PR = 4.1, 95%CI = 3.0-5.4). Using equivalised household income, the shape more closely resembled a threshold effect, with an approximate halving of the prevalence ratio between the first and second social status quintiles for the adverse impact of oral conditions and fair or poor self-rated oral health. Adjustment for covariates did not attenuate the magnitude of PRs.
The nature of the relationship between social status and oral conditions differed according to the measure used to index social status. Perception of relative social standing followed an approximately straight-line relationship. In contrast, there was a discrete threshold of income below which oral health deteriorated, suggesting that the benefit to oral health of material resources occurs mostly at the lower end of the across the full socioeconomic distribution.
社会地位与健康之间关系的本质具有理论和应用意义。使用相对社会地位衡量指标（麦克阿瑟主观社会地位量表）和绝对物质资源衡量指标（等价家庭收入）比较社会经济与口腔健康关系的形态；调查行为在减弱口腔健康状况社会经济梯度方面的作用；并对这种关系的三种假设解释机制（物质、心理社会、行为）进行评论。
2003年，采用分层整群设计，从澳大利亚阿德莱德2915名43 - 57岁成年人中收集横断面自我报告数据。口腔状况包括：（1）牙齿少于24颗；（2）在14项口腔健康影响概况中，有1项及以上影响经常或非常频繁被报告；（3）自我评估口腔健康为一般或较差；（4）对咀嚼能力满意度低。患病率比值和95%置信区间（PR，95%CI）通过逻辑回归模型计算。协变量包括年龄、性别、出生国家、吸烟、饮酒、体重指数、刷牙频率和牙间隙清洁频率。
随着相对社会地位五分位数的增加，每种口腔状况的患病率呈近似线性下降关系。在完全调整模型中，对咀嚼能力满意度低的梯度最陡（PR = 4.1，95%CI = 3.0 - 5.4）。使用等价家庭收入时，形态更类似于阈值效应，对于口腔状况的不利影响和自我评估口腔健康为一般或较差，在第一和第二社会地位五分位数之间患病率比值大约减半。对协变量进行调整并未减弱PR的大小。
根据用于衡量社会地位的指标不同，社会地位与口腔状况之间关系的本质也有所不同。相对社会地位的认知呈现近似直线关系。相比之下，存在一个收入离散阈值，低于该阈值口腔健康会恶化，这表明物质资源对口腔健康的益处主要发生在整个社会经济分布的较低端。
