Clinical Dentistry, Glasgow Dental Hospital & School, University of Glasgow, Glasgow, UK.
Community Dent Oral Epidemiol. 2013 Dec;41(6):499-508. doi: 10.1111/cdoe.12040. Epub 2013 Feb 11.
To investigate the appropriateness of different measures of socio-economic inequalities, in relation to adult oral health in Scotland, utilizing data from a series of large, representative population surveys.
The Scottish Health Surveys (SHeS) (1995; 1998; 2003; 2008/09) are cross-sectional national population-based surveys used to monitor health status in those living in private households. The age groups included in this study are as follows: 45-54; 55-64 years: all survey years; 65-74: 1998 onwards; 75+: 2003 onwards. Primary outcome was no natural teeth (edentulism). Three measures of socio-economic position: Occupational social class, Education, Carstairs deprivation score (2001) were used. Simple (absolute/relative differences) and complex measures (Slope Index, Relative Index, Concentration Index and c-index) of inequality were produced for each age group across all four surveys.
Simple and complex (absolute) measures of inequality have both demonstrated narrowing disparities in edentulism over time in the 45- to 64-year-old group, a levelling off in those aged 65 and above, and a rise in those aged 75+. Complex relative measures (RII, Concentration Index and c-index), however, show an increasing trend in inequalities over time for all age groups, suggesting that rates of improvement in edentulism rates are not uniform across all social groups.
Simple absolute inequality provides a quick and easy indication of the extent of disparities between extreme groups, whereas complex measures (absolute and relative) consider the gradient in health across all social groups. We have demonstrated that both are useful measures of inequality and should be considered complementary to one another. The appropriate choice of complex measure of inequality will depend on the audience to whom the results are to be communicated. This methodological approach is not confined to oral health but is applicable to other health outcomes that are socially patterned.
利用一系列大型代表性人群调查的数据，研究不同社会经济不平等衡量指标与苏格兰成年人口腔健康的适宜性。
苏格兰健康调查（SHeS）（1995 年；1998 年；2003 年；2008/09 年）是一项全国性的横断面人群调查，用于监测居住在私人家庭中的人群的健康状况。本研究纳入的年龄组如下：45-54 岁；55-64 岁：所有调查年份；65-74 岁：1998 年以后；75 岁及以上：2003 年以后。主要结局为无自然牙（失牙）。使用了三种社会经济地位衡量指标：职业社会阶层、教育、卡斯特斯剥夺评分（2001 年）。针对所有四个调查，为每个年龄组生成了简单（绝对/相对差异）和复杂（斜率指数、相对指数、集中指数和 c 指数）不平等衡量指标。
45 至 64 岁年龄组的简单和复杂（绝对）不平等衡量指标均显示失牙的差异随时间缩小，65 岁及以上年龄组的差异趋于稳定，75 岁及以上年龄组的差异上升。然而，复杂的相对衡量指标（RII、集中指数和 c 指数）显示所有年龄组的不平等程度随时间呈上升趋势，这表明失牙率的改善率在所有社会群体中并不均匀。
简单的绝对不平等提供了极端群体之间差异程度的快速简便指示，而复杂的衡量指标（绝对和相对）考虑了所有社会群体的健康梯度。我们已经证明，这两种衡量不平等的方法都是有用的，应该互为补充。复杂不平等衡量指标的适当选择将取决于向其传达结果的受众。这种方法不仅适用于口腔健康，还适用于其他具有社会模式的健康结果。
