Steele J, Shen J, Tsakos G, Fuller E, Morris S, Watt R, Guarnizo-Herreño C, Wildman J
School of Dental Sciences and Centre for Oral Health Research, Newcastle University, UK
Institute of Health and Society, Newcastle University, UK.
J Dent Res. 2015 Jan;94(1):19-26. doi: 10.1177/0022034514553978. Epub 2014 Oct 24.
Oral health inequalities associated with socioeconomic status are widely observed but may depend on the way that both oral health and socioeconomic status are measured. Our aim was to investigate inequalities using diverse indicators of oral health and 4 socioeconomic determinants, in the context of age and cohort. Multiple linear or logistic regressions were estimated for 7 oral health measures representing very different outcomes (2 caries prevalence measures, decayed/missing/filled teeth, 6-mm pockets, number of teeth, anterior spaces, and excellent oral health) against 4 socioeconomic measures (income, education, Index of Multiple Deprivation, and occupational social class) for adults aged ≥21 y in the 2009 UK Adult Dental Health Survey data set. Confounders were adjusted and marginal effects calculated. The results showed highly variable relationships for the different combinations of variables and that age group was critical, with different relationships at different ages. There were significant income inequalities in caries prevalence in the youngest age group, marginal effects of 0.10 to 0.18, representing a 10- to 18-percentage point increase in the probability of caries between the wealthiest and every other quintile, but there was not a clear gradient across the quintiles. With number of teeth as an outcome, there were significant income gradients after adjustment in older groups, up to 4.5 teeth (95% confidence interval, 2.2-6.8) between richest and poorest but none for the younger groups. For periodontal disease, income inequalities were mediated by other socioeconomic variables and smoking, while for anterior spaces, the relationships were age dependent and complex. In conclusion, oral health inequalities manifest in different ways in different age groups, representing age and cohort effects. Income sometimes has an independent relationship, but education and area of residence are also contributory. Appropriate choices of measures in relation to age are fundamental if we are to understand and address inequalities.
与社会经济地位相关的口腔健康不平等现象广泛存在，但这可能取决于口腔健康和社会经济地位的衡量方式。我们的目的是在年龄和队列的背景下，使用多种口腔健康指标和4种社会经济决定因素来调查不平等现象。针对2009年英国成人牙科健康调查数据集中年龄≥21岁的成年人，我们对代表截然不同结果的7种口腔健康指标（2种龋齿患病率指标、龋失补牙数、6毫米牙周袋、牙齿数量、前牙间隙和极佳口腔健康状况）与4种社会经济指标（收入、教育程度、多重贫困指数和职业社会阶层）进行了多元线性或逻辑回归分析。对混杂因素进行了调整并计算了边际效应。结果表明，不同变量组合之间的关系差异很大，年龄组至关重要，不同年龄的关系各不相同。在最年轻的年龄组中，龋齿患病率存在显著的收入不平等，边际效应为0.10至0.18，这意味着最富有群体与其他每个五分位数群体相比，患龋齿的概率增加了10至18个百分点，但在各五分位数之间没有明显的梯度变化。以前牙间隙为结果时，在老年组中调整后存在显著的收入梯度，最富有和最贫穷群体之间相差多达4.5颗牙（95%置信区间，2.2 - 6.8），但年轻群体中没有这种情况。对于牙周疾病，收入不平等由其他社会经济变量和吸烟介导，而对于前牙间隙，其关系取决于年龄且较为复杂。总之，口腔健康不平等在不同年龄组中以不同方式表现出来，体现了年龄和队列效应。收入有时具有独立关系，但教育程度和居住地区也有影响。如果我们要理解和解决不平等问题，根据年龄选择合适的衡量指标至关重要。
