Bernabé Eduardo, Humphris Gerry, Freeman Ruth
Division of Population and Patient Health, King's College London Dental Institute at Guy's, King's College and St. Thomas' Hospitals, London, UK.
Health Psychology, School of Medicine, University of St Andrews, St Andrews, UK.
Community Dent Oral Epidemiol. 2017 Aug;45(4):348-355. doi: 10.1111/cdoe.12297. Epub 2017 Mar 28.
To evaluate the contribution of dental anxiety to social gradients in different oral health outcomes and whether social gradients in oral health persist once dental anxiety is removed from the population examined.
Data from 9035 British adults were analysed. Participants' socioeconomic position (SEP) was measured through education and household income. Dental anxiety was measured with the Modified Dental Anxiety Scale. Poor subjective oral health, oral impacts on quality of life and edentulism among all adults and the number of teeth, the number of decayed, missing and filled surfaces (DMFS) and sextants with pocketing among dentate adults were the oral health outcomes. The contribution of dental anxiety to absolute and relative social inequalities in each oral health outcome (measured with the Slope and Relative Index of Inequality [SII and RII], respectively) was estimated from regression models without and with adjustment for dental anxiety and quantified with the percentage attenuation. Interactions between each SEP indicator and dental anxiety were used to test what would happen if dental anxiety were removed from the whole population.
The largest contribution of dental anxiety to explaining oral health inequalities was found for education gradients in perceived outcomes (11%-13%), but dental anxiety explained <4% of social gradients in edentulism. Among dentate adults, dental anxiety accounted for <5% and <7% of education and income gradients, respectively. Only four of the 24 interactions tested were statistically significant. Hence, the education- and income-based SII and RII for oral impacts were nonsignificant among anxiety-free adults but were significant at higher levels of dental anxiety.
Little support was found for the role of dental anxiety in explaining social inequalities in various perceived and clinical oral health measures. Oral health inequalities were found among both nondentally anxious and anxious participants.
评估牙科焦虑对不同口腔健康结果社会梯度的影响，以及从所研究人群中去除牙科焦虑后口腔健康的社会梯度是否依然存在。
分析了来自9035名英国成年人的数据。通过教育程度和家庭收入衡量参与者的社会经济地位（SEP）。使用改良牙科焦虑量表测量牙科焦虑。所有成年人的主观口腔健康差、口腔对生活质量的影响和无牙情况，以及有牙成年人的牙齿数量、龋失补牙面数（DMFS）和有牙周袋的牙区，均作为口腔健康结果。根据未调整和调整牙科焦虑的回归模型，估计牙科焦虑对每种口腔健康结果中绝对和相对社会不平等的贡献（分别用不平等斜率和相对指数[SII和RII]衡量），并用衰减百分比进行量化。每个SEP指标与牙科焦虑之间的相互作用用于测试如果从整个人口中去除牙科焦虑会发生什么情况。
牙科焦虑对解释口腔健康不平等的最大贡献出现在感知结果的教育梯度方面（11%-13%），但牙科焦虑对无牙情况社会梯度的解释不足4%。在有牙成年人中，牙科焦虑分别占教育和收入梯度的比例均小于5%和7%。在测试的24种相互作用中，只有4种具有统计学意义。因此，在无焦虑成年人中，基于教育和收入的口腔影响SII和RII不显著，但在牙科焦虑程度较高时显著。
几乎没有证据支持牙科焦虑在解释各种感知和临床口腔健康指标中的社会不平等方面所起的作用。在无牙科焦虑和有牙科焦虑的参与者中均发现了口腔健康不平等现象。
