Moradi Ghobad, Moinafshar Ardavan, Adabi Hemen, Sharafi Mona, Mostafavi Farideh, Bolbanabad Amjad Mohamadi
Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran.
J Prev Med Public Health. 2017 Sep;50(5):303-310. doi: 10.3961/jpmph.17.035.
The aim of this study was to evaluate socioeconomic inequalities in the prevalence of dental caries among an urban population.
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.
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).
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.
本研究旨在评估城市人口中龋齿患病率的社会经济不平等情况。
2015年，在伊朗库尔德斯坦地区对2000名15至40岁的人群进行了此项研究。由4名经过培训的牙科专业学生通过问卷调查收集数据。因变量为龋失补牙（DMF）指数。采用主成分分析法，根据家庭资产确定家庭的社会经济地位（SES）。使用集中指数衡量不平等情况；此外，采用瓦哈卡分析法确定各种决定因素对观察到的不平等的贡献。
DMF指数得分较低的集中指数为-0.32（95%置信区间[CI]，-0.40至-0.36）；因此，DMF指数得分较低的情况在社会经济地位较低的群体中更为集中（p<0.001）。分解分析表明，社会经济地位最不利群体中DMF指数得分较低的平均患病率为43.7%（95%CI, 40.4至46.9%），而社会经济地位最有利群体中为14.4%（95%CI, 9.5至9.2%）。结果发现这些群体之间观察到差距中有85.8%是由于性别、父母教育程度和居住地区的差异所致。社会经济地位较高的人群中DMF指数得分较低的情况比社会经济地位较低的人群中更为少见（优势比，0.31；95%CI, 0.19至0.52）。
在所研究的社区中发现口腔健康状况存在令人担忧的社会经济不平等程度。因此，建议通过采取适当政策，如向较贫困群体提供口腔健康服务并将此类服务纳入保险计划，来减少口腔健康状况的不平等。
