Mejia Gloria C, Elani Hawazin W, Harper Sam, Murray Thomson W, Ju Xiangqun, Kawachi Ichiro, Kaufman Jay S, Jamieson Lisa M
Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, SA, 5005, Australia.
Harvard School of Dental Medicine, Harvard University, Boston, MA, USA.
BMC Oral Health. 2018 Oct 26;18(1):176. doi: 10.1186/s12903-018-0630-3.
Socioeconomic inequalities are associated with oral health status, either subjectively (self-rated oral health) or objectively (clinically-diagnosed dental diseases). The aim of this study is to compare the magnitude of socioeconomic inequality in oral health and dental disease among adults in Australia, Canada, New Zealand and the United States (US).
Nationally-representative survey examination data were used to calculate adjusted absolute differences (AD) in prevalence of untreated decay and fair/poor self-rated oral health (SROH) in income and education. We pooled age- and gender-adjusted inequality estimates using random effects meta-analysis.
New Zealand demonstrated the highest adjusted estimate for untreated decay; the US showed the highest adjusted prevalence of fair/poor SROH. The meta-analysis showed little heterogeneity across countries for the prevalence of decayed teeth; the pooled ADs were 19.7 (95% CI = 16.7-22.7) and 12.0 (95% CI = 8.4-15.7) between highest and lowest education and income groups, respectively. There was heterogeneity in the mean number of decayed teeth and in fair/poor SROH. New Zealand had the widest inequality in decay (education AD = 0.8; 95% CI = 0.4-1.2; income AD = 1.0; 95% CI = 0.5-1.5) and the US the widest inequality in fair/poor SROH (education AD = 40.4; 95% CI = 35.2-45.5; income AD = 20.5; 95% CI = 13.0-27.9).
The differences in estimates, and variation in the magnitude of inequality, suggest the need for further examining socio-cultural and contextual determinants of oral health and dental disease in both the included and other countries.
社会经济不平等与口腔健康状况相关，无论是主观的（自评口腔健康）还是客观的（临床诊断的牙科疾病）。本研究的目的是比较澳大利亚、加拿大、新西兰和美国成年人在口腔健康和牙科疾病方面社会经济不平等的程度。
使用具有全国代表性的调查检查数据来计算收入和教育方面未治疗龋齿患病率以及自评口腔健康状况为“一般/差”（SROH）的调整后绝对差异（AD）。我们使用随机效应荟萃分析汇总了年龄和性别调整后的不平等估计值。
新西兰在未治疗龋齿方面的调整估计值最高；美国自评口腔健康状况为“一般/差”的调整患病率最高。荟萃分析表明，各国之间龋齿患病率的异质性很小；最高和最低教育及收入组之间的汇总AD分别为19.7（95%置信区间=16.7-22.7）和12.0（95%置信区间=8.4-15.7）。龋齿平均数量和自评口腔健康状况为“一般/差”存在异质性。新西兰在龋齿方面的不平等最为严重（教育AD=0.8；95%置信区间=0.4-1.2；收入AD=1.0；95%置信区间=0.5-1.5），而美国在自评口腔健康状况为“一般/差”方面的不平等最为严重（教育AD=4%；95%置信区间=35.2-45.5；收入AD=20.5；95%置信区间=13.0-27.9）。
估计值的差异以及不平等程度的变化表明，需要进一步研究纳入研究的国家以及其他国家口腔健康和牙科疾病的社会文化及背景决定因素。
