Facultad de Odontología, Universidad Nacional de Colombia, Bogota, Colombia
Department of Epidemiology and Public Health, University College London, London, UK.
J Epidemiol Community Health. 2019 Aug;73(8):737-744. doi: 10.1136/jech-2018-212049. Epub 2019 May 16.
Health inequalities, including inequalities in oral health, are problems of social injustice worldwide. Evidence on this issue from low-income and middle-income countries is still needed. We aimed to examine the relationship between oral health and different dimensions of socioeconomic position (SEP) in Colombia, a very unequal society emerging from a long-lasting internal armed conflict.
Using data from the last Colombian Oral Health Survey (2014), we analysed inequalities in severe untreated caries (≥3 teeth), edentulousness (total tooth loss) and number of missing teeth. Inequalities by education, income, area-level SEP and health insurance scheme were estimated by the relative index of inequality and slope index of inequality (RII and SII, respectively).
A general pattern of social gradients was observed and significant inequalities for all outcomes and SEP indicators were identified with RII and SII. Relative inequalities were larger for decay by health insurance scheme, with worse decay levels among the uninsured (RII: 2.57; 95% CI 2.11 to 3.13), and in edentulousness (RII: 3.23; 95% CI 1.88 to 5.55) and number of missing teeth (RII: 2.08; 95% CI 1.86 to 2.33) by education, with worse levels of these outcomes among the lower educated groups. Absolute inequalities followed the same pattern. Inequalities were larger in urban areas.
Health insurance and education appear to be the main contributors to oral health inequalities in Colombia, posing challenges for designing public health strategies and social policies. Tackling health inequalities is crucial for a fairer society in a Colombian post-conflict era and our findings highlight the importance of investing in education policies and universal health care coverage.
健康不平等，包括口腔健康不平等，是全球范围内社会不公的问题。仍需要来自低收入和中等收入国家的关于这个问题的证据。我们旨在研究哥伦比亚的口腔健康与不同社会经济地位（SEP）维度之间的关系，哥伦比亚是一个从长期内战中崛起的非常不平等的社会。
利用来自哥伦比亚最近一次口腔健康调查（2014 年）的数据，我们分析了严重未经治疗的龋齿（≥3 颗牙齿）、无牙（总牙齿缺失）和缺牙数的不平等现象。通过相对不平等指数和斜率不平等指数（RII 和 SII）分别对教育、收入、地区社会经济地位和医疗保险计划的不平等进行了估计。
观察到一种普遍的社会梯度模式，所有结果和 SEP 指标都存在显著的不平等，RII 和 SII 都显示出相对不平等。按医疗保险计划划分的相对不平等程度更大，无保险者的龋齿程度更差（RII：2.57；95%CI 2.11 至 3.13），无牙（RII：3.23；95%CI 1.88 至 5.55）和缺牙数（RII：2.08；95%CI 1.86 至 2.33）也更大，受教育程度较低的人群这些结果的水平更差。绝对不平等也遵循相同的模式。城市地区的不平等程度更大。
医疗保险和教育似乎是哥伦比亚口腔健康不平等的主要原因，这对制定公共卫生战略和社会政策构成了挑战。解决健康不平等问题对于哥伦比亚冲突后时代更加公平的社会至关重要，我们的研究结果强调了投资教育政策和全民医疗保险覆盖范围的重要性。
