Oswaldo Cruz Foundation, Rene Rachou Institute, Belo Horizonte, Brazil.
Department of Epidemiology, School of Public Health, University of São Paulo, São Paulo, Brazil.
J Dent Res. 2020 Nov;99(12):1341-1347. doi: 10.1177/0022034520935854. Epub 2020 Jul 6.
This study aimed to measure the magnitude of education-related inequalities in the use of dental services among older adults (aged 50 y or older) from a sizable multicountry sample of 23 upper-middle- and high-income countries. This study used cross-sectional data from nationally representative surveys of people aged 50 y and over. Countries included in the Health and Retirement Study surveys were the following: Brazil, China, South Korea, Mexico, United States, Austria, Belgium, Croatia, Czech Republic, Denmark, Estonia, France, Germany, Greece, Italy, Israel, Luxembourg, Poland, Portugal, Slovenia, Spain, Sweden, and Switzerland. The dependent variable was the use of dental services, based on the self-report of having had a dental visit within the previous year, except for the United States and South Korea, which used 2-y recall periods. Educational level was used as the measure of socioeconomic position and was standardized across countries. Multivariate logistic regression modeling was used to evaluate the factors associated with the use of dental services, and the magnitude of education inequalities in the use of dental services was assessed using the slope index of inequality (SII) to measure absolute inequalities and the relative index of inequality for relative inequalities. The pooled prevalence of the use of dental services was 31.7% and ranged from 18.7% in China to 81.2% in Sweden. In the overall sample, the absolute difference in the prevalence of use between the lowest and highest educational groups was 20 percentage points. SII was significant for all countries except Portugal. Relative educational inequalities were significant for all countries and ranged from 3.2 in Poland to 1.2 in Sweden. There were significant education-related inequalities in the use of dental care by older adults in all countries. Monitoring these inequalities is critical to the planning and delivery of dental services.
本研究旨在从 23 个中上收入和高收入国家的大规模多国样本中，衡量老年人（50 岁及以上）在使用牙科服务方面与教育相关的不平等程度。本研究使用了来自国家代表性的 50 岁及以上人群调查的横断面数据。参与健康与退休研究调查的国家包括：巴西、中国、韩国、墨西哥、美国、奥地利、比利时、克罗地亚、捷克共和国、丹麦、爱沙尼亚、法国、德国、希腊、意大利、以色列、卢森堡、波兰、葡萄牙、斯洛文尼亚、西班牙、瑞典和瑞士。因变量是使用牙科服务的情况，基于在过去一年中进行过牙科就诊的自我报告，美国和韩国除外，这两个国家使用了 2 年的回顾期。教育水平被用作衡量社会经济地位的指标，并在各国之间进行了标准化。多变量逻辑回归模型用于评估与使用牙科服务相关的因素，使用不平等斜率指数（SII）来评估使用牙科服务方面的教育不平等程度，以衡量绝对不平等和相对不平等的相对指数。使用牙科服务的总体流行率为 31.7%，范围从中国的 18.7%到瑞典的 81.2%。在总体样本中，最低和最高教育组之间使用的流行率差异为 20 个百分点。除葡萄牙外，所有国家的 SII 均具有统计学意义。相对教育不平等在所有国家均具有统计学意义，范围从波兰的 3.2 到瑞典的 1.2。所有国家的老年人在使用牙科护理方面都存在与教育相关的不平等。监测这些不平等现象对于规划和提供牙科服务至关重要。
