Department of Preventive Dentistry, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China.
Chinese Stomatological Association, Beijing, China.
Community Dent Oral Epidemiol. 2021 Feb;49(1):47-54. doi: 10.1111/cdoe.12575. Epub 2020 Sep 21.
This study aimed to measure socioeconomic-related inequality and horizontal inequity in the use of oral health services and decompose this inequality among adults of different age groups in China.
In total, 10 973 adults (3669 aged 35-44 years, 3767 aged 55-64 years and 3537 aged 65-74 years) who participated in the 4th National Oral Health Survey (2015-2016) in China were included. Concentration curves and the Erreygers-corrected concentration index (EI) were employed to measure socioeconomic-related inequality in the use of oral health services. Then, inequity in this utilization was measured by the horizontal inequity index (HI). Furthermore, decomposition analyses were conducted for the three groups to explain the contributions of income level, need factors (ie self-assessed oral health and evaluated oral health status), other factors (ie sex, residential location, educational attainment level and type of basic insurance) and a residual term to overall inequality in oral health service utilization.
The significant positive EI and HI values indicated that pro-rich inequality and inequity in oral health service utilization exist among Chinese adults. Income and type of basic medical insurance contributed the most to socioeconomic-related inequality in the use of oral health services among adults aged 55-64 and 65-74 years. However, the main driving factors of socioeconomic inequality among adults aged 35-44 years in dental care use included income, educational achievement, type of basic medical insurance and residential location. The need variables accounted for a very small proportion of overall socioeconomic-related inequality in oral health service use in all three groups.
Oral healthcare service utilization was disproportionately concentrated among better-off Chinese adults. The primary determinants of inequality in dental care use in different age groups provide information for policymakers to create more targeted policies to achieve equity in the oral healthcare system in China.
本研究旨在衡量中国成年人在口腔卫生服务利用方面的社会经济相关不平等和水平不公平，并分解不同年龄组成年人之间的这种不平等。
本研究共纳入了 10973 名成年人（35-44 岁 3669 人，55-64 岁 3767 人，65-74 岁 3537 人），他们均参与了中国第四次全国口腔健康调查（2015-2016 年）。采用集中曲线和 Erreygers 校正集中指数（EI）衡量口腔卫生服务利用的社会经济相关不平等。然后，利用水平不公平指数（HI）衡量这种利用的不公平程度。此外，对三组进行分解分析，以解释收入水平、需求因素（即自我评估的口腔健康和评估的口腔健康状况）、其他因素（即性别、居住地点、教育程度和基本医疗保险类型）和残差对口腔卫生服务利用总体不平等的贡献。
显著的正 EI 和 HI 值表明，中国成年人的口腔卫生服务利用存在富裕程度不均等和不公平现象。收入和基本医疗保险类型对 55-64 岁和 65-74 岁成年人口腔卫生服务利用的社会经济相关不平等贡献最大。然而，35-44 岁成年人在牙科保健利用方面的社会经济不平等的主要驱动因素包括收入、教育成就、基本医疗保险类型和居住地点。需求变量在所有三个组中仅占口腔卫生服务利用总体社会经济相关不平等的很小一部分。
口腔医疗服务的利用在富裕的中国成年人中不成比例地集中。不同年龄组牙科保健利用不平等的主要决定因素为政策制定者提供了信息，以便制定更有针对性的政策，在中国的口腔医疗体系中实现公平。
