一项关于全民健康服务覆盖指数、卫生支出与儿童早期龋病关系的生态学研究。

An ecological study on the association between universal health service coverage index, health expenditures, and early childhood caries.

机构信息

Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, Nigeria.

Alexandria University, Alexandria, Egypt.

出版信息

BMC Oral Health. 2021 Mar 17;21(1):126. doi: 10.1186/s12903-021-01500-8.

DOI:10.1186/s12903-021-01500-8

PMID:33731081

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7968322/

Abstract

BACKGROUND

Universal health care (UHC) may assist families whose children are most prone to early childhood caries (ECC) in accessing dental treatment and prevention. The purpose of this study was to determine the association between UHC, health expenditure and the global prevalence of ECC.

METHODS

Health expenditure as percentage of gross domestic product, UHC service coverage index, and the percentage of 3-5-year-old children with ECC were compared among countries with various income levels using one-way analysis of variance (ANOVA). Three linear regression models were developed, and each was adjusted for the country income level with the prevalence of ECC in 3-5-year-old children being the dependent variable. In model 1, UHC service coverage index was the independent variable whereas in model 2, the independent variable was the health expenditure as percentage of GDP. Model 3 included both independent variables together. Regression coefficients (B), 95% confidence intervals (CIs), P values, and partial eta squared (ƞ) as measure of effect size were calculated.

RESULTS

Linear regression including both independent factors revealed that health expenditure as percentage of GDP (P < 0.0001) was significantly associated with the percentage of ECC in 3-5-year-old children while UHC service coverage index was not significantly associated with the prevalence of ECC (P = 0.05). Every 1% increase in GDP allocated to health expenditure was associated with a 3.7% lower percentage of children with ECC (B = - 3.71, 95% CI: - 5.51, - 1.91). UHC service coverage index was not associated with the percentage of children with ECC (B = 0.61, 95% CI: - 0.01, 1.23). The impact of health expenditure on the prevalence of ECC was stronger than that of UHC coverage on the prevalence of ECC (ƞ = 0.18 vs. 0.05).

CONCLUSIONS

Higher expenditure on health care may be associated with lower prevalence of ECC and may be a more viable approach to reducing early childhood oral health disparities than UHC alone. The findings suggest that currently, UHC is weakly associated with lower global prevalence of ECC.

摘要

背景

全民健康覆盖（UHC）可能有助于那些其子女最容易患早期儿童龋（ECC）的家庭获得牙科治疗和预防。本研究旨在确定 UHC、卫生支出与全球 ECC 患病率之间的关系。

方法

使用方差分析（ANOVA）比较不同收入水平国家的卫生支出占国内生产总值的百分比、UHC 服务覆盖率指数以及 3-5 岁儿童 ECC 的百分比。采用三种线性回归模型，每个模型均按国家收入水平进行调整，以 3-5 岁儿童 ECC 的患病率为因变量。在模型 1 中，UHC 服务覆盖率指数为自变量，而在模型 2 中，卫生支出占国内生产总值的百分比为自变量。模型 3 同时包含两个自变量。计算回归系数（B）、95%置信区间（CI）、P 值和效应大小的部分 eta 平方（ƞ）。

结果

包含两个独立因素的线性回归表明，卫生支出占国内生产总值的百分比（P<0.0001）与 3-5 岁儿童 ECC 的百分比显著相关，而 UHC 服务覆盖率指数与 ECC 的患病率无显著相关性（P=0.05）。卫生支出占国内生产总值的百分比每增加 1%，ECC 儿童的比例就会降低 3.7%（B=-3.71，95%CI：-5.51，-1.91）。UHC 服务覆盖率指数与儿童 ECC 的百分比无关（B=0.61，95%CI：-0.01，1.23）。卫生支出对 ECC 患病率的影响大于 UHC 覆盖率对 ECC 患病率的影响（ƞ=0.18 与 0.05）。