Departamento de Salud Colectiva, Facultad de Odontología, Universidad Nacional de Colombia, Bogotá, Colombia
Department of Epidemiology and Public Health, University College London, London, UK.
J Epidemiol Community Health. 2021 Nov;75(11):1063-1069. doi: 10.1136/jech-2020-216072. Epub 2021 Apr 23.
While inequalities in oral health are documented, little is known about the extent to which they are attributable to potentially modifiable factors. We examined the role of behavioural and dental attendance pathways in explaining oral health inequalities among adults in England, Wales and Northern Ireland.
Using nationally representative data, we analysed inequalities in self-rated oral health and number of natural teeth. Highest educational attainment, equivalised household income and occupational social class were used to derive a latent socioeconomic position (SEP) variable. Pathways were dental attendance and behaviours (smoking and oral hygiene). We used structural equation modelling to test the hypothesis that SEP influences oral health directly and also indirectly via dental attendance and behavioural pathways.
Lower SEP was directly associated with fewer natural teeth and worse self-rated oral health (standardised path coefficients, -0.21 (SE=0.01) and -0.10 (SE=0.01), respectively). We also found significant indirect effects via behavioural factors for both outcomes and via dental attendance primarily for self-rated oral health. While the standardised parameters of total effects were similar between the two outcomes, for number of teeth, the estimated effect of SEP was mostly direct while for self-rated oral health, it was almost equally split between direct and indirect effects.
Reducing inequalities in dental attendance and health behaviours is necessary but not sufficient to tackle socioeconomic inequalities in oral health.
尽管口腔健康不平等现象已有记录，但对于这些不平等现象在多大程度上归因于可改变的因素知之甚少。我们研究了行为和牙科就诊途径在解释英格兰、威尔士和北爱尔兰成年人口腔健康不平等方面的作用。
我们使用全国代表性数据，分析了自我报告的口腔健康状况和天然牙齿数量的不平等。利用最高教育程度、等效家庭收入和职业社会阶层来推导出潜在的社会经济地位（SEP）变量。途径是牙科就诊和行为（吸烟和口腔卫生）。我们使用结构方程模型来检验假设，即 SEP 直接影响口腔健康，也通过牙科就诊和行为途径间接影响口腔健康。
较低的 SEP 与较少的天然牙齿和较差的自我报告口腔健康直接相关（标准化路径系数分别为-0.21（SE=0.01）和-0.10（SE=0.01））。我们还发现，两个结果都存在通过行为因素的显著间接影响，而主要通过牙科就诊途径对自我报告的口腔健康存在间接影响。虽然两个结果的总效应的标准化参数相似，但对于牙齿数量，SEP 的估计效应主要是直接的，而对于自我报告的口腔健康，直接和间接效应几乎平分秋色。
减少牙科就诊和健康行为方面的不平等是必要的，但不足以解决口腔健康方面的社会经济不平等问题。
