中国学龄前儿童口腔保健利用的社会经济相关不平等。

Socioeconomic-related inequality in dental care utilization among preschool children in China.

机构信息

Department of Second Clinical Division, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, National Clinical Research Center for Oral Diseases, Peking University School and Hospital of Stomatology, Beijing, China.

Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.

出版信息

Community Dent Oral Epidemiol. 2021 Dec;49(6):505-512. doi: 10.1111/cdoe.12681. Epub 2021 Jul 20.

DOI:10.1111/cdoe.12681

PMID:34288037

Abstract

OBJECTIVES

This study aimed to investigate socioeconomic-related inequality in dental care service utilization in the past 12 months among Chinese preschool children and to explore the contribution of various factors to this inequality.

METHOD

A total of 40 305 children aged 3-5 years from 372 kindergartens who participated in the Fourth National Oral Health Survey in China were included in the final analysis. The method of data weighting in complex sampling was adopted to make the samples more representative. Erreygers-corrected concentration index (EI) was used to measure socioeconomic-related inequality in dental care service utilization. The horizontal inequality index (HI) was employed to analyse horizontal inequality. Decomposition analyses were conducted to explore the contributions of income level, need variables (dmft, caregiver-evaluated oral health status and toothache experience) and nonneed variables (caregiver education level, residential location, age, and sex) to the inequality of health service utilization.

RESULT

The utilization of oral health services within the past 12 months among the high-, middle- and low-income groups was 17.4% (95% CI: 15.6-19.3), 13.6% (95% CI: 12.2-15.1) and 9.4% (95% CI: 8.1-11.0) respectively. The concentration curve was below the line of equality, and the EI and HI were 0.072 and 0.078, respectively, indicating that dental care utilization in children aged 3-5 years was concentrated in those who were better off. The contribution of the need variables to socioeconomic-related inequality in dental services was minimal, and most dental care utilization inequality could be explained by household income, caregiver education attainment and urban-rural disparities, accounting for 32.0%, 49.4% and 20.4% respectively.

CONCLUSION

This study reveals the existence of pro-rich inequality in dental care utilization among preschool children in China. The decomposition analysis suggests that income, caregiver education background and urban-rural disparities are the main factors contributing to this outcome. Equity-oriented policies and programmes are needed to achieve equitable dental care utilization.

摘要

目的

本研究旨在调查过去 12 个月中国学龄前儿童在牙科保健服务利用方面的社会经济相关不平等现象，并探讨各种因素对这种不平等的贡献。

方法

本研究最终纳入了来自中国第四次全国口腔健康调查的 372 所幼儿园的 40305 名 3-5 岁儿童。采用复杂抽样数据加权方法使样本更具代表性。采用 Erreygers 校正的集中指数（EI）来衡量牙科保健服务利用的社会经济相关不平等程度。采用水平不平等指数（HI）来分析水平不平等。进行分解分析，以探讨收入水平、需要变量（dmft、照顾者评估的口腔健康状况和牙痛经历）和非需要变量（照顾者教育水平、居住地点、年龄和性别）对卫生服务利用不平等的贡献。

结果

高、中、低收入组过去 12 个月内口腔保健服务的利用率分别为 17.4%（95%可信区间：15.6-19.3）、13.6%（95%可信区间：12.2-15.1）和 9.4%（95%可信区间：8.1-11.0）。集中曲线位于均等线以下，EI 和 HI 分别为 0.072 和 0.078，表明 3-5 岁儿童的牙科保健利用集中在经济条件较好的儿童。需要变量对牙科服务社会经济相关不平等的贡献很小，家庭收入、照顾者教育程度和城乡差异可解释 32.0%、49.4%和 20.4%的牙科保健利用不平等。