基于市场的牙科保健系统中牙科服务获取机会的不平等：来自挪威 1975-2018 年的一项人口研究。

Inequality in access to dental services in a market-based dental care system: A population study from Norway 1975-2018.

机构信息

Department of Community Dentistry, University of Oslo, Oslo, Norway.

Department of Obstetrics and Gynecology, Institute of Clinical Medicine, Akershus University Hospital, Lørenskog, Norway.

出版信息

Community Dent Oral Epidemiol. 2022 Dec;50(6):548-558. doi: 10.1111/cdoe.12709. Epub 2021 Nov 22.

DOI:10.1111/cdoe.12709

PMID:34806803

Abstract

OBJECTIVE

To examine income-related inequalities in access to dental services from 1975 to 2018. In Norway, dental care services for adults are privately financed. This may lead to income-related inequalities in access. In the early 1970s, that is, at the beginning of the study period, there were marked inequalities in access to dental services according to personal income. However, from the beginning of the 1970s, there has been a large increase in gross national income per capita in Norway as a result of the growth of the oil and gas industry. This increase in income also meant that people with a low income in 1975 had a rise in their level of income. According to the law of diminishing utility, an increase in income leads to higher consumption of dental services for people with a low level of income compared to people with a high level of income. The study hypothesis is that the inequalities in access to dental services that existed in 1975 became less over time.

METHODS

Statistics Norway collected samples of cross-sectional health survey data for the following years: 1975, 1985, 1995, 2002, 2008, 2012 and 2018. For each sample, individuals 21 years and older were drawn randomly from the non-institutionalized adult population using a two-stage stratified cluster sample technique. Inequalities were measured using the concentration index. The dependent variable was the use of dental services during the last year, and the key independent variable was equivalized household income.

RESULTS

The concentration index for inequalities in use of dental services according to income decreased from 0.10 (95% CI = 0.09, 0.11) in 1975 to 0.04 (95% CI = 0.03, 0.05) in 2018. The decrease was particularly large from 2002 to 2012. This was a period with a large growth in gross national income.

CONCLUSION

People with a low income had a marked increase in their purchasing power from 1975 to 2018. This coincided with an increase in demand for dental care for this low-income group.

摘要

目的

从 1975 年到 2018 年，研究收入相关的牙科服务获取不平等现象。在挪威，成年人的牙科护理服务是私人出资的。这可能导致获取服务的机会出现收入相关的不平等。在 20 世纪 70 年代初，也就是研究开始时，根据个人收入，牙科服务的获取存在明显的不平等。然而，从 20 世纪 70 年代初开始，由于石油和天然气工业的发展，挪威的人均国民总收入大幅增长。这种收入的增长也意味着，1975 年收入较低的人其收入水平有所提高。根据边际效用递减规律，收入的增加会导致低收入人群对牙科服务的消费高于高收入人群。研究假设是，1975 年存在的牙科服务获取不平等现象随着时间的推移而减少。

方法

挪威统计局收集了以下年份的横断面健康调查数据样本：1975 年、1985 年、1995 年、2002 年、2008 年、2012 年和 2018 年。对于每个样本，使用两阶段分层聚类抽样技术从非机构化成年人群中随机抽取 21 岁及以上的个体。不平等程度用集中指数衡量。因变量是过去一年中使用牙科服务的情况，关键自变量是家庭收入的等价值。