Chari Malini, Ravaghi Vahid, Sabbah Wael, Gomaa Noha, Singhal Sonica, Quiñonez Carlos
Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada.
School of Dentistry, University of Birmingham, Birmingham, England, United Kingdom.
PLoS One. 2022 May 4;17(5):e0268006. doi: 10.1371/journal.pone.0268006. eCollection 2022.
The objective of this study was to quantify the magnitude of absolute and relative oral health inequality in countries with similar socio-political environments, but differing oral health care systems such as Canada, the United States (US), and the United Kingdom (UK), in the first decade of the new millennium. Clinical oral health data were obtained from the Canadian Health Measures Survey 2007-2009, the National Health and Nutrition Examination Survey 2007-2008, and the Adult Dental Health Survey 2009, for Canada, the US and UK, respectively. The slope index of inequality (SII) and relative index of inequality (RII) were used to quantify absolute and relative inequality, respectively. There was significant oral health inequality in all three countries. Among dentate individuals, inequality in untreated decay was highest among Americans (SII:28.2; RII:4.7), followed by Canada (SII:21.0; RII:3.09) and lowest in the UK (SII:15.8; RII:1.75). Inequality for filled teeth was negligible in all three countries. For edentulism, inequality was highest in Canada (SII: 30.3; RII: 13.2), followed by the UK (SII: 10.2; RII: 11.5) and lowest in the US (SII: 10.3; and RII: 9.26). Lower oral health inequality in the UK speaks to the more equitable nature of its oral health care system, while a highly privatized dental care environment in Canada and the US may explain the higher inequality in these countries. However, despite an almost equal utilization of restorative dental care, there remained a higher concentration of unmet needs among the poor in all three countries.
本研究的目的是量化在社会政治环境相似，但口腔卫生保健系统不同的国家，如加拿大、美国和英国，在新千年的第一个十年中绝对和相对口腔健康不平等的程度。临床口腔健康数据分别来自加拿大2007 - 2009年健康指标调查、美国2007 - 2008年国家健康与营养检查调查以及英国2009年成人牙齿健康调查。不平等斜率指数（SII）和不平等相对指数（RII）分别用于量化绝对不平等和相对不平等。这三个国家均存在显著的口腔健康不平等。在有牙人群中，未治疗龋齿的不平等在美国最高（SII：28.2；RII：4.7），其次是加拿大（SII：21.0；RII：3.09），在英国最低（SII：15.8；RII：1.75）。在这三个国家中，补牙的不平等可忽略不计。对于无牙情况，不平等在加拿大最高（SII：30.3；RII：13.2），其次是英国（SII：10.2；RII：11.5），在美国最低（SII：10.3；RII：9.26）。英国较低的口腔健康不平等表明其口腔卫生保健系统更具公平性，而加拿大和美国高度私有化的牙科护理环境可能解释了这些国家较高的不平等。然而，尽管修复性牙科护理的利用率几乎相同，但在这三个国家中，贫困人口中未满足需求的集中度仍然较高。
