Am J Epidemiol. 2023 Apr 6;192(4):560-572. doi: 10.1093/aje/kwac205.
Knowledge of and practice around health inequities have been limited by scarce investigations on intersecting forms of structural oppression, including the extent to which their effects are more severe among multiply marginalized groups. We addressed these insufficiencies by adopting a structural intersectionality approach to the study of edentulism (i.e., complete tooth loss), the dental equivalent of mortality. While individual information was gathered from approximately 200,000 adult (ages 18-64 years) respondents to the 2010 US Behavioral Risk Factor Surveillance System survey, state-level data for 2000 and 2010 were obtained from a 2021 study by Homan et al. (J Health Soc Behav. 2021;62(3):350-370) and the US Census. These 3 sources provided information on edentulism, race, sex, structural racism, structural sexism, and income inequality, in addition to multiple covariates. Analyses showed that the intersections between structural sexism and state-level income inequality and structural racism were associated with 1.4 (95% confidence interval: 1.1, 1.9) and 1.5 (95% confidence interval: 1.1, 2.2) times' increased odds of complete tooth loss, respectively. The frequency of edentulism was highest among non-Hispanic Black men residing in states with high structural racism, high structural sexism, and high economic inequality. Based on these and other findings, we highlight the importance of a structural intersectionality approach to research and policy related to health inequities in the United States and elsewhere.
对健康不平等的认识和实践受到稀缺的交叉形式的结构性压迫调查的限制，包括这些压迫在多重边缘化群体中更为严重的程度。我们通过采用结构交叉性方法来研究无牙症（即完全牙齿缺失）来解决这些不足，无牙症是死亡率的牙科等效物。虽然个人信息是从大约 200,000 名 18-64 岁的美国行为风险因素监测系统调查的成年受访者中收集的，但 2000 年和 2010 年的州级数据是从 2021 年 Homan 等人的一项研究（J Health Soc Behav. 2021;62(3):350-370）和美国人口普查中获得的。这 3 个来源提供了无牙症、种族、性别、结构性种族主义、结构性性别主义和收入不平等的信息，以及多个协变量。分析表明，结构性性别主义与州级收入不平等和结构性种族主义之间的交叉点与完全牙齿缺失的几率增加 1.4 倍（95%置信区间：1.1，1.9）和 1.5 倍（95%置信区间：1.1，2.2）相关。无牙症的频率在居住在结构上种族主义、性别主义和经济不平等程度高的州的非西班牙裔黑人男性中最高。基于这些和其他发现，我们强调了在研究和政策方面采用结构交叉性方法的重要性，以解决美国和其他地方的健康不平等问题。
