Åstrøm Anne Nordrehaug, Mastrovito Berit, Sannevik Josefine, Lie Stein Atle
Department of Clinical Dentistry, University of Bergen, Bergen, Norway.
Region Östergotland, Tandvårdsenheten, Linköping, Sweden.
Gerodontology. 2024 Mar;41(1):17-27. doi: 10.1111/ger.12680. Epub 2023 Mar 7.
The aim of this study was to describe inequalities in tooth loss and dissatisfaction with teeth related to time-invariant and time-variant socio-demographic characteristics and use of dental care across the middle and older life course and to assess whether oral health inequalities remain stable, widen or narrow from age 50 to 75.
In 1992, 6346 residents, aged 50, consented to participate in a prospective cohort study including postal questionnaire follow-ups every fifth year until age 75. Tooth loss and dissatisfaction with teeth were assessed at each survey wave in addition to socio-demographic factors and use of dental care. Multivariable logistic regression, generalised estimating equations, GEE, and random intercept logistic mixed models were used for estimation of population-averaged and person-specific odds ratio. Interaction terms of each covariate with the time indicator were added to test whether inequalities changed across time.
Person-specific OR and 95% CI estimates for tooth loss varied from 1.29 (1.09-1.53) (unmarried vs married) to 9.20 (6.07-13.94) (foreign country vs native). Estimated ORs for tooth dissatisfaction ranged from 1.33 (1.15-1.55) (unmarried vs married) to 2.59 (2.15-3.11) (smoking vs no smoking). Inequalities in tooth loss according to sex, educational level and country of birth were smaller in magnitude in 2017 than in 1992. Inequality estimates in dissatisfaction with teeth according to use of dental care and perceived health were, respectively, smaller and greater at older than at younger age.
Socio-demographic inequalities in oral health persisted from age 50 to 75 and varied in magnitude across time. Both convergence and widening of disparities in oral health occurred towards older ages.
本研究旨在描述与时间不变和时间变化的社会人口学特征以及中老年生命历程中牙科护理使用情况相关的牙齿脱落和牙齿不满意方面的不平等现象，并评估从50岁到75岁口腔健康不平等现象是保持稳定、扩大还是缩小。
1992年，6346名50岁居民同意参与一项前瞻性队列研究，每五年进行一次邮政问卷调查随访，直至75岁。除了社会人口学因素和牙科护理使用情况外，每次调查波次都对牙齿脱落和牙齿不满意情况进行评估。使用多变量逻辑回归、广义估计方程（GEE）和随机截距逻辑混合模型来估计总体平均和个体特异的比值比。添加每个协变量与时间指标的交互项以检验不平等现象是否随时间变化。
牙齿脱落的个体特异比值比和95%置信区间估计值从1.29（1.09 - 1.53）（未婚与已婚）到9.20（6.07 - 13.94）（外国与本国）不等。牙齿不满意的估计比值比从1.33（1.15 - 1.55）（未婚与已婚）到2.59（2.15 - 3.11）（吸烟与不吸烟）不等。2017年，按性别、教育水平和出生国家划分的牙齿脱落不平等程度比1992年小。根据牙科护理使用情况和感知健康状况划分的牙齿不满意不平等估计值，在老年人中分别比年轻人小和大。
50岁至75岁期间，口腔健康方面的社会人口学不平等现象持续存在，且随时间程度有所不同。口腔健康差距在老年时既有趋同也有扩大。
