Anticona C, Suominen A L, Bastos J L, Lif Holgerson P, Gustafsson P E
Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.
Department of Odontology, Umeå University, Umeå, Sweden.
JDR Clin Trans Res. 2024 Dec 19;10(4):23800844241305109. doi: 10.1177/23800844241305109.
The main strategy to achieve equal provision of oral care in Sweden has been to offer partial subsidies for the adult population. However, their effects on unmet oral care needs (UOCNs) have not been extensively assessed.
This study used an intersectionality framework to examine 1) the overall frequency of UOCNs, 2) single-indicator inequities, and 3) intersectional inequities in total UOCNs and financial-related UOCNs (FUOCNs) in Sweden before and after implementation of a partial subsidization reform in 2008.
Data from 12 national surveys conducted over 2004 to 2018 were divided into 3 periods: prereform (2004 to 2007), early postreform (2008 to 2011), and late postreform (2012 to 2018). The analytic sample consisted of 98,177 respondents aged 24 to 84 y. Changes in the prevalence of UOCNs were estimated by inferential statistics. Single-indicator and intersectional inequities were examined by intersectional analysis of individual heterogeneity and discriminatory accuracy, across 48 strata defined by gender, age, educational level, income, and immigrant status.
The prevalence of total UOCNs and FUOCNs decreased significantly early after the reform, followed by a slight rebound. Relative inequities increased by education, income, and immigrant status after the reform and decreased for age. The discriminatory accuracy for both types of UOCNs was moderate and improved marginally but significantly with the inclusion of the intersectional strata. Most intersectional strata showed greater FUOCN inequities after the reform.
Contrary to expected, larger inequities in FUOCNs were identified in most intersectional strata after the reform. The moderate discriminatory accuracy suggested that Sweden could benefit from future strategies to foster equity that are universal but proportionately more intense among the intersectional strata with greater inequities (proportionate universalism).
This analysis highlighted the benefit of adopting the principle of proportionate universalism as a strategy to reduce unmet oral care needs in Sweden. This would mean implementing universal strategies and specific support measures for the most vulnerable social groups as a future oral care policy change in Sweden.
瑞典实现口腔护理平等供应的主要策略是为成年人口提供部分补贴。然而，其对未满足的口腔护理需求（UOCN）的影响尚未得到广泛评估。
本研究使用交叉性框架来考察：1）UOCN的总体频率；2）单指标不平等；3）2008年部分补贴改革实施前后瑞典UOCN总数和财务相关UOCN（FUOCN）中的交叉不平等。
2004年至2018年期间进行的12次全国性调查数据被分为3个时期：改革前（2004年至2007年）、改革后早期（2008年至2011年）和改革后晚期（2012年至2018年）。分析样本包括98177名年龄在24至84岁之间的受访者。通过推断统计估计UOCN患病率的变化。通过对由性别、年龄、教育水平、收入和移民身份定义的48个阶层的个体异质性和歧视准确性进行交叉分析，考察单指标和交叉不平等。
改革后早期，UOCN总数和FUOCN的患病率显著下降，随后略有反弹。改革后，教育、收入和移民身份方面的相对不平等增加，年龄方面的相对不平等减少。两种类型UOCN的歧视准确性中等，纳入交叉阶层后略有但显著提高。改革后，大多数交叉阶层的FUOCN不平等程度更大。
与预期相反，改革后大多数交叉阶层中FUOCN的不平等程度更大。中等的歧视准确性表明，瑞典可以从未来促进公平的策略中受益，这些策略是普遍适用的，但在不平等程度更大的交叉阶层中更为严格（相称普遍主义）。
本分析强调了采用相称普遍主义原则作为减少瑞典未满足的口腔护理需求的策略的益处。这意味着作为瑞典未来口腔护理政策的变化，为最脆弱的社会群体实施普遍策略和具体支持措施。
