Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
International Journal for Equity in Health
Published in: International Journal for Equity in Health 1/2017

Open Access 01-12-2017 | Research

Socioeconomic inequalities in dental health among middle-aged adults and the role of behavioral and psychosocial factors: evidence from the Spanish National Health Survey

Authors: Diego Alberto Capurro, Michael Davidsen

Published in: International Journal for Equity in Health | Issue 1/2017

Login to get access

Abstract

Background

The goal of this analysis was to describe socioeconomic inequalities in dental health among Spanish middle-aged adults, and the role of behavioral and psychosocial factors in explaining these inequalities.

Methods

This cross-sectional study used survey data from the 2006 Spanish National Health Survey and focused on adults ages 30 – 64. The outcome was dental health status based on the presence of self-reported dental problems. We used education, income, and occupational class as indicators of socioeconomic position and applied logistic regression analysis to estimate associations. We included behavioral and psychosocial variables in the models and compared non-adjusted to adjusted estimates to assess their potential role in explaining socioeconomic gradients.

Results

Results showed clear socioeconomic gradients in dental health among middle-aged adults. The percentage of people who reported more dental problems increased among those with lower levels of education, income, and occupation. These gradients were statistically significant (p < .001). Logistic regression showed that groups with lower education, income, and occupation had higher odds of reporting the outcome (p < .001). Associations were stronger when considering education as the indicator of socioeconomic position. Substantial unexplained associations remained significant after adjusting the model by behavioral and psychosocial variables.

Conclusions

This study shows significant socioeconomic gradients in dental health among middle-aged adults in Spain. Behavioral and psychosocial variables were insufficient to explain the inequalities described, suggesting the intervention of other factors. Further research should incorporate additional explanations to better understand and comprehensively address socioeconomic inequalities in dental health.
Literature
1.
Petersen PE, Bourgeois D, Ogawa H, Estupinan-Day S, Ndiaye C. The global burden of oral diseases and risks to oral health. Bull World Health Organ. 2005;83(9):661–9.PubMedPubMedCentral
2.
3.
Patel R. The state of oral health in Europe. Report commissioned by the platform for better oral health in Europe. Brussels: Platform for Better Oral Health in Europe; 2012.
4.
Bravo M, Casals E, Cortes F, Llodra JC, Alvarez I, Hermo P, et al. Encuesta de salud oral en España 2005 [oral health survey in Spain 2005]. RCOE. 2006;11(4):409–56.
5.
Watt R, Listl S, Peres M, Heilmann A, editors. Social inequalities in oral health: from evidence to action. London: International Centre for Oral Health Inequalities Research and Policy; 2015.
6.
Costa SM, Martins CC, Bonfim Mde L, Zina LG, Paiva SM, Pordeus IA, et al. A systematic review of socioeconomic indicators and dental caries in adults. Int J Environ Res Public Health. 2012;9(10):3540–74.CrossRefPubMedPubMedCentral
7.
Watt R, Sheiham A. Inequalities in oral health: a review of the evidence and recommendations for action. Br Dent J. 1999;187(1):6–12.PubMed
8.
Watt RG, Williams DM, Sheiham A. The role of the dental team in promoting health equity. Br Dent J. 2014;216(1):11–4.CrossRefPubMed
9.
Sabbah W, Tsakos G, Chandola T, Sheiham A, Watt RG. Social gradients in oral and general health. J Dent Res. 2007;86(10):992–6.CrossRefPubMed
10.
Petersen PE, Kwan S. Equity, social determinants and public health programmes—the case of oral health. Community Dent Oral Epidemiol. 2011;39(6):481–7.CrossRefPubMed
11.
Williams DM. The research agenda on oral health inequalities: the IADR-GOHIRA initiative. Med Princ Pract. 2014;23 Suppl 1:52–9.PubMed
12.
Petersen PE. Social inequalities in dental health. Towards a theoretical explanation. Community Dent Oral Epidemiol. 1990;18(3):153–8.CrossRefPubMed
13.
Sisson KL. Theoretical explanations for social inequalities in oral health. Community Dent Oral Epidemiol. 2007;35(2):81–8.CrossRefPubMed
14.
Newton JT, Bower EJ. The social determinants of oral health: new approaches to conceptualizing and researching complex causal networks. Community Dent Oral Epidemiol. 2005;33(1):25–34.CrossRefPubMed
15.
Petersen PE. Inequalities in oral health: the social context for oral health. In: Pine C, Harris R, editors. Community oral health. Berlin: Quintessence Publishing Co. Ltd.; 2007.
16.
Sabbah W, Tsakos G, Sheiham A, Watt RG. The role of health-related behaviors in the socioeconomic disparities in oral health. Soc Sci Med. 2009;68(2):298–303.CrossRefPubMed
17.
Sanders AE, Spencer AJ, Slade GD. Evaluating the role of dental behaviour in oral health inequalities. Community Dent Oral Epidemiol. 2006;34(1):71–9.CrossRefPubMed
18.
Tsuboya T, Aida J, Kawachi I, Katase K, Osaka K. Early life-course socioeconomic position, adult work-related factors and oral health disparities: cross-sectional analysis of the J-SHINE study. BMJ Open. 2014;4(10):e005701.CrossRefPubMedPubMedCentral
19.
Jung SH, Watt RG, Sheiham A, Ryu JI, Tsakos G. Exploring pathways for socio-economic inequalities in self-reported oral symptoms among Korean adolescents. Community Dent Oral Epidemiol. 2011;39(3):221–9.CrossRefPubMed
20.
U.S. Department of Health and Human Services. Oral health in america: a report of the surgeon general. Rockville: U.S. Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health; 2000.
21.
Watt RG, Steele JG, Treasure ET, White DA, Pitts NB, Murray JJ. Adult dental health survey 2009: implications of findings for clinical practice and oral health policy. Br Dent J. 2013;214(2):71–5.CrossRefPubMed
22.
National Statistics Institute. National Health Survey 2006. Detailed Methodology. Madrid: National Statistics Institute; 2006.
23.
National Statistics Institute. Evaluación de la falta de respuesta en la Encuesta Nacional de Salud 2006. Madrid: National Statistics Institute; 2006.
24.
Braveman PA, Cubbin C, Egerter S, Chideya S, Marchi KS, Metzler M, et al. Socioeconomic status in health research: one size does not fit all. JAMA. 2005;294(22):2879–88.CrossRefPubMed
25.
Hagenaars AJ, De Vos K, Zaidi A. Poverty statistics in the late 1980s: Research based on micro-data. Luxembourg: Office for official publications of the European Union; 1994.
26.
Muntaner C, Borrell C, Vanroelen C, Chung H, Benach J, Kim IH, et al. Employment relations, social class and health: a review and analysis of conceptual and measurement alternatives. Soc Sci Med. 2010;71(12):2130–40.CrossRefPubMed
27.
Goldberg D, Williams P. A user’s guide to the general health questionnaire. NFGER Nelson: Windsor; 1988.
28.
Sanchez-Lopez Mdel P, Dresch V. The 12-item general health questionnaire (GHQ-12): reliability, external validity and factor structure in the spanish population. Psicothema. 2008;20(4):839–43.PubMed
29.
Smilkstein G, Ashworth C, Montano D. Validity and reliability of the family APGAR as a test of family function. J Fam Pract. 1982;15(2):303–11.PubMed
30.
Bellon Saameno JA, Delgado Sanchez A, del Castillo JD L, Lardelli Claret P. Validity and reliability of the family Apgar family function test. Aten Primaria. 1996;18(6):289–96.PubMed
31.
Broadhead WE, Gehlbach SH, de Gruy FV, Kaplan BH. The duke-UNC functional social support questionnaire. Measurement of social support in family medicine patients. Med Care. 1988;26(7):709–23.CrossRefPubMed
32.
Bellon Saameno JA, Delgado Sanchez A, Luna del Castillo JD, Lardelli Claret P. Validity and reliability of the duke-UNC-11 questionnaire of functional social support. Aten Primaria. 1996;18(4):153–6. 8–63.PubMed
33.
Bartley M. Health inequality. An introduction to theories, concepts and methods. Cambridge: Polity Press; 2004.
34.
Rubin DB. Multiple imputation for nonresponse in surveys. New York: John Wiley and Sons; 1987.CrossRef
35.
Schafer JL. Analysis of incomplete multivariate data. New York: Chapman & Hall; 1997.CrossRef
36.
Perera I, Ekanayake L. Influence of oral health-related behaviours on income inequalities in oral health among adolescents. Community Dent Oral Epidemiol. 2011;39(4):345–51.CrossRefPubMed
37.
Rouxel PL, Heilmann A, Aida J, Tsakos G, Watt RG. Social capital: theory, evidence, and implications for oral health. Community Dent Oral Epidemiol. 2015;43(2):97–105.CrossRefPubMed
38.
Aida J, Kuriyama S, Ohmori-Matsuda K, Hozawa A, Osaka K, Tsuji I. The association between neighborhood social capital and self-reported dentate status in elderly Japanese--the ohsaki cohort 2006 study. Community Dent Oral Epidemiol. 2011;39(3):239–49.CrossRefPubMed
39.
Aida J, Hanibuchi T, Nakade M, Hirai H, Osaka K, Kondo K. The different effects of vertical social capital and horizontal social capital on dental status: a multilevel analysis. Soc Sci Med. 2009;69(4):512–8.CrossRefPubMed
40.
Baker SR, Mat A, Robinson PG. What psychosocial factors influence adolescents’ oral health? J Dent Res. 2010;89(11):1230–5.CrossRefPubMed
41.
Pinilla J, Negrin-Hernandez MA, Abasolo I. Time trends in socio-economic inequalities in the lack of access to dental services among children in Spain 1987–2011. Int J Equity Health. 2015;14:9.CrossRefPubMedPubMedCentral
42.
OECD. Health at a glance 2013: OECD indicators. Paris: OECD Publishing; 2013.
43.
44.
Locker D. Deprivation and oral health: a review. Community Dent Oral Epidemiol. 2000;28(3):161–9.CrossRefPubMed
45.
Turrell G, Sanders AE, Slade GD, Spencer AJ, Marcenes W. The independent contribution of neighborhood disadvantage and individual-level socioeconomic position to self-reported oral health: a multilevel analysis. Community Dent Oral Epidemiol. 2007;35(3):195–206.CrossRefPubMed
46.
Lindmark U, Hakeberg M, Hugoson A. Sense of coherence and its relationship with oral health-related behaviour and knowledge of and attitudes towards oral health. Community Dent Oral Epidemiol. 2011;39(6):542–53.CrossRefPubMed
47.
Unell L, Soderfeldt B, Halling A, Paulander J, Birkhed D. Oral disease, impairment, and illness: congruence between clinical and questionnaire findings. Acta Odontol Scand. 1997;55(2):127–32.CrossRefPubMed
48.
Pitiphat W, Garcia RI, Douglass CW, Joshipura KJ. Validation of self-reported oral health measures. J Public Health Dent. 2002;62(2):122–8.CrossRefPubMed
49.
Pinelli C, de Castro Monteiro Loffredo L. Reproducibility and validity of self-perceived oral health conditions. Clin Oral Investig. 2007;11(4):431–7.CrossRefPubMed
50.
Heft MW, Gilbert GH, Shelton BJ, Duncan RP. Relationship of dental status, sociodemographic status, and oral symptoms to perceived need for dental care. Community Dent Oral Epidemiol. 2003;31(5):351–60.CrossRefPubMed
Metadata
Title
Socioeconomic inequalities in dental health among middle-aged adults and the role of behavioral and psychosocial factors: evidence from the Spanish National Health Survey
Authors
Diego Alberto Capurro
Michael Davidsen
Publication date
01-12-2017
Publisher
BioMed Central
Published in
International Journal for Equity in Health / Issue 1/2017
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/s12939-017-0529-7

Other articles of this Issue 1/2017

International Journal for Equity in Health 1/2017 Go to the issue

Research

Towards an equitable healthcare in China: evaluating the productive efficiency of community health centers in Jiangsu Province

Erratum

Erratum to: Multifactorial discrimination as a fundamental cause of mental health inequities

Editorial

Practicing governance towards equity in health systems: LMIC perspectives and experience

Research

The association of early life socioeconomic conditions with prediabetes and type 2 diabetes: results from the Maastricht study

Research

Current and future availability of and need for human resources for sexual, reproductive, maternal and newborn health in 41 countries in Sub-Saharan Africa

Research

Internalized homophobia, mental health, sexual behaviors, and outness of gay/bisexual men from Southwest China