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BMC Oral Health. 2018 Oct 26;18(1):176. doi: 10.1186/s12903-018-0630-3.

Socioeconomic status, oral health and dental disease in Australia, Canada, New Zealand and the United States.

Author information

1
Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, SA, 5005, Australia. gloria.mejia@adelaide.edu.au.
2
Harvard School of Dental Medicine, Harvard University, Boston, MA, USA.
3
Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Quebec, H3A 1A2, Canada.
4
Sir John Walsh Research Institute, Faculty of Dentistry, The University of Otago, Dunedin, New Zealand.
5
Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, SA, 5005, Australia.
6
Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA.

Abstract

BACKGROUND:

Socioeconomic inequalities are associated with oral health status, either subjectively (self-rated oral health) or objectively (clinically-diagnosed dental diseases). The aim of this study is to compare the magnitude of socioeconomic inequality in oral health and dental disease among adults in Australia, Canada, New Zealand and the United States (US).

METHODS:

Nationally-representative survey examination data were used to calculate adjusted absolute differences (AD) in prevalence of untreated decay and fair/poor self-rated oral health (SROH) in income and education. We pooled age- and gender-adjusted inequality estimates using random effects meta-analysis.

RESULTS:

New Zealand demonstrated the highest adjusted estimate for untreated decay; the US showed the highest adjusted prevalence of fair/poor SROH. The meta-analysis showed little heterogeneity across countries for the prevalence of decayed teeth; the pooled ADs were 19.7 (95% CI = 16.7-22.7) and 12.0 (95% CI = 8.4-15.7) between highest and lowest education and income groups, respectively. There was heterogeneity in the mean number of decayed teeth and in fair/poor SROH. New Zealand had the widest inequality in decay (education AD = 0.8; 95% CI = 0.4-1.2; income AD = 1.0; 95% CI = 0.5-1.5) and the US the widest inequality in fair/poor SROH (education AD = 40.4; 95% CI = 35.2-45.5; income AD = 20.5; 95% CI = 13.0-27.9).

CONCLUSIONS:

The differences in estimates, and variation in the magnitude of inequality, suggest the need for further examining socio-cultural and contextual determinants of oral health and dental disease in both the included and other countries.

KEYWORDS:

Dental caries; Oral health; Self-report; Socioeconomic factors

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