Social gradients and cumulative effects of income and education on dental health in the Fourth German Oral Health Study

Medical Sociology Unit, Hannover Medical School, Hannover, Germany.
Community Dentistry And Oral Epidemiology (Impact Factor: 2.03). 04/2010; 38(2):120-8. DOI: 10.1111/j.1600-0528.2009.00520.x
Source: PubMed


To consider differential effects of income and education on oral health for each indicator separately and in combination. Finally the combined effects of the lowest income level and the lowest level of education were examined.
Data were drawn from the Fourth German Oral Health Study. They were collected using proportional random sampling in order to obtain information also for less densely populated regions. The subjects included in the study were between 35 and 44 years of age (n = 925). It included a clinical dental examination and a sociological survey. Social differentiation was depicted by education and income (divided into categories), oral health was measured using the DMFT-index.
Social gradients emerged for both indicators of social differentiation. The effects derived from single analyses were somewhat higher than those obtained by simultaneous estimations. The odds ratio of the lowest as compared with the highest income category was OR = 3.74 and OR = 2.34 in the analysis with both indicators. For education the respective effects were OR = 3.75 and OR = 2.95. The cumulative effect of the lowest income and the lowest educational level combined was OR = 6.06.
Education and income are shaping social inequalities in oral health independently from each other, and they are only moderately correlated. They refer to different dimensions of disadvantage thus making preventive measures more complicated.

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    • "Dental caries remains the most prevalent disease worldwide , burdening billions of people, especially children, with pain and subsequently poorer quality of life and general health (Luan et al. 2000; Barbosa and Gavião 2008; Declerck et al. 2008; Beikler and Flemmig 2011; de Amorim et al. 2012; Marcenes et al. 2013). While the prevalence of untreated caries lesions and the number of carious, filled, or missing teeth (i.e., caries experience) have been declining in adolescents for 3 decades in many countries, a growing number of studies have found the distribution of caries lesions to be increasingly skewed, with a small fraction of (usually) disadvantaged individuals experiencing the majority of lesions or restorations (Marthaler 2004; Petersen 2005; Geyer et al. 2010; Pitts et al. 2011; Do 2012). It has therefore been hypothesized that socioeconomic position (SEP) predicts or even causally affects caries, as has been reported for many other diseases (Marmot and Smith 1997; Whitehead and Dahlgren 2006; Marmot et al. 2012). "
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    ABSTRACT: Dental caries is the most prevalent disease worldwide, with the majority of caries lesions being concentrated in few, often disadvantaged social groups. We aimed to systematically assess current evidence for the association between socioeconomic position (SEP) and caries. The study protocol was registered with PROSPERO (CRD42013005947). We included studies investigating the association between social position (determined by own or parental educational or occupational background, or income) and caries prevalence, experience or incidence. Risk of bias was assessed using the Newcastle-Ottawa-Scale for observational studies. Reported differences between the lowest and highest SEP were assessed, and data not missing at random imputed. Random-effects inverse-generic meta-analyses were performed, and subgroup and meta-regression analyses used to control for possible confounding. Publication bias was assessed via Funnel plot analysis and Egger test. From 5,539 screened records, 155 studies with mostly low or moderate quality evaluating a total of 329,798 individuals were included. Studies used various designs, SEP measures and outcome parameters. 83 studies found at least one measure of caries to be significantly higher in low-SEP compared with high-SEP individuals, whilst only three studies found the opposite. The odds of having any caries lesions or caries experience (DMFT/dmft>0) were significantly greater in those with low own or parental educational or occupational background or income (between OR [95% CI]=1.21 [1.03-1.41] and OR=1.48 [1.34-1.63]). The association between low educational background and having DMFT/dmft>0 was significantly increased in highly developed countries (R2=1.32 [0.53-2.13]). Publication bias was present but did not significantly affect our estimates. Due to risk of bias in included studies, the available evidence was graded as low or very low. Low SEP is associated with a higher risk of having caries lesions or experience. This association might be stronger in developed countries. Established diagnostic and treatment concepts might not account for the unequal distribution of caries.
    No preview · Article · Oct 2014 · Journal of Dental Research
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    • "As in other studies (25–28), our study also found that attending junior high school or higher education (≥6 years) was inversely associated with severe periodontitis. Those with higher education levels are usually employed, tend to have more income, and use oral health services more. "
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    ABSTRACT: Background Although the interrelationship between poor oral health and chronic diseases is well established, few related studies are available in China. In this study, the prevalence of severe periodontitis and its association with chronic diseases among adults in China have been explored. Design During China's 2010 Chronic Disease and Risk Factor Surveillance (CCDRFS) survey among adults aged 18 and older, 3 out of 162 surveillance points and the entire sample from each point (600×3=1,800 subjects) were selected as pilot study sites in which oral examination was performed. Basic demographic information, chronic diseases status, and results of oral examination were collected from 2010 CCDRFS data. A standard oral examination was conducted by trained staff. Periodontitis was defined as moderate (4–5 mm pockets) or severe (≥6 mm pockets). Chronic disease status was determined by using standard methods and criteria. Multivariate logistic analysis was used to identify the independent association of various factors with severe periodontitis. Results Of 1,800 subjects, 1,728 subjects (96%) provided complete information. The prevalence of severe periodontitis was 1.9% (32/1,728) (95% CI=1.2–2.5). In multivariate model, participants with diabetes were 2.4 times (OR=2.4, 95% CI=1.1–5.6) more likely to have severe periodontitis. Being male was significantly associated with severe periodontitis (OR=3.5, 95% CI=1.6–7.7). Living in a rural area was related to an increased chance of having severe periodontitis (OR=2.1, 95% CI=1.0– 4.9). Attainment of at least 6 years of education was inversely associated with severe periodontitis (OR=0.3, 95% CI=0.1–0.8). Conclusions According to this pilot project, prevalence of severe periodontitis was low. Control measures should be particularly emphasized for high-risk groups such as less educated people (<6 years of education), people living in rural areas, men, and diabetes patients. Population-based studies, including oral examination by trained staff, are feasible and should be done in order to understand the burden of periodontitis and to provide an effective response to this key oral health issue.
    Full-text · Article · Jul 2014 · Global Health Action
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    • "Income affects eating patterns, housing, knowledge and access to health care, all of them directly affect either exposure to risk or protection from disease [10]. Education is also considered an important component of socioeconomic status that contributes to health differences [12]. Moreover, psychological wellbeing, a lack of stress and access to social networks are factors that have been attributed to health maintenance. "
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    ABSTRACT: Background In recent decades, studies in the field of public health have increasingly focused on social determinants that affect the health-illness process. The epidemiological perspective considers oral health to be a reflection of socioeconomic and environmental aspects, and it is particularly influenced by the social context. The aim of the present study was to assess the association between the severity of dental caries among adults aged 35 to 44 years and characteristics on the different levels at which the determinants of caries operate (individual, social structure and social context). Methods A home-based, cross-sectional field study was carried out involving a sample of 1,150 adults (35 to 44 years of age) residing in metropolitan Belo Horizonte, Brazil. The DMFT (decayed, missing, filled tooth) index (≥14) was used to determine the severity of dental caries. Bivariate and multivariate analyses were carried out using the Poisson regression model with the level of significance set at 5% (p < 0.05) and 95% confidence intervals. Results The majority of the participants (68.5%) had high caries severity. The rate of high-severity caries in the group between 40 and 44 years of age was 1.15-fold (CI: 1.04-1.26) greater than that among those aged 35 to 39 years. A greater prevalence of high caries severity was found among those who frequently visited the dentist (PR = 1.18; CI: 1.07-1.30), those with a lower income (PR = 1.11; CI: 1.01-1.23), those who reported that their neighborhood did not come together in the previous year to petition political leaders for benefits (PR = 1.16; CI: 1.05-1.28) and those who are unable to make decisions (without empowerment) (PR = 1.12; CI: 1.01-1.24). Conclusions The present study revealed high dental caries severity in adults, which was associated with individual characteristics, health-related behavior and social structure and contextual variables. These findings underscore the importance of considering social determinants involved in the health-illness process when carrying out epidemiological studies on dental caries.
    Full-text · Article · Jul 2012 · BMC Oral Health
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