Explaining oral health inequalities in European welfare state regimes: The role of health behaviours.

Abstract

To assess the extent to which behavioural factors, including those related to dental care, account for oral health inequalities in different European welfare state regimes. Data from the Eurobarometer 2009 survey were analysed. Nationally representative samples of dentate adults aged ≥45years (n=9979) from 21 European countries classified into the five welfare regimes (Scandinavian, Anglo-Saxon, Bismarckian, Southern, Eastern) were considered. Inequalities in no functional dentition (having <20 natural teeth) by education and occupation were identified using the Relative and Slope Indices of Inequality (RII and SII, respectively). The percentage reduction in RII and SII was calculated from regression models before and after adjustment for behaviours, first one at a time and then all together. Behaviours explained 21.0% (95% CI 8.7, 31.4) and 13.1% (95% CI 7.9, 33.2) of educational inequalities in no functional dentition (RII) in the Scandinavian and Eastern regimes, respectively. For occupational inequalities, the attenuations in RII in these welfare regimes were 19.3% (95% CI 7.1, 24.2) and 10.5% (95% CI 3.4, 22.5), respectively. Attenuations were weaker and nonsignificant in the Bismarckian, Anglo-Saxon and Southern regimes. Among the behaviours analysed, alcohol consumption was particularly relevant in explaining inequalities in the Scandinavian regime, and this was confirmed in sensitivity analyses through three-way cross-level interaction terms in multilevel models. Behaviours related to dental care produced similar, consistent attenuations in the Scandinavian and Eastern regimes for both socioeconomic indicators. SII findings showed a similar picture. The role of particular behaviours in explaining oral health inequalities could be heterogeneous across European welfare regimes, indicating that their importance might be influenced by the general approach to social policies.