Abstract
ObjectivesWith health inequalities high on the policy agenda, this study measures oral health inequalities in the UK.MethodsWe compare an objective clinical measure of oral health (number of natural teeth) with a self-reported measure of the impact of oral health (the Oral Health Impact Profile, OHIP) to establish whether the type of measure affects the scale of inequality measured. Gini coefficients and Concentration Indices (CIs) are calculated with subsequent decompositions using data from the 1998 UK Adult Dental Health Survey. Because the information on OHIP is only available on dentate individuals, analyses on the number of natural teeth are conducted for two samples – the entire sample and the sample with dentate individuals only, the latter to allow direct comparison with OHIP.ResultsWe find considerable overall pure oral health inequalities (number of teeth: Gini = 0.68 (including edentate), Gini = 0.40 (excluding edentate); OHIP: Gini = 0.33) and income-related inequalities for both measures (number of teeth: CI = 0.35 (including edentate), CI = 0.15 (excluding edentate); OHIP: CI = 0.03), and the CI is generally higher for the number of teeth than for OHIP. There are differences across age groups, with CI increasing with age for the number of teeth (excluding edentate: 16–30 years: CI = 0.01, 65 + years: CI = 0.11; including edentate: 16–30 years: CI = 0.01, 65 + years: CI = 0.19). However, inequalities for OHIP were highest in the youngest age group (CI = 0.05). Number of teeth reflects the accumulation of damage over a lifetime, while OHIP records more immediate concerns.ConclusionsThere are considerable pure oral health inequalities and income-related oral health inequalities in the UK. Using sophisticated methods to measure oral health inequality, we have been able to compare inequality in oral health with inequality in general health. The results provide a benchmark for future comparisons but also indicate that the type of health measure may be of considerable significance in how we think about and measure oral health inequalities.
Highlights
Recent research has demonstrated consistent and clear social gradients in oral health in Britain [5, 6] and in other countries [2, 7,8,9]
Sophisticated inequality measurement would seem necessary to investigate oral health inequality because socioeconomic gradients give important insights into inequalities, they do not provide measures of the scale of inequalities that are comparable across different types of health, countries or time
The average reversed Oral Health Impact Profile (OHIP) score is 12, which is close to the maximum score of 14 suggesting a mean of around two oral health problems among the population
Summary
Recent research has demonstrated consistent and clear social gradients in oral health in Britain [5, 6] and in other countries [2, 7,8,9]. Researchers in the wider field of health inequalities often rely on self-reported health measures available in household surveys because objective measures are often too costly to collect. Two oral health indicators were used as outcome variables: the number of natural teeth and the 14-item Oral Health Impact Profile (OHIP) score. We use a count of the number of oral healthrelated problems occurring fairly or very often [15], so the score ranges between 0 and 14 For this analysis, the overall score of OHIP has been reversed, so that a higher score indicates better oral health, to provide consistency with the number of teeth indicator. The Lorenz curve for health is formed by plotting the cumulative proportion of health in the population against the cumulative population, ranked by health With no inequality, this would plot a 45° line.
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