Abstract
BackgroundOral pain affects people’s daily activities and quality of life. The burden of oral pain may vary across socio-economic positions. Currently, little is known about the social gradient in the cost of oral pain among South Africans. This study therefore assessed the social gradient in the cost of oral pain and the related dental service utilisation pattern among South African adults.MethodsData were obtained from a nationally representative cross-sectional survey of South African adults ≥16 year-old (n = 2651) as part of the South African Social Attitudes Survey conducted by the South African Human Sciences Research Council. The survey included demographic data, individual-level socio-economic position (SEP), self-reported oral health status, past six months’ oral pain experience and cost. The area-level SEP was obtained from the 2010 General Household Survey (n = 25,653 households) and the 2010/2011Quarterly Labour Force Survey conducted in South Africa. The composite indices used for individual-level SEP (α = 0.76) and area-level SEP (α = 0.88) were divided into tertiles. Data analysis was done using t-tests and ANOVA. Significance was set at p < 0.05.ResultsThe prevalence of oral pain among the adult South Africans was 19.4 % (95 % CI = 17.2–21.9). The most commonly reported form of oral pain was ‘toothache’ (78.9 %). The majority of the wealthiest participants sought care from private dental clinics (64.7 %), or from public dental clinics (19.7 %), while the poorest tended to visit a public dental clinic (45 %) or nurse/general medical practitioner (17.4 %). In the poorest areas, 21 % responded to pain by ‘doing nothing’. The individual expenditure for oral pain showed a social gradient from an average of ZAR61.44 spent by those of lowest SEP to ZAR433.83 by the wealthiest (national average ZAR170.92). Average time lost from school/work was two days over the six-month period, but days lost was highest for those living in middle class neighbourhoods (3.41), while those from the richest neighbourhood had lost significantly fewer days from oral pain (0.64).ConclusionsThere is a significant social gradient in the burden of oral pain. Improved access to dental care, possibly through carefully planned universal National Health Insurance (NHI), may reduce oral health disparities in South Africa.
Highlights
Oral pain affects people’s daily activities and quality of life
The presence of oral pain may not override or negate the barriers experienced by people of low socio-economic position who wish to access a dental facility, but the severity of the pain that people experience appears to be associated with the timing of the poor’s seeking dental care [10]
The prevalence of oral pain shows a significant social gradient by area-level with those living in the richest areas reporting the lowest oral pain prevalence
Summary
Oral pain affects people’s daily activities and quality of life. The burden of oral pain may vary across socio-economic positions. The presence of oral pain may not override or negate the barriers experienced by people of low socio-economic position who wish to access a dental facility, but the severity of the pain that people experience appears to be associated with the timing of the poor’s seeking dental care [10]. When they are faced with such barriers, some poor people may seek alternative ways to alleviate their pain. The cost of care could be an important factor preventing the poor from seeking care [13]
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