Abstract
This study examined inequalities in dental check-ups and medical screenings using subjective and objective socioeconomic indicators. Data from 23,464 adults, aged 20 years old and over, who participated in a multi-national survey across Europe (Eurobarometer 72.3) were analysed. Participants’ socioeconomic position (SEP) was measured by education, difficulty in paying bills and subjective social status. Use of preventive services was measured by attendance for dental check-ups, cancer and cardiovascular screenings in the past 12 months. Socioeconomic inequalities were assessed in two-level logistic regression (adults nested within countries), adjusting for demographic factors and type of healthcare system. There were apparent social inequalities in using all three preventive services. However, only dental check-ups showed consistent and significant inequalities across all socioeconomic indicators with those in the bottom groups in education (odds ratio: 0.51; 95% confidence interval: 0.46–0.55), difficulty in paying bills (OR: 0.64; 95% CI: 0.59–0.72) and subjective social status (OR: 0.63; 95% CI: 0.57–0.69) having lower odds of reporting dental check-ups in the past 12 months than those in the top groups. Cancer screening was not associated with difficulty in paying bills whereas cardiovascular disease screening was not associated with education and subjective social status. Despite the availability of universal health coverage, there were clear social gradients in using preventive services particularly across education and subjective social status groups. The stronger and more consistent gradients observed in dental check-ups compared to cancer and cardiovascular screening could be attributed to difference in the level of coverage of dental and medical services in Europe.
Highlights
Screenings and check-ups for medical and dental conditions have been identified as important contributors to reduction in the burden of diseases as they help to identify high risk individuals and enable timely intervention [1,2]
Significant positive linear trends in use of dental check-ups, cancer screening and cardiovascular disease (CVD) screening were observed according to education, difficulty in paying bills and subjective social status
This study examined socioeconomic inequality in using preventive dental and medical services, namely dental check-ups as well as cancer and CVD screening, among adults in the 27 European Union countries using objective and subjective socioeconomic position (SEP) indicators
Summary
Screenings and check-ups for medical and dental conditions have been identified as important contributors to reduction in the burden of diseases as they help to identify high risk individuals and enable timely intervention [1,2]. Cancer screening is associated with lower rates of cancer-related mortality [3,4]. Cardiovascular screening is linked to lower rates of cardiovascular disease-related mortality [5]. Regular dental attendance for check-ups are related to lower rates of dental caries, periodontal disease and tooth loss [6,7]. The use of healthcare services is influenced by a number of individual and contextual factors [8]. Social inequalities in use of preventive healthcare services are likely to exacerbate the existing
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