Abstract
BackgroundThe objective of this study was to assess socioeconomic inequalities in subjective measures of oral health in a national sample of adults in England, Wales and Northern Ireland.MethodsWe analysed data from the 2009 Adult Dental Health Survey for 8,765 adults aged 21 years and over. We examined inequalities in three oral health measures: self-rated oral health, Oral Health Impact Profile (OHIP-14), and Oral Impacts on Daily Performance (OIDP). Educational attainment, occupational social class and household income were included as socioeconomic position (SEP) indicators. Multivariable logistic regression models were fitted and from the regression coefficients, predictive margins and conditional marginal effects were estimated to compare predicted probabilities of the outcome across different SEP levels. We also assessed the effect of missing data on our results by re-estimating the regression models after imputing missing data.ResultsThere were significant differences in predicted probabilities of the outcomes by SEP level among dentate, but not among edentate, participants. For example, persons with no qualifications showed a higher predicted probability of reporting bad oral health (9.1 percentage points higher, 95% CI: 6.54, 11.68) compared to those with a degree or equivalent. Similarly, predicted probabilities of bad oral health and oral impacts were significantly higher for participants in lower income quintiles compared to those in the highest income level (p < 0.001). Marginal effects for all outcomes were weaker for occupational social class compared to education or income. Educational and income-related inequalities were larger among young people and non-significant among 65+ year-olds. Using imputed data confirmed the aforementioned results.ConclusionsThere were clear socio-economic inequalities in subjective oral health among adults in England, Wales and Northern Ireland with stronger gradients for those at younger ages.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2458-14-827) contains supplementary material, which is available to authorized users.
Highlights
The objective of this study was to assess socioeconomic inequalities in subjective measures of oral health in a national sample of adults in England, Wales and Northern Ireland
Significant differences were observed by occupational social class with a higher predicted probability of reporting bad oral health (5 percentage points) for subjects in manual occupations compared to those in the professional/managerial occupational level, and the same was the case for oral impacts
The predicted probabilities of oral health outcomes were significantly different from the reference category and gradually increased at lower socioeconomic position (SEP) levels with only two exceptions: 1) income and self-rated oral health, and
Summary
The objective of this study was to assess socioeconomic inequalities in subjective measures of oral health in a national sample of adults in England, Wales and Northern Ireland. Research has shown consistent inequalities with individuals in lower SEP being more likely to have poorer oral health, as measured by both clinical and subjective indicators [1,2,3,4,5,6,7,8,9,10,11,12,13]. Evidence from national oral health surveys has shown consistent inequalities with social gradients in different oral health outcomes including edentulousness, decay experience, periodontal disease, and trauma [1]. As a response to this clear and consistent evidence, tackling oral health inequalities has become a major goal of the health policy in the UK In this context, updated information using different SEP indicators and measures of oral health is needed to support relevant public policy recommendations
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