Abstract
BackgroundSocioeconomic-related inequality in oral hygiene behaviors in Iran is poorly understood. This study aims to measure and decompose socioeconomic-related inequalities in oral hygiene behaviors among middle-aged and elderly adults in Iran.MethodsA cross-sectional analysis was performed using data from the Prospective Epidemiological Research Studies in IrAN (PERSIAN), a large national cohort study. A total of 130,016 individuals aged 35 years and above from 17 cohort centers in Iran were included in the study. The normalized concentration index (Cn) was used to measure the magnitude of inequality in oral hygiene behaviors, i.e. brushing at least twice and flossing once daily, among middle-aged and elderly Iranian adults included in the cohort centers. Decomposition analysis was performed to quantify the contribution of each determinant to the observed inequality in oral hygiene behaviors.ResultsTotally, 65.5% of middle-aged and elderly adults brushed their teeth twice a day or more, 7.6% flossed at least once a day and 3.48% had both habits. The estimated Cn of the two habits combined, i.e. tooth brushing and dental flossing, for all provinces taken part in the PERSIAN cohort study was 0.399 (95% confidence interval [CI]: 0.383 to 0.417), indicating that the prevalence of the two habits combined is more concentrated among individuals with higher socioeconomic status. Inequality in oral hygiene behaviors was pro-rich in all cohort centers. The decomposition results suggested socioeconomic status as the main factor contributing to the overall inequality, followed by the level of education, and the province of residence.ConclusionA low prevalence of oral hygiene behaviors among middle-aged and elderly Iranian adults was observed. There was also a pro-rich inequality in oral hygiene behaviors among middle-aged and elderly adults in all cohort centers. These results suggest an urgent need for targeted policy interventions to increase the prevalence of preventive oral hygiene behaviors among the poor and less-educated middle-aged and elderly adults in Iran.
Highlights
Socioeconomic-related inequality in oral hygiene behaviors in Iran is poorly understood
Oral and dental problems can be avoided by appropriate oral hygiene behaviors and preventive self-care practices, these problems continue to persist in many countries around the world [4, 5]
The results demonstrated that the cohort of Razavi Khorasan had the highest proportion of the two habits combined (13.3%), followed by the cohort of Chaharmahal and Bakhtiari (8.3%) and Mazandaran (5.4%) provinces
Summary
Socioeconomic-related inequality in oral hygiene behaviors in Iran is poorly understood. Proper oral health behaviors such as tooth brushing, dental flossing and receiving regular dental checkups are effective strategies to prevent tooth decay, and periodontal diseases [5, 6]. According to the American Dental Association (ADA), regular habits of tooth brushing (at least twice a day) and flossing (at least once a day) can effectively prevent oral problems [7]. Especially poor dental self-cares (e.g. tooth brushing and dental flossing) and non-use of dental service are associated with the dental impairments, and reduced oral health-related quality of life [11]. Socioeconomic-related inequalities in oral health status have been observed in low-, middle-, and high-income countries [16, 17], so that higher SES individuals clean their teeth more effectively and frequently and use more self-performed preventive strategies [18]
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