Abstract
BackgroundSocial determinants drive disparities in dental visiting. Disparities can be measured simply by comparing outcomes between groups (inequality) but can also consider concepts of social justice or fairness (inequity). This study aimed to assess differences in dental visiting in the United States in terms of both social inequality and inequity.MethodsData were obtained from a cross-sectional study—the National Health and Nutrition Examination Survey (NHANES) 2015–2016, and participants were US adults aged 30+ years. The outcome of interest, use of oral health care services, was measured in terms of dental visiting in the past 12 months. Disparity was operationalized through education and income. Other characteristics included age, gender, race/ethnicity, main language, country of birth, citizenship and oral health status. To characterize existing inequality in dental service use, we examined bivariate relationships using indices of inequality: the absolute and relative concentration index (ACI and RCI), the slope index of inequality (SII) and relative index of inequality (RII) and through concentration curves (CC). Indirect standardization with a non-linear model was used to measure inequity.ResultsA total of 4745 US adults were included. Bivariate analysis showed a gradient by both education and income in dental visiting, with a higher proportion (> 60%) of those with lower educational attainment /lower income having not visited a dentist. The concentration curves showed pro-higher education and income inequality. All measures of absolute and relative indices were negative, indicating that from lower to higher socioeconomic position (education and income), the prevalence of no dental visiting decreased: ACI and RCI estimates were approximately 8% and 20%, while SII and RII estimates were 50% and 30%. After need-standardization, the group with the highest educational level had nearly 2.5 times- and the highest income had near three times less probability of not having a dental visit in the past 12 months than those with the lowest education and income, respectively.ConclusionThe findings indicate that use of oral health care is threatened by existing social inequalities and inequities, disproportionately burdening disadvantaged populations. Efforts to reduce both oral health inequalities and inequities must start with action in the social, economic and policy spheres.
Highlights
Social determinants drive disparities in dental visiting
Socioeconomic inequalities are commonly found in oral health status, including dental caries [6], periodontal disease [7], oral health-related quality of life [8]; lower income limits access to dental care/service [9, 10] and lower education is associated with lower oral health literacy [11] and poor oral hygiene behaviours [12]
Inequality in dental visits To characterize existing inequality in the use of oral health care services, we examined bivariate relationships, used indices of inequality and depicted inequalities through concentration curves (CC)
Summary
Social determinants drive disparities in dental visiting. Disparities can be measured by comparing outcomes between groups (inequality) but can consider concepts of social justice or fairness (inequity). Ju et al BMC Oral Health (2021) 21:370 safety and so on), structural (including gender, race and ethnicity, immigration status, geography and more) and political factors drive access to services and health outcomes; this is evidenced by international studies on the social determinants of health [2, 3]. Oral health equity, defined as the fair distribution of oral health determinants, outcomes, and resources within and between segments of the population, regardless of social standing—should drive health system and policy goals [13]. Achieving this goal entails (1) quantifying disparities in a reliable and transparent way, (2) using the evidence-based research findings to inform policy, and (3) turning policy into action and practice (5). Measurement requires conceptual clarity in defining disparities (inequality and inequity)
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