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ObjectiveTo compare the magnitude of, and contributors to, income-related inequalities in oral health outcomes within and between Canada and the United States over time.MethodsThe concentration index was used to estimate income-related inequalities in three oral health outcomes from the Nutrition Canada National Survey 1970–1972, Canadian Health Measures Survey 2007–2009, Health and Nutrition Examination Survey I 1971–1974, and National Health and Nutrition Examination Survey 2007–2008. Concentration indices were decomposed to determine the contribution of demographic and socioeconomic factors to oral health inequalities.ResultsOur estimates show that over time in both countries, inequalities in decayed teeth and edentulism were concentrated among the poor and inequalities in filled teeth were concentrated among the rich. Over time, inequalities in decayed teeth increased and decreased for measures of filled teeth and edentulism in both countries. Inequalities were higher in the United States compared to Canada for filled and decayed teeth outcomes. Socioeconomic characteristics (education, income) contributed greater to inequalities than demographic characteristics (age, sex). As well, income contributed more to inequalities in recent surveys in both Canada and the United States.ConclusionsInequalities in oral health have persisted over the past 35 years in Canada and the United States, and are associated with age, sex, education, and income and have varied over time.

OBJECTIVE: To quantify the extent to which income and education explain gradients in oral health outcomes. METHODS:Using data from the Canadian Community Health Survey (CCHS 2003), binary logistic regression models were constructed to examine the relationship between income and education on self-reported oral health (SROH) and chewing difficulties (CD) while controlling for age, sex, ethnicity, employment status and dental insurance coverage. The relative index of inequality (RII) was utilized to quantify the extent to which income and education explain gradients in poor SROH and CD.RESULTS: Income and education gradients were present for SROH and CD. From fully adjusted models, income inequalities were greater for CD (RII inc = 2.85) than for SROH (RII inc = 2.75), with no substantial difference in education inequalities between the two. Income explained 37.4% and 42.4% of the education gradient in SROH and CD respectively, whereas education explained 45.2% and 6.1% of income gradients in SROH and CD respectively. Education appears to play a larger role than income when explaining inequalities in SROH; however, it is the opposite for CD. CONCLUSION:In this sample of the Canadian adult population, income explained over one third of the education gradient in SROH and CDs, whereas the contribution of education to income gradients varied by choice of self-reported outcome. Results call for stakeholders to improve affordability of dental care in order to reduce inequalities in the Canadian population.KEY WORDS: Oral health; socio-economic factors; educational status; income; population health La traduction du résumé se trouve à la fin de l'article.

Our findings suggest that in general, self-reports are poor estimates for normative dental treatment needs but do have some merit in confirming non-needs. Exceptionally, self-reports do have suitable diagnostic accuracy for predicting orthodontic and endodontic needs.