Dental expenditure, progressivity and horizontal inequality in Chinese adults: based on the 4th National Oral Health Epidemiology Survey

Cheng, Meng Lin; Wang, Chun Xiao; Wang, Xing; Xiong, Feng; Tai, Baojun; Hu, Yu; Lin, Huancai; Wang, Bo; Zheng, Shu Guo; Liu, Xue Nan; Rong, Wen Sheng; Wang, Wei Jian; Si, Yan; Xu, Tao

doi:10.1186/s12903-020-01128-0

Cited by 16 publications

(11 citation statements)

References 30 publications

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“…As in a previous study in China, 8 Chinese medical reform, especially reform of the dental system, has much room for improvement. 40 The results of the decomposition analyses supplement previous findings that socioeconomic-related inequality in dental care service utilization cannot be comprehensively explained by those variables influencing the affordability of dental care payments, which further suggests that this inequality may not be eliminated only by providing financial support. 10 Mirroring previous research that also found that education 5,8,14 and residential location 8 contributed to inequality in the use of oral health services, the present study suggests that educational attainment and residential location have more of an impact among younger adults aged 35-44 years than among older adults.…”

Section: Discussionsupporting

confidence: 71%

Measuring and decomposing socioeconomic‐related inequality in the use of oral health services among Chinese adults

Gao

et al. 2020

Comm Dent Oral Epid

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Objectives: This study aimed to measure socioeconomic-related inequality and horizontal inequity in the use of oral health services and decompose this inequality among adults of different age groups in China. Methods: In total, 10 973 adults (3669 aged 35-44 years, 3767 aged 55-64 years and 3537 aged 65-74 years) who participated in the 4th National Oral Health Survey (2015-2016) in China were included. Concentration curves and the Erreygerscorrected concentration index (EI) were employed to measure socioeconomic-related inequality in the use of oral health services. Then, inequity in this utilization was measured by the horizontal inequity index (HI). Furthermore, decomposition analyses were conducted for the three groups to explain the contributions of income level, need factors (ie self-assessed oral health and evaluated oral health status), other factors (ie sex, residential location, educational attainment level and type of basic insurance) and a residual term to overall inequality in oral health service utilization. Results: The significant positive EI and HI values indicated that pro-rich inequality and inequity in oral health service utilization exist among Chinese adults. Income and type of basic medical insurance contributed the most to socioeconomic-related inequality in the use of oral health services among adults aged 55-64 and 65-74 years. However, the main driving factors of socioeconomic inequality among adults aged 35-44 years in dental care use included income, educational achievement, type of basic medical insurance and residential location. The need variables accounted for a very small proportion of overall socioeconomic-related inequality in oral health service use in all three groups. Conclusions: Oral healthcare service utilization was disproportionately concentrated among better-off Chinese adults. The primary determinants of inequality in dental care use in different age groups provide information for policymakers to create more targeted policies to achieve equity in the oral healthcare system in China.

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Section: Discussionsupporting

confidence: 71%

Measuring and decomposing socioeconomic‐related inequality in the use of oral health services among Chinese adults

Gao

et al. 2020

Comm Dent Oral Epid

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“…First, income inequality may lead to the reduction of investment on the public health resources such as water fluoridation [ 42 , 43 ]. Secondly, the percentage of routine expenditure on health care is low among the low-income group and the dental expenditure is still a tiny fraction in terms of the health care payments in China [ 44 ]. Besides, studies showed that people with low incomes tend to neglect health-related behaviors such as smoking and regular health care [ 21 , 22 , 45 ].…”

Section: Discussionmentioning

confidence: 99%

Income-related inequality and decomposition of edentulism among aged people in China

Du¹,

Cheng

Zhang

et al. 2022

BMC Oral Health

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Background The aim of this study was to assess the income-related inequality of edentulism among the aged in China and identify the contributing factors. Methods A secondary analysis of data from the 4th National Oral Health Epidemiology Survey in China was conducted, and 65–74 years old were selected for the analysis of income-related inequality of edentulism. The concentration curve, Concentration index (CI) and Erreygers-corrected concentration index (EI) were used to represent inequality and its degree qualitatively and quantitatively, respectively. A decomposition method based on probit model was employed to determine the contributors of inequality, including demographic factors, income status, oral health-related knowledge, attitude and practices and self-perceived general health status. Results In China, aged people with edentulism were concentrated in the poor. The CI was − 0.2337 (95% CIs: − 0.3503, − 0.1170). The EI was − 0.0413 (95% CIs: − 0.0619, − 0.0207). The decomposition results showed that income (75.02%) and oral health-related knowledge, attitude and practices (15.52%) were the main contributors to the inequality. Conclusion This study showed that pro-poor inequality among the elderly with edentulism existed in China. Corresponding policies against the contributors could be considered to promote the health equality of the elders.

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“…14 According to previous studies, dental service utilization among Chinese preschool children may be influenced by caregiver education background, socioeconomic status, perception of their children's oral health status, dental insurance dental fear and demographic factors. 16 Although some studies have found socioeconomic-related inequalities in dental service utilization among adults in China, [17][18][19] the evidence related to inequality in children's dental service utilization is insufficient.…”

Section: Introductionmentioning

confidence: 99%

“…19,[22][23][24] Inequality in dental care utilization among Chinese adults has been measured in previous studies by means of CI. [17][18][19] However, evidence related to inequality in dental care indicating that dental care utilization in children aged 3-5 years was concentrated in those who were better off. The contribution of the need variables to socioeconomicrelated inequality in dental services was minimal, and most dental care utilization inequality could be explained by household income, caregiver education attainment and urban-rural disparities, accounting for 32.0%, 49.4% and 20.4% respectively.…”

Section: Introductionmentioning

confidence: 99%

Socioeconomic‐related inequality in dental care utilization among preschool children in China

Chang

Gao

et al. 2021

Comm Dent Oral Epid

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Objectives: This study aimed to investigate socioeconomic-related inequality in dental care service utilization in the past 12 months among Chinese preschool children and to explore the contribution of various factors to this inequality.Method: A total of 40 305 children aged 3-5 years from 372 kindergartens who participated in the Fourth National Oral Health Survey in China were included in the final analysis. The method of data weighting in complex sampling was adopted to make the samples more representative. Erreygers-corrected concentration index (EI) was used to measure socioeconomic-related inequality in dental care service utilization. The horizontal inequality index (HI) was employed to analyse horizontal inequality. Decomposition analyses were conducted to explore the contributions of income level, need variables (dmft, caregiver-evaluated oral health status and toothache experience) and nonneed variables (caregiver education level, residential location, age, and sex) to the inequality of health service utilization. Result:The utilization of oral health services within the past 12 months among the high-, middle-and low-income groups was 17.4% (95% CI: 15.6-19.3), 13.6% (95% CI: 12.2-15.1) and 9.4% (95% CI: 8.1-11.0) respectively. The concentration curve was below the line of equality, and the EI and HI were 0.072 and 0.078, respectively, How to cite this article: Chang Q, Gao X, Xu M, et al. Socioeconomic-related inequality in dental care utilization among preschool children in China.

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Dental expenditure, progressivity and horizontal inequality in Chinese adults: based on the 4th National Oral Health Epidemiology Survey

Cited by 16 publications

References 30 publications

Measuring and decomposing socioeconomic‐related inequality in the use of oral health services among Chinese adults

Measuring and decomposing socioeconomic‐related inequality in the use of oral health services among Chinese adults

Income-related inequality and decomposition of edentulism among aged people in China

Socioeconomic‐related inequality in dental care utilization among preschool children in China

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