Neo‐Marxian social class inequalities in oral health among the South Korean population

Abstract

Aim The aims of this study were to examine inequalities in periodontitis and tooth loss among South Korean adults using the Wright's Neo‐Marxian social class (NMSC) indicator and to assess the impact of material, psychosocial, health behavioural and workplace environmental factors in the association of social class with oral health. Methods This study used the data from the 4th Korea National Health and Nutrition Examination Survey with 6710 participants aged 19‐54 years old. Participants were classified into 12 social class positions based on the Wright's social class map. Healthy gum and absence of tooth loss were the health outcomes. Mediating factors were material (M), psychosocial (PS), health behavioural (HB) and workplace environmental (WPE) factors. A series of logistic regressions were performed to analyse the data. Odds ratio (OR) and 95% confidence interval (CI) were used to report the results. Results For the absence of periodontal pockets status, expert supervisors were the healthiest periodontal group among the social classes (OR = 2.15 95% CI 1.59‐2.90) in the age and gender adjusted model. For the absence of tooth loss, skilled workers had the highest OR for absence of tooth loss (OR = 1.64 95% CI 1.31‐2.05) in the age‐ and gender‐adjusted model. For absence of periodontal pockets, the explanatory power of the M factor was the highest in all social class positions except for nonskilled supervisors followed by the HB factor. Additionally, the absence of tooth loss had a fairly similar pattern. The explanatory power of the M factor was the highest in all social class positions except for the petty bourgeoisie (highest: HB) and nonskilled supervisors (highest: WPE) followed by the HB and WPE factors. Conclusion There were nongradient oral health inequalities among the South Korean population according to the NMSC. Oral health promotion programmes that focus on changing the socioeconomic environment and health behaviours should be implemented.

Systematic Review of the Literature on Dental Caries and Periodontal Disease in Socio-Economically Disadvantaged Individuals

“…Furthermore, they are more likely to have fewer teeth than the population median number (59.2%, n. = 734/1289 vs. 42.7%, n. = 216/538, p < 0.001) [ 102 ]. On the contrary, a high degree of education increases the prevalence of subjects without tooth loss (51.9% [n. = 809/1559] vs. 60.6% [n. = 1064/1753] p < 0.001; 6710 participants) [ 150 ]. Considering the number of residual teeth as an outcome, low income was found to be a risk factor of tooth loss.…”

Periodontal diseases and potential risk factors in Egyptian adult population—Results from a national cross-sectional study

“…Low SES is considered by far the most consistent predictive factor for tooth loss [ 26 ], yet, in our study no significant socioeconomic difference was detected with respect to prevalence of tooth loss among Egyptian adults. Similarly, the socioeconomic position failed to describe people’s oral health status in other populations where some social classes exhibited poorer oral health and significantly more tooth loss when compared to lower classes [ 39 ]. One plausible explanation for this inconsistency is that generally, socioeconomic position is determined based on individual’s income, level of educational attainment, and occupational class and thus understanding how it impacts health outcomes is quite complex [ 40 ].…”

Socioeconomic determinants of periodontitis

“…Also, there was a strong association between self-reported periodontal symptoms with occupation, income, and education. Novrinda et al, 33 The association between social class and the absence of periodontal pockets was significant for expert supervisors and expert workers.…”

“…Also, there was a strong association between self‐reported periodontal symptoms with occupation, income, and education. Novrinda et al, 33 using data from the fourth Korea National Health and Nutrition Examination Survey, evaluated the mediating effect of material (income and housing), psychologic, behavioral, and workplace environmental factors on the association of social class with tooth loss and periodontitis. The association between social class and the absence of periodontal pockets was significant for expert supervisors and expert workers.…”