Social inequalities in tooth loss: A multinational comparison

Elani, Hawazin W.; Harper, Sam; Thomson, W. Murray; Espinoza, Iris; Mejía, Gloria C.; Ju, Xiangqun; Jamieson, Lisa; Kawachi, Ichiro; Kaufman, Jay S.

doi:10.1111/cdoe.12285

Cited by 67 publications

(78 citation statements)

References 23 publications

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“…There were nongradient oral health inequalities among the South Korean population according to the NMSC. The finding also confirmed previous theories and studies which reported that oral health inequalities are related to social class or social status . SEP appeared to be closely related to periodontal status and tooth loss, especially for the Korean population as reported by Han et al.…”

Section: Discussionsupporting

confidence: 91%

“…It was similar with the results of Elani et al. in which the highest education level group had the lowest prevalence of edentulism and had the highest mean number of teeth present . Both results implied that educational level has an important role in oral health.…”

Section: Discussionsupporting

confidence: 90%

“…The M factor was the second highest for the petty bourgeoisie.The poorer of nonskilled workers remained statistically significant even after adjusting more proximal determinants, as material factors, health behaviours, psychosocial factors and workplace environment.4 | DISCUSSIONThere were nongradient oral health inequalities among the South Korean population according to the NMSC. The finding also confirmed previous theories and studies which reported that oral health inequalities are related to social class or social status 1,7,10,14,[25][26][27]. SEP appeared to be closely related to periodontal status and tooth loss, especially for the Korean population as reported by Han et al and Lee et al14,26 Irie et al28 found a gradient in the development of periodontal disease according to occupational status among male workers in Japan.…”

supporting

confidence: 89%

“…Educational level was used as a SEP indicator in Elani et al. , while in this study, income and house ownership were also used as SEP indicators …”

Section: Discussionmentioning

confidence: 99%

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

Novrinda

Han

Jung-Choi

et al. 2018

Comm Dent Oral Epid

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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.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 90%

supporting

confidence: 89%

“…Educational level was used as a SEP indicator in Elani et al. , while in this study, income and house ownership were also used as SEP indicators …”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

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

Novrinda

Han

Jung-Choi

et al. 2018

Comm Dent Oral Epid

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“…To clarify the meaning of tooth loss in the epidemiologic context, it would be helpful to use longitudinal data. A few studies report on tooth survival over time or trends in repeated cross-sectional samples [14][15][16][17][18][19] but most rely on self-reported tooth loss with limitations in validity, 14,16,17 or are performed in selected patient groups with limitations in generalizability into the general population. 19,20 To date, the largest published longitudinal analysis of changes in dental status comes from the Dunedin study, a prospective cohort study of approximately 1000 participants born in 1972/1973.…”

Section: Introductionmentioning

confidence: 99%

Tooth loss is a complex measure of oral disease: Determinants and methodological considerations

Haworth

Shungin

Kwak

et al. 2018

Comm Dent Oral Epid

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ObjectivesCounts of missing teeth or measures of incident tooth loss are gaining attention as a simple way to measure dental status in large population studies. We explore the meaning of these metrics and how missing teeth might influence other measures of dental status.MethodsAn observational study was performed in 2 contrasting adult populations. In total, 62 522 adult participants were available with clinically assessed caries and periodontal indices from the Swedish arm of the Gene‐Lifestyle Interactions and Dental Endpoints Study (GLIDE) and the Korea National Health and Nutrition Examination Survey (KNHANES) in the Republic of Korea. Longitudinal measures of tooth loss were available for 28 244 participants in GLIDE with median follow‐up of 10.6 years.ResultsIn longitudinal analysis, hazard for tooth loss was associated with baseline dental status (previous tooth loss, periodontal status and caries status) and socio‐demographic variables (age, smoking status and highest educational level). Analysis of cross‐sectional data suggested that indices of caries exposure were not independent of periodontal status. The strength and direction of association varied between groups, even for measures specifically intended to avoid measuring tooth loss. Individuals with impaired periodontal health (community periodontal index [CPI] 3 or higher in any sextant) had higher standardized decayed and filled surfaces (DFS; number of DFS divided by total number of tooth surfaces) in GLIDE (incidence risk ratio [IRR] 1.05 [95% CI: 1.04, 1.07], but lower standardized DFS in KNHANES (IRR: 0.95 [0.92, 0.98]) than individuals with better periodontal health (CPI <3 in all sextants).ConclusionsIncident tooth loss is a complex measure of dental disease, with multiple determinants. The relative importance of dental caries and periodontal disease as drivers of tooth loss differs between age groups. Measures of dental caries exposure are associated with periodontal status in the studied populations, and these associations can be population‐specific. Consideration of the study‐specific properties of these metrics may be required for valid inference in large population studies.

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Dental Coverage and Care When Transitioning From Medicaid to Medicare

Elani,

Sommers,

Yuan

et al. 2024

JAMA Health Forum

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ImportanceMillions of adults with low incomes lose Medicaid eligibility when transitioning to Medicare at age 65 years. However, it remains unclear how this transition is associated with dental care.ObjectiveTo examine the consequences of transitions from Medicaid to Medicare on coverage and use of dental services.Design, Setting, and ParticipantsCross-sectional data from the Health and Retirement Study from 2014 to 2020 and a regression discontinuity design were used to compare changes in outcomes before and after turning age 65 years among a population likely to be Medicaid-eligible before age 65 years. The sample included adults aged 50 to 90 years who had not attended college in 28 states.ExposureTransitions from Medicaid to Medicare at age 65 years.Main Outcomes and MeasuresHealth insurance (Medicaid, Medicare, dual coverage, private, and uninsurance), dental coverage (Medicaid, Medicare, private, or none), and having a dental visit and out-of-pocket dental spending during the previous 2 years.ResultsOf the 15 837 study participants, 9510 (56.2% weighted) were female, 6984 (28.7% weighted) were Black individuals, Hispanic individuals, and individuals of other race (including American Indian, Alaskan Native, Asian, Native Hawaiian, and Pacific Islander individuals), and 8853 (71.3% weighted) were White; the mean (SD) age was 69.2 (10.3) years. Turning age 65 years was associated with an increase in Medicare coverage in states with Medicaid dental benefits (66.5 percentage points [pp]; 95% CI, 58.3-74.7) and those without dental benefits (67.8 pp; 95% CI, 52.6-83.0). There was a concurrent reduction in private coverage, Medicaid, and uninsured rates. For dental outcomes, in states providing Medicaid dental benefits, turning age 65 years was associated with a 13.1-pp decrease in the likelihood of dental coverage (95% CI, 10.7-15.5), largely due to the loss of Medicaid dental coverage. Among adults reporting being Black, Hispanic, or other race, there was a 3.9-pp decline in dental visits during the previous 2 years (95% CI, −6.1 to −1.7). In states without Medicaid dental benefits, turning age 65 years was associated with no change in the likelihood of dental coverage and a 15.6-pp increase in dental visits (95% CI, 6.3-25.0). Out-of-pocket dental spending decreased in both groups of states (−13.0% [95% CI, −24.2 to −0.1] and −19.2% [95% CI, −33.6 to −1.6], respectively).Conclusions and RelevanceThe results of this cross-sectional study suggest that transitioning from Medicaid to Medicare at age 65 years was associated with a lower level of dental coverage and may increase barriers to accessing dental care for beneficiaries who had Medicaid dental coverage before age 65 years. However, for adults living in states without Medicaid dental benefits, the transition was associated with increased use of dental services and no change in overall dental coverage rates.

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Social inequalities in tooth loss: A multinational comparison

Abstract: There is a considerable variation in the magnitude of inequalities in tooth loss across the countries included in this analysis.

Cited by 67 publications

References 23 publications

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

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

Tooth loss is a complex measure of oral disease: Determinants and methodological considerations

Dental Coverage and Care When Transitioning From Medicaid to Medicare

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