Socio-economic Inequalities and Oral Health in Canada and the United States

Abstract

This paper describes and compares the magnitude of socio-economic inequalities in oral health among adults in Canada and the US over the past 35 years. We analyzed data from nationally representative examination surveys in Canada and the US: Nutrition Canada National Survey (1970-1972, N = 11,546), Canadian Health Measures Survey (2007-2009, N = 3,508), The First National Health and Nutrition Examination Survey (1971-1974, N = 13,131), and National Health and Nutrition Examination Survey (2007-2008, N = 5,707). Oral health outcomes examined were prevalence of edentulism, proportion of individuals having at least 1 untreated decayed tooth, and proportion of individuals having at least 1 filled tooth. Sociodemographic indicators included in our analysis were place of birth, education, and income. Data were age-adjusted, and survey weights were used to account for the complex survey design in making population inferences. Our findings demonstrate that oral health outcomes have improved for adults in both countries. In the 1970s, Canada had a higher prevalence of edentulism and dental decay and lower prevalence of filled teeth. This was also combined with a more pronounced social inequality gradient among place of birth, education, and income groups. Over time, both countries demonstrated a decline in absolute socio-economic inequalities in oral health.

The Role of Behaviour in Inequality in Increments of Dental Caries among Finnish Adults

“…Finland is a welfare state where the psychological impact of income inequality, relative deprivation and job insecurity on health behaviours are less severe than in other industrialized countries [Marmot, 2005;Marmot and Wilkinson, 2006]. However, we were still able to observe differences in dental caries and related behaviours between different education groups, though less steep than those reported elsewhere [Vehkalahti et al, 1991;Sabbah et al, 2009;Elani et al, 2012]. This observation highlights the importance of the contribution of formal education as a marker of socioeconomic position to health and dental behaviours.…”

Educational Level as a Social Determinant of Health and Its Relationship to Periodontal Disease as a Health Outcome

“…The Elani, et al article was selected because it discussed the frequency of edentulism [4]. Although it is not indicated in the article how the individuals became edentulous, it was implied that there was periodontal disease, based on the fact that the other factors that were being studied were disease of the teeth or solutions for tooth disease.…”

“…Two articles [4,12] discussed socio-economic inequalities by comparing the loss of teeth to periodontal disease and other dental maladies over a given period of time. Elani, et al, which compared Canada to the US, concluded that even though there was a decrease in equalities for both Canada and the US from 1972, the start of the study and 2007-08, its conclusion, the rate of edentulism increased in the US for socially disadvantaged groups [4].…”

“…Elani, et al, which compared Canada to the US, concluded that even though there was a decrease in equalities for both Canada and the US from 1972, the start of the study and 2007-08, its conclusion, the rate of edentulism increased in the US for socially disadvantaged groups [4]. Peres, et al compared income related inequalities in inadequate dentition in Australia, Brazil and the US.…”

“…Several of them were eliminated due to age of the study, inability to find a full version of the study in English, or inability to obtain the article. Eight articles were reviewed and selected based on the studies' representation of populations throughout the world, in order to obtain a broader perspective of periodontal disease in the world [2][3][4]8,9,11,12,16]. One article compared its participants by race, two others compared their participants by country, and three were cross-sectional studies.…”