A cross-national comparison of income gradients in oral health quality of life in four welfare states: application of the Korpi and Palme typology

Abstract

Background The extent to which welfare states may influence health outcomes has not been explored. It was hypothesised that policies which target the poor are associated with greater income inequality in oral health quality of life than those that provide earnings-related benefits to all citizens. Methods Data were from nationally representative surveys in the UK (n=4064), Finland (n=5078), Germany (n=1454) and Australia (n=2292) conducted from 1998 to 2002. The typology of Korpi and Palme classifies these countries into four different welfare states. In each survey, subjects completed the Oral Health Impact Profile (OHIP-14) questionnaire, which evaluates the adverse consequence of dental conditions on quality of life. For each country, survey estimation commands were used to create linear regression models that estimated the slope of the gradient between four quartiles of income and OHIP-14 severity scores. Parameter estimates for income gradients were contrasted across countries using Wald χ2 tests specifying a critical p value of 0.008, equivalent to a Bonferroni correction of p<0.05 for the six pairwise tests. Results Statistically significant income gradients in OHIP-14 severity scores were found in all countries except Germany. A global test confirmed significant cross-national differences in the magnitude of income gradients. In Australia, where a flat rate of benefits targeted the poor, the mean OHIP-14 severity score reduced by 1.7 units (95% CI −2.15 to −1.34) with each increasing quartile of household income, a significantly steeper gradient than in other countries. Conclusion The coverage and generosity of welfare state benefits appear to influence levels of inequality in population oral health quality of life.

Calidad de Vida Relacionada con Salud Oral: Impacto de Diversas Situaciones Clínicas Odontológicas y Factores Socio-Demográficos. Revisión de la Literatura

“…Las actitudes y valores pueden ser alterados mediante intervenciones breves, que podrían ser útiles para crear cambio de conducta en odontología preventiva (Thomson et al). También influye en la adultez la autopercepción de la madre (Shearer et al), recibir atención odontológica en servicios públicos, visitar irregularmente al odontólogo, bajos ingresos económicos (Locker & Quiñonez;Sanders et al, 2009a), el nivel de educación (Caglayan et al; Inukai et al; Kotzer et al; Papaioannou et al) y que resida en el área rural (Kotzer et al).…”

“…Medir la calidad de vida conforme el estado bucodental resulta subjetivo al estar influenciado por distintos factores, que no pueden ser observados de manera directa, motivo por el cual se han desarrollado instrumentos de medición representadas por dimensiones que pretenden valorar la percepción psicosocial personal de cada individuo, utilizadas para estimar y complementar la evaluación fí-sica (de la Fuente-Hernández et al) El Perfil de Impacto de Salud Oral conocido por sus siglas en inglés OHIP (Oral Health Índex Profile) es uno de los instrumentos más utilizados para la evaluación de la percepción sobre salud oral en pacientes y su impacto en la calidad de vida diaria (López-Jornet et al, 2009;Montero-Martín et al, 2009). Si bien, existen otros instrumentos de medición de la calidad de vida oral, el OHIP es el que ha sido más estudiado (Sanders et al, 2009a), cuyo enfoque está basado en la frecuencia de los impactos percibidos (Montero et al, 2010).…”

“…En otro estudio, con pacientes estadounidenses, se encontró que los niveles de autopercepción se incrementaban con mayores niveles de pérdida dental, necesidad de tratamiento percibida, falta de seguro dental privado y bajos ingresos económicos, similar a lo ocurrido en la población australiana (Sanders et al, 2009a), donde además se encontró que la puntuación media del OHIP se reducía en 1,7 unidades con cada aumento del cuartil de ingreso de los hogares, siendo esto más pronunciado en otros países (Sanders et al, 2009b).…”

Tooth wear and quality of life among adults in the United Kingdom

“…In addition, they did not control for potential covariates. As sociodemographic factors are closely related to both tooth wear [3,4,13] and quality of life [14][15][16], they may confound the association between tooth wear and quality of life.…”

The Italian Dental Sector in a Period of Economic Crisis

“…Using both the distinction among different welfare regimes suggested by Ferrera [66] and Eurobarometer data [67], Sanders et al [68] and Guarnizo-Herreño et al [69], for example, state that "a welfare regime with more redistributive and universal welfare policies results in better general oral health" and that this achievement, which has been reached in Scandinavian countries "could also be related to their health policies. They explicitly target the social determinants of health […] and have a large number of universal health-care services with a high level of decommodification" [69,p.172].…”