Health insurance and education: major contributors to oral health inequalities in Colombia

Guarnizo-Herreño, Carol C; Watt, Richard G.; Garzón‐Orjuela, Nathaly; Suárez-Zúñiga, Elizabeth; Tsakos, Georgios

doi:10.1136/jech-2018-212049

Cited by 21 publications

(21 citation statements)

References 39 publications

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“…The statistical analyses (logistic regression and SEM) revealed that health insurance and discrimination are relevant factors accounting for a portion of the association between SEP and oral health. This finding extends previous studies on the role of health insurance [ 52 – 55 ] and discrimination [ 24 , 25 , 46 – 49 , 51 , 56 ] as well as explaining (oral) health inequalities across countries.…”

Section: Discussionsupporting

confidence: 89%

Oral health inequality among Indonesian workers in South Korea: role of health insurance and discrimination factors

Novrinda

Han

2022

BMC Oral Health

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Background The health of migrant workers is becoming an important public health issue. Although there are an increasing number of migrant workers in Korea, the health status in migrant populations remains unknown. The aims of this study were (1) to evaluate the association between income and self-rated oral health (SROH), and (2) to assess the role of health insurance and self-perceived discrimination in the association between income and SROH among Indonesian migrant workers in Korea. Methods Information about self-reported income, SROH, coverage/utilization of health insurance (HI), living difficulties related to oral health (LDROH), oral health literacy (OHL), and discrimination were obtained from Indonesian migrant workers in Korea (n = 248). The main explanatory variable was income, and SROH was an outcome variable. Logistic regression analyses were performed controlling for age, gender, HI, LDROH, OHL, and discrimination. The paths from income to SROH were analyzed using the Partial Least Square-Structural Equation Model (PLS-SEM). Results Among Indonesian migrant workers, the lower income group had the highest probability of a poor SROH compared to the higher income group. The variables showing a high explanatory power were discrimination among the low income group and HI among the middle income group. In PLS-SEM, the variables such as HI, LDROH, OHL, and discrimination contributed 11% to explaining the association between income and SROH. Conclusion A monotonic gradient was revealed among migrant workers according to the association between income and SROH. Discrimination and HI contributed to oral health inequalities.

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Section: Discussionsupporting

confidence: 89%

Oral health inequality among Indonesian workers in South Korea: role of health insurance and discrimination factors

Novrinda

Han

2022

BMC Oral Health

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“…51,63 A national-level study done in Colombia that looked at the association of different socioeconomic-position dimensions and oral health found that those who lacked national-health insurance and those with lower education levels showed the highest oral health problems. 64 Cross-sectional studies conducted in Chile in 2-4-year-old and 4-year-old children, 65 as well as in Colombia in 8-71-month-old children, 46 and in Mexico in 3-6-year-old children 61 showed that older age was associated with an increased relevance and severity of caries.…”

Section: Socioeconomic and Demographic Factors In Laccmentioning

confidence: 99%

Risk factors for dental caries in Latin American and Caribbean countries

et al. 2021

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Identifying the risk factors for dental caries is vital in epidemiology and clinical practices for developing effective preventive strategies, both, at the individual and collective levels. Different causality/determination models have been proposed to understand the development process of dental caries. In the present review, we designed a model inspired by the world-known social determinants models proposed in the 90s and more recently in the 10s, wherein the contextual factors are placed more externally and encompass the individual factors. The contextual factors included those related to the cultural and societal values, as well as the social and health government policies. The individual factors were classified into the following categories: socioeconomic (social class, occupation, income, and education level), demographic characteristics (age, sex, and ethnicity), behavioral factors (non-use of fluoride dentifrice, sugar consumption, poor oral hygiene, and lack of preventive dental care), and biological factors (recent caries experience/active caries lesions, biofilm retentive factors, developmental defects of the enamel, disabilities, saliva amount and quality, cariogenic biofilm). Each of these variables was addressed, while focusing on the current evidence from studies conducted in Latin American and Caribbean countries (LACC). Based on the proposed model, educational aspects were addressed, and individual caries risk assessment and management decisions were proposed; further, implications for public health policies and clinical practice were described. The identification of modifiable risk factors for dental caries should be the basis for multi-strategy actions that consider the diversity of Latin American communities.

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“…The health insurance scheme does not seem to help address health inequalities, which has also been emphasized in other analyses with Colombian data [36,[44][45][46]. Systematic inequalities exist, with those uninsured or in the subsidized scheme having higher neonatal mortality rates [47], shorter gastric cancer survival rates [36], longer delays in tuberculosis diagnosis [45], less frequent use of preventive services [48,49], more barriers to accessing health care when needed [50] and poorer oral health [37]. This evidence, together with our findings, suggests that the Colombian health care system urgently needs to shift towards universal coverage and a structural redesign to address these high levels of fragmentation.…”

Section: Discussionmentioning

confidence: 99%

“…This leaves a proportion of the population (6% in our data) as uninsured, i.e., those who are not in formal employment or able to pay a monthly fee and are not considered 'poor' based on the means test. Although not a direct measure of SEP, health insurance status has been used as a proxy for socioeconomic circumstances in previous analyses of health inequalities in Colombia [36,37] due to the abovementioned features of the different schemes.…”

Section: Plos Onementioning

confidence: 99%

Socioeconomic inequalities in birth outcomes: An 11-year analysis in Colombia

2021

Self Cite

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Objective To examine socioeconomic inequalities in birth outcomes among infants born between 2008 and 2018 and assessed trends in inequalities during that period in Colombia, a middle-income country with high levels of inequality emerging from a long internal armed conflict. Methods Using birth certificate data in Colombia, we analysed the outcomes of low birth weight, an Apgar score <7 at 5 minutes after birth and the number of prenatal visits among full-term pregnancies. Maternal education and health insurance schemes were used as socioeconomic position (SEP) indicators. Inequalities were estimated using the prevalence/mean of the outcomes across categories of the SEP indicators and calculating the relative and slope indices of inequality (RII and SII, respectively). Results Among the 5,433,265 full-term singleton births analysed, there was a slight improvement in the outcomes analysed over the study period (lower low-birth-weight and Apgar<7 prevalence rates and higher number of prenatal visits). We observed a general pattern of social gradients and significant relative (RII) and absolute (SII) inequalities for all outcomes across both SEP indicators. RII and SII estimates with their corresponding CIs revealed a general picture of no significant changes in inequalities over time, with some particular, time-dependent exceptions. When comparing the initial and final years of our study period, inequalities in low birth weight related to maternal education increased while those in Apgar score <7 decreased. Relative inequalities across health insurance schemes increased for the two birth outcomes but decreased for the number of prenatal visits. Conclusion The lack of a consistent improvement in the magnitude of inequalities in birth outcomes over an 11-year period is a worrying issue because it could aggravate the cycle of inequality, given the influence of birth outcomes on health, social and economic outcomes throughout the life course. The findings of our analysis emphasize the importance of policies aimed at providing access to quality education and providing a health care system with universal coverage and high levels of integration.

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Health insurance and education: major contributors to oral health inequalities in Colombia

Cited by 21 publications

References 39 publications

Oral health inequality among Indonesian workers in South Korea: role of health insurance and discrimination factors

Oral health inequality among Indonesian workers in South Korea: role of health insurance and discrimination factors

Risk factors for dental caries in Latin American and Caribbean countries

Socioeconomic inequalities in birth outcomes: An 11-year analysis in Colombia

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