Measuring and decomposing socioeconomic‐related inequality in the use of oral health services among Chinese adults

Xu, Mengru; Gao, Xiaoli; Wu, Hongyan; Ding, Min; Zhang, Chunzi; Du, Shuo; Wang, Xing; Feng, Xiping; Tai, Baojun; Hu, Deyu; Lin, Huancai; Wang, Bo; Wang, Chunxiao; Zheng, Shuguo; Liu, Xuenan; Rong, Wensheng; Wang, Weijian; Xu, Tao; Si, Yan

doi:10.1111/cdoe.12575

Cited by 12 publications

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“…The copyright holder for this this version posted August 6, 2021. ; https://doi.org/10.1101/2021.08.02.21261259 doi: medRxiv preprint been carried out at one point in time, or on selected groups of the population, for example in samples of young adults or elderly people. [23][24][25][26][27][28][29][30][31][32] The main finding from this study is that inequalities in use of dental services according to income have decreased over time. This is an interesting result, considering that there is no public or private insurance for dental services in Norway.…”

Section: Discussionmentioning

confidence: 68%

Inequality in access to dental services in a market-based dental care system. A population study from Norway 1975-2018

Jiang

Grytten

Kinge

2021

Preprint

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ObjectiveTo examine income-related inequalities in access to dental services from 1975 to 2018. In Norway, dental care services for adults are privately financed. This might lead to income-related inequalities in access to dental services. However, over the last decades Norwegians have experienced a rapid growth in income, including people with lower income. This may have led to improved access to dental services for these people. Therefore, inequalities in access to dental services may have become less over the last decades.Research designThis was a prospective study. Statistics Norway collected samples of cross-sectional health survey data for the following years: 1975, 1985, 1995, 2002, 2008, 2012 and 2018. For each sample, individuals 20 years and older were drawn randomly from the non-institutionalized adult population using a two-stage stratified cluster sample technique. Inequalities were measured using the concentration index. The dependent variable was use of dental services during the last year and the key independent variable was equalized household income.ResultsThe concentration index for inequalities in use of dental services according to income decreased from 0.10 (95% confidence interval = 0.09, 0.11) in 1975 to 0.04 (95% confidence interval = 0.03, 0.05) in 2018. The decrease was particularly large from 2002 to 2012. This was a period with a large growth in gross national income.ConclusionPeople with a low income had a marked increase in their purchasing power from 1975 to 2018. This coincided with an increase in demand for dental care for this low-income group.

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Section: Discussionmentioning

confidence: 68%

Inequality in access to dental services in a market-based dental care system. A population study from Norway 1975-2018

Jiang

Grytten

Kinge

2021

Preprint

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“…14 According to previous studies, dental service utilization among Chinese preschool children may be influenced by caregiver education background, socioeconomic status, perception of their children's oral health status, dental insurance dental fear and demographic factors. 16 Although some studies have found socioeconomic-related inequalities in dental service utilization among adults in China, [17][18][19] the evidence related to inequality in children's dental service utilization is insufficient.…”

Section: Introductionmentioning

confidence: 99%

“…The concentration index (CI), enjoying increasing popularity, has been used to quantify and measure inequality in dental care service utilization, represent inequality visually by means of the concentration curve and identify the factors contributing to inequality in previous studies. 19,[22][23][24] Inequality in dental care utilization among Chinese adults has been measured in previous studies by means of CI. [17][18][19] However, evidence related to inequality in dental care indicating that dental care utilization in children aged 3-5 years was concentrated in those who were better off.…”

Section: Introductionmentioning

confidence: 99%

“…19,[22][23][24] Inequality in dental care utilization among Chinese adults has been measured in previous studies by means of CI. [17][18][19] However, evidence related to inequality in dental care indicating that dental care utilization in children aged 3-5 years was concentrated in those who were better off. The contribution of the need variables to socioeconomicrelated inequality in dental services was minimal, and most dental care utilization inequality could be explained by household income, caregiver education attainment and urban-rural disparities, accounting for 32.0%, 49.4% and 20.4% respectively.…”

Section: Introductionmentioning

confidence: 99%

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Socioeconomic‐related inequality in dental care utilization among preschool children in China

Chang

Gao

et al. 2021

Comm Dent Oral Epid

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Objectives: This study aimed to investigate socioeconomic-related inequality in dental care service utilization in the past 12 months among Chinese preschool children and to explore the contribution of various factors to this inequality.Method: A total of 40 305 children aged 3-5 years from 372 kindergartens who participated in the Fourth National Oral Health Survey in China were included in the final analysis. The method of data weighting in complex sampling was adopted to make the samples more representative. Erreygers-corrected concentration index (EI) was used to measure socioeconomic-related inequality in dental care service utilization. The horizontal inequality index (HI) was employed to analyse horizontal inequality. Decomposition analyses were conducted to explore the contributions of income level, need variables (dmft, caregiver-evaluated oral health status and toothache experience) and nonneed variables (caregiver education level, residential location, age, and sex) to the inequality of health service utilization. Result:The utilization of oral health services within the past 12 months among the high-, middle-and low-income groups was 17.4% (95% CI: 15.6-19.3), 13.6% (95% CI: 12.2-15.1) and 9.4% (95% CI: 8.1-11.0) respectively. The concentration curve was below the line of equality, and the EI and HI were 0.072 and 0.078, respectively, How to cite this article: Chang Q, Gao X, Xu M, et al. Socioeconomic-related inequality in dental care utilization among preschool children in China.

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“…Tselmuun Chinzorig [ 13 ] reported inequalities in caries experience among Mongolian children. Mengru Xu [ 14 ] measured and decomposed socioeconomic-related inequality in the use of oral health services among Chinese adults and found that oral health care service utilization was disproportionately concentrated among better-off Chinese adults. These studies focused either on a single aspect of oral disease or on oral health care service utilization.…”

Section: Introductionmentioning

confidence: 99%

Greater inequalities in dental caries treatment than in caries experience: a concentration index decomposition approach

Qin

Chen

et al. 2021

BMC Oral Health

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Background The aim of the current study was to (a) measure the socioeconomic inequalities in oral health and examine whether the inequalities are greater in disease experience or in its treatment and to (b) decompose the factors that influence oral health inequalities among the adults of Guangdong Province. Methods A cross-sectional study was conducted among 35- to 44-year-old and 65- to 74-year-old adults in Guangdong Province. All participants underwent oral health examinations and answered questionnaires about their oral health. We measured the concentration indices of the DMFT and its separate components, namely, decayed teeth (DT), missing teeth (MT), and filled teeth (FT), to explore the inequalities in oral health status; then, we analysed its decomposition to interpret the factors that influence the inequalities. Results The results showed that significant inequality was concentrated on FT (CI = 0.24, 95% CI = 0.14/0.33, SE = 0.05). The concentration indices for the DMFT (CI = 0.02, 95% CI = 0.02/0.06, SE = 0.02) and MT (CI = 0.02, 95% CI 0.03/0.08, SE = 0.03) were small and close to zero, while the concentration for DT (CI = − 0.04, 95% CI = − 0.01/0.02, SE = 0.03) was not statistically significant. The results from the decomposition analysis suggested that a substantial proportion of the inequality was explained by household income, high education level, regular oral examination and type of insurance (5.1%, 12.4%, 43.2%, − 39.6% (Urban Employee Basic Medical Insurance System) and 34.5% (New-Type Rural Medical Collaboration System), respectively). Conclusions The results indicated greater inequalities in dental caries than in caries experience. Among the included factors, household income, high education level, and regular oral health examinations had the greatest impact on the inequalities in the number of FT. In addition, the current medical insurance systems, including the Urban Employee Basic Medical Insurance System, Urban Resident Basic Medical Insurance System, and the New-Type Rural Medical Collaboration System, have not been effectively used in oral treatment. Policy-making and the implementation of interventions for tackling socioeconomic oral health inequalities should focus on reducing the burden of treatment and providing greater access to dental care for low-income groups. Welfare policies are skewed towards rural areas and low-income people.

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Measuring and decomposing socioeconomic‐related inequality in the use of oral health services among Chinese adults

Cited by 12 publications

References 38 publications

Inequality in access to dental services in a market-based dental care system. A population study from Norway 1975-2018

Inequality in access to dental services in a market-based dental care system. A population study from Norway 1975-2018

Socioeconomic‐related inequality in dental care utilization among preschool children in China

Greater inequalities in dental caries treatment than in caries experience: a concentration index decomposition approach

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