Socioeconomic-related inequalities in oral hygiene behaviors: a cross-sectional analysis of the PERSIAN cohort study

Abstract

Background: Socioeconomic-related inequality in oral hygiene behaviors in Iran is poorly understood. This study aims to measure and decompose socioeconomic-related inequalities in oral hygiene behaviors among middle-aged and elderly adults in Iran. Methods: A cross-sectional analysis was performed using data from the Prospective Epidemiological Research Studies in IrAN (PERSIAN), a large national cohort study. A total of 130,016 individuals aged 35 years and above from 17 cohort centers in Iran were included in the study. The normalized concentration index (C n) was used to measure the magnitude of inequality in oral hygiene behaviors, i.e. brushing at least twice and flossing once daily, among middle-aged and elderly Iranian adults included in the cohort centers. Decomposition analysis was performed to quantify the contribution of each determinant to the observed inequality in oral hygiene behaviors. Results: Totally, 65.5% of middle-aged and elderly adults brushed their teeth twice a day or more, 7.6% flossed at least once a day and 3.48% had both habits. The estimated C n of the two habits combined, i.e. tooth brushing and dental flossing, for all provinces taken part in the PERSIAN cohort study was 0.399 (95% confidence interval [CI]: 0.383 to 0.417), indicating that the prevalence of the two habits combined is more concentrated among individuals with higher socioeconomic status. Inequality in oral hygiene behaviors was pro-rich in all cohort centers. The decomposition results suggested socioeconomic status as the main factor contributing to the overall inequality, followed by the level of education, and the province of residence. Conclusion: A low prevalence of oral hygiene behaviors among middle-aged and elderly Iranian adults was observed. There was also a pro-rich inequality in oral hygiene behaviors among middle-aged and elderly adults in all cohort centers. These results suggest an urgent need for targeted policy interventions to increase the prevalence of preventive oral hygiene behaviors among the poor and less-educated middle-aged and elderly adults in Iran.

Non-communicable diseases in the southwest of Iran: profile and baseline data from the Shahrekord PERSIAN Cohort Study

“…Education was defined in 5 levels: no schooling (<1 year of primary school), primary school (1-5 years), middle school (6-8 years), high school (9-12 years), and university (>12 years). The wealth index was calculated using multiple correspondence analysis (MCA) on household assets and divided into five quintiles [ 13 , 18 , 21 ]. The tools were used for baseline data collection from 2015 to 2019 and are described in Table 1 .…”

Use of oral health care services in the United States: unequal, inequitable—a cross-sectional study

“…The latter highlights the importance of structural factors and further supports the role of social determinants in health. Widespread public health insurance coverage or implementation of pro-equity policies could result in the decline of dental health care inequalities and inequity [ 12 , 41 ].…”

“…Race and ethnicity, income, education, and gender are relevant social determinants from ethical and policy perspectives [ 4 , 5 ]. Socioeconomic inequalities are commonly found in oral health status, including dental caries [ 6 ], periodontal disease [ 7 ], oral health-related quality of life [ 8 ]; lower income limits access to dental care/service [ 9 , 10 ] and lower education is associated with lower oral health literacy [ 11 ] and poor oral hygiene behaviours [ 12 ].…”

The Role of Selected Habits, Periodontal Disease and Oral Hygiene Status on the Occurrence and Prognosis of Oral Mucosal Lesions

“…Not surprisingly lower level of education and occupational status were significantly associated with moderate to poor oral hygiene status and periodontal disease status among the current sample. Low levels of education and occupational status negatively impact on hygiene practices due to poor knowledge, attitudes and economic constraints [44]. Recent research evidence suggested the importance of oral hygiene for betel chewers to control bacterial pathogen related oral diseases such as periodontitis [45].…”