期刊
BMC ORAL HEALTH
卷 15, 期 -, 页码 -出版社
BMC
DOI: 10.1186/s12903-015-0020-z
关键词
Dental public health; Edentulous/edentulism; Income inequality; Gender differences; Multilevel analysis
资金
- Japan Society for the Promotion of Science [23243070, 22390400, 24390469, 22592327]
- Health and Labour Sciences Research Grant
- Comprehensive Research on Aging and Health [H24-Choju-Wakate-009]
- Ministry of Health, Labour and Welfare (MHLW), Japan [H24-Junkanki [Seishu]-Ippan-007]
- Grants-in-Aid for Scientific Research [23243070, 22390400, 22592327, 24390469] Funding Source: KAKEN
Background: Community-level factors as well as individual-level factors affect individual health. To date, no studies have examined the association between community-level social gradient and edentulousness. The aim of this study was to investigate individual-and community-level social inequalities in edentulousness and to determine any explanatory factors in this association. Methods: We analyzed the data from the Japan Gerontological Evaluation Study (JAGES). In 2010-2012, 112,123 subjects aged 65 or older responded to the questionnaire survey (response rate = 66.3%). Multilevel logistic regression analysis was applied to determine the association between community-level income and edentulousness after accounting for individual-level income and demographic covariates. Then, we estimated the probability of edentulousness by individual-and community-level incomes after adjusted for covariates. Results: Of 79,563 valid participants, the prevalence of edentulousness among 39,550 men (49.7%) and 40,013 women (50.3%) were both 13.8%. Living in communities with higher mean incomes and having higher individual-level incomes were significantly associated with a lower risk of edentulousness (odds ratios [ORs] by 10,000 USD increments were 0.37 (95% confidence interval [CI] [0.22-0.63]) for community-level and 0.85 (95% CI [0.84-0.86]) for individual-level income). Individual-and community-level social factors, including density of dental clinics, partially explained the social gradients. However, in the fully adjusted model, both community-and individual-level social gradients of edentulousness remained significant (ORs = 0.43 (95% CI [0.27-0.67]) and 0.90 (95% CI [0.88-0.91]), respectively). One standard deviation changes in community- and individual-level incomes were associated with 0.78 and 0.84 times lower odds of edentulousness, respectively. In addition, compared to men, women living in communities with higher average incomes had a significantly lower risk of edentulousness (p-value for interaction <0.001). Conclusions: Individual-and community-level social inequalities in dental health were observed. Public health policies should account for social determinants of oral health when reducing oral health inequalities.
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