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Meta-Analysis
. 2018 Oct 26;18(1):176.
doi: 10.1186/s12903-018-0630-3.

Socioeconomic status, oral health and dental disease in Australia, Canada, New Zealand and the United States

Gloria C Mejia  1 , Hawazin W Elani  2 , Sam Harper  3 , W Murray Thomson  4 , Xiangqun Ju  5 , Ichiro Kawachi  6 , Jay S Kaufman  3 , Lisa M Jamieson  5
Affiliations
Meta-Analysis

Socioeconomic status, oral health and dental disease in Australia, Canada, New Zealand and the United States

Gloria C Mejia et al. BMC Oral Health. .

Abstract

Background: Socioeconomic inequalities are associated with oral health status, either subjectively (self-rated oral health) or objectively (clinically-diagnosed dental diseases). The aim of this study is to compare the magnitude of socioeconomic inequality in oral health and dental disease among adults in Australia, Canada, New Zealand and the United States (US).

Methods: Nationally-representative survey examination data were used to calculate adjusted absolute differences (AD) in prevalence of untreated decay and fair/poor self-rated oral health (SROH) in income and education. We pooled age- and gender-adjusted inequality estimates using random effects meta-analysis.

Results: New Zealand demonstrated the highest adjusted estimate for untreated decay; the US showed the highest adjusted prevalence of fair/poor SROH. The meta-analysis showed little heterogeneity across countries for the prevalence of decayed teeth; the pooled ADs were 19.7 (95% CI = 16.7-22.7) and 12.0 (95% CI = 8.4-15.7) between highest and lowest education and income groups, respectively. There was heterogeneity in the mean number of decayed teeth and in fair/poor SROH. New Zealand had the widest inequality in decay (education AD = 0.8; 95% CI = 0.4-1.2; income AD = 1.0; 95% CI = 0.5-1.5) and the US the widest inequality in fair/poor SROH (education AD = 40.4; 95% CI = 35.2-45.5; income AD = 20.5; 95% CI = 13.0-27.9).

Conclusions: The differences in estimates, and variation in the magnitude of inequality, suggest the need for further examining socio-cultural and contextual determinants of oral health and dental disease in both the included and other countries.

Keywords: Dental caries; Oral health; Self-report; Socioeconomic factors.

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Conflict of interest statement

Ethics approval and consent to participate

This study is informed by a secondary analysis of national survey data; the authors obtained de-identified data from data custodians and had no contact with survey participants. Ethical approval for the original studies/surveys was obtained from the New Zealand Health and Disability Multi-region Ethics Committee (Approval number MEC/07/11/149), the University of Adelaide, NCHS Research Ethics Review Board (Protocol number 98–12) and Health Canada Research Ethics Board. Approval for the study presented in this paper was obtained from the institutional review board (IRB) of McGill University Faculty of Medicine (IRB study number A03-E25-13B; IRB Assurance Number FWA 00004545) and Harvard School of Public Health (protocol number IRB13–1201), which includes all countries included in the analysis.

Consent for publication

Not Applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Meta-analysis estimates for educational inequality
Fig. 2
Fig. 2
Meta-analysis for income inequality
See this image and copyright information in PMC

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