Individual- and community-level social gradients of edentulousness.
Individual- and community-level social gradients of edentulousness.
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DOI：
10.1186/s12903-015-0020-z
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发表时间：
2015-03-11
期刊：
影响因子：
2.9
通讯作者：
JAGES Group
中科院分区：
文献类型：
--
作者：
Ito K;Aida J;Yamamoto T;Ohtsuka R;Nakade M;Suzuki K;Kondo K;Osaka K;JAGES Group
社区层面的因素和个人层面的因素都影响着个人的健康。到目前为止，还没有研究探讨社区水平的社会梯度和无牙症之间的关联。本研究的目的是调查个人和社区层面的社会不平等的无牙症，并确定任何解释因素，在这种关联。我们分析了日本老年学评估研究（JAGES）的数据。2010-2012年，112，123名65岁或以上的受试者回答了问卷调查（回答率= 66.3%）。在考虑个人收入和人口统计学协变量后，采用多水平logistic回归分析确定社区收入和无牙症之间的关联。然后，我们估计的概率无牙的个人和社区水平的收入调整后的协变量。在79，563名有效参与者中，39，550名男性（49.7%）和40，013名女性（50.3%）的无齿症患病率均为13.8%。生活在平均收入较高的社区和个人收入较高的社区与无牙症的风险较低显著相关（社区水平的优势比[OR]为0.37（95%置信区间[CI] [0.22-0.63]），个人收入水平为0.85（95% CI [0.84-0.86]））。个人和社区层面的社会因素，包括牙科诊所的密度，部分解释了社会梯度。然而，在完全调整的模型中，无牙的社区和个人水平的社会梯度仍然显着（OR = 0.43（95%CI [0.27-0.67]）和0.90（95%CI [0.88-0.91]），分别）。社区和个人收入的一个标准差变化分别与无牙症的几率降低0.78和0.84倍相关。此外，与男性相比，生活在平均收入较高的社区的女性无牙症的风险显著降低（交互作用的p值< 0.001）。观察到个人和社区一级的社会不平等的牙齿健康。公共卫生政策在减少口腔健康不平等时，应考虑口腔健康的社会决定因素。
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. 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. 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). 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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