Social determinants of tooth loss
Social determinants of tooth loss
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DOI：
10.1111/j.1475-6773.2003.00205.x
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发表时间：
2003-12-01
影响因子：
3.4
通讯作者：
Shelton, BJ
中科院分区：
文献类型：
--
作者：
Gilbert, GH;Duncan, RP;Shelton, BJ
目标。量化种族和社会经济地位（SES）在口腔健康方面的差异，以牙齿脱落来衡量，并确定牙齿护理使用和其他因素在解释差异中的作用。数据来源/研究设置。佛罗里达牙科保健研究，包括非裔美国人（AAs）和非西班牙裔白人45岁或以上，至少有一颗牙齿。研究设计。我们采用前瞻性队列设计。相关人群特征按易感因素、使能因素和需要因素分组。关键的结果是牙齿脱落，这是一项衡量人口口腔健康的主要指标，在进入牙科保健系统之前和之后进行了观察。通过将单个牙齿的损失与牙齿上的疾病水平联系起来，使用特定牙齿的数据来增加推断力。数据收集方法。在基线、24和48个月进行面对面访谈和临床检查，每6个月进行一次电话访谈。主要的发现。非裔美国人和社会经济地位较低的人报告了更多的新的牙齿症状，但不太可能获得牙科护理。当他们接受治疗时，他们更有可能经历牙齿脱落，也不太可能报告牙医与他们讨论过替代治疗方法。在分析的第一阶段，疾病严重程度和新症状的差异解释了牙齿脱落的差异。种族和社会经济地位的差异对牙齿脱落和牙齿护理的态度没有影响。由于几乎所有的牙齿脱落都是通过拔牙发生的，除非考虑到牙齿保健使用的差异，否则种族和社会经济地位对牙齿脱落的总体影响被人为地最小化。种族和社会经济地位是牙齿脱落的重要决定因素。非裔美国人和社会经济地位较低的人在基线时牙齿较少，但在基线后仍有更多的牙齿脱落。统计上，牙齿特定病例组合调整似乎可以解释牙齿脱落的社会差异差异。然而，当考虑到牙科保健使用的社会差异时，牙齿脱落的社会差异并不直接由于临床情况而变得明显。这是因为，在相同的疾病程度和严重程度下，一旦进入牙科保健系统，aa级和低SES级的人接受拔牙的可能性更大。这一现象强调了理解医疗保健使用、牙科保险覆盖范围和服务接收方面的差异如何导致健康差异的重要性。如果没有这样的理解，种族和社会经济地位对健康的总体影响可能会被低估。
Objectives. To quantify racial and socioeconomic status (SES) disparities in oral health, as measured by tooth loss, and to determine the role of dental care use and other factors in explaining disparities.Data Sources/Study Setting. The Florida Dental Care Study, comprising African Americans (AAs) and non-Hispanic whites 45 years old or older who had at least one tooth.Study Design. We used a prospective cohort design. Relevant population characteristics were grouped by predisposing, enabling, and need variables. The key outcome was tooth loss, a leading measure of a population's oral health, looked at before and after entering the dental care system. Tooth-specific data were used to increase inferential power by relating the loss of individual teeth to the disease level on those teeth.Data Collection Methods. In-person interviews and clinical examinations were done at baseline, 24, and 48 months, with telephone interviews every 6 months.Principal Findings. African Americans and persons of lower SES reported more new dental symptoms, but were less likely to obtain dental care. When they did receive care, they were more likely to experience tooth loss and less likely to report that dentists had discussed alternative treatments with them. At the first stage of analysis, differences in disease severity and new symptoms explained tooth loss disparities. Racial and SES differences in attitudes toward tooth loss and dental care were not contributory. Because almost all tooth loss occurs by means of dental extraction, the total effects of race and SES on tooth loss were artificially minimized unless disparities in dental care use were taken into account.Conclusions. Race and SES are strong determinants of tooth loss. African Americans and lower SES persons had fewer teeth at baseline and still lost more teeth after baseline. Tooth-specific case-mix adjustment appears, statistically, to explain social disparity variation in tooth loss. However, when social disparities in dental care use are taken into account, social disparities in tooth loss that are not directly due to clinical circumstance become evident. This is because AAs and lower SES persons are more likely to receive a dental extraction once they enter the dental care system, given the same disease extent and severity. This phenomenon underscores the importance of understanding how disparities in health care use, dental insurance coverage, and service receipt contribute to disparities in health. Absent such understanding, the total effects of race and SES on health can be underestimated.