Investigating socioeconomic inequalities in oral health using the Adult Dental Health Survey

对英国人牙齿状况的调查表明，社会地位最高的人享有最好的口腔健康，而社会地位最低的人口腔健康状况最差。该项目旨在衡量良好口腔健康在整个人口中的不平等分布，调查其不平等的原因，并确定它是否随着时间的推移而变得或多或少不平等。这是牙科服务发展的一个重要时期，研究结果将直接影响英国卫生政策的制定，并为减少口腔健康不平等的国际努力提供参考。可以理解的是，由于老龄化过程、性别差异和不同的遗传天赋，并不是每个人都享有同样的健康水平。然而，当人们需要照顾时，就会有最重要的公平考虑。这些决定了不同需要程度的人为了满足他们的需要而受到不同的对待(纵向公平)，而具有相同需要程度的人受到同等对待(横向公平)。政策制定者和实践者面临的问题是健康不平等，这些不平等可能是可以避免的和不公正的，特别是与财富、教育或社会地位有关的不平等。这些反映了生活机会中更广泛的不平等，反过来又阻碍了人们最大限度地发挥自己的潜力，影响到更广泛的经济和社会。口腔健康是整体健康的一个关键因素，而那些口腔健康状况不佳的人面临着相当大的社会和经济负担。例如，年轻时牙齿不美观，或者晚年因假牙不合适而产生的社交机会，对就业机会的影响是显而易见的。此外，改善口腔健康的成本可能会螺旋式上升，即使在全国卫生系统内也是如此。仅在英格兰，每年用于口腔健康的支出就超过50亿GB(NHS和私立)，但这是一个在不平等文献中基本上被忽视的领域。在这项研究中，我们通过分析一个独特的二级数据集--英国成人牙科健康调查--来调查围绕口腔健康不平等的问题。从1968年到2009年，这项研究已经运行了五次，大约每十年一次，在这项研究中，我们将使用1988年、1998年和2009年的数据。这个项目将调查四个问题。首先，重要的是要衡量社会经济不平等的程度，并知道衡量口腔健康的哪个方面。使用统计方法应用于一系列口腔健康结果和社会经济指标，我们将确定广泛的口腔健康不平等衡量标准，揭示临床衡量标准(例如牙齿数量)和人们如何报告自己健康(例如与口腔健康相关的生活质量)之间的差异。这是一个牙科服务发生巨大变化的时代，因此这些将提供评估政策干预措施的基准。其次，这个项目将调查一系列社会地位和财富指标对口腔健康的相互作用和影响。这些往往是复杂的，除非它们被理解，否则很难制定政策来改善每个人的健康，但理解它们意味着有可能采取干预措施来改善健康。第三，该项目将调查这些无数的社会和经济影响如何导致不平等。这意味着，任何旨在改善健康的干预或政策变化都会改善那些最需要的人的健康。最后一个要素将是观察口腔健康不平等的时间趋势，将最近的数据(2009年)与之前几十年的数据(1988年和1998年)进行比较。根据我们拥有的数据，这是一种独特的可能性，将使我们更丰富地了解口腔健康世界是如何变化的，以及任何干预措施可能有多紧迫。

An overview of the dental conditions of the British population suggests that the best oral health is enjoyed by those towards the top of the social scale, while the worst oral health afflicts those towards the bottom. This project aims to measure the unequal distribution of good oral health across the population, to investigate why it is unequal, and to establish whether it is getting more or less unequal over time. This is an important time in the development of dental services and the findings will feed directly into the development of health policy in the UK and inform international efforts to reduce inequalities in oral health.It is understandable that not everyone enjoys the same level of health, because of the ageing process, gender differences and different genetic endowments. However, when people are in need of care, there are over-arching equity considerations. These determine that individuals with different levels of need are treated differently in order to meet their needs (vertical equity), while those with the same level of need are treated the same (horizontal equity).The problem for policy makers and practitioners are the health inequalities that are potentially avoidable and unjust, specifically those that are related to wealth, education or social position. These reflect wider inequalities in life's opportunities, in turn preventing people from maximising their own potential, affecting the wider economy and society as a whole.Oral health is a key element of health overall, and those suffering from poor oral health face considerable social and financial burdens. The impact on a person's employment opportunities from having (for example) unattractive teeth as a young adult, or social opportunities because of poorly-fitting dentures later in life, are easy to see. Further, the costs of improving oral health can spiral, even within a national health system. Expenditure on oral health reaches over £5Bn annually in England alone (NHS and private), yet it is an area which has been largely overlooked in the inequalities literature. In this study we investigate the issues surrounding oral health inequalities through the analysis of a unique secondary dataset - the UK Adult Dental Health Survey. This has been run five times, roughly every decade from 1968 to 2009, and in this study we will use the 1988, 1998 and 2009 data.This project will investigate four issues. Firstly, it is important to measure the level of socioeconomic inequalities and to know what aspect of oral health to measure. Using statistical methods applied to a range of oral health outcomes and socioeconomic indicators, we will identify a broad range of oral health inequality measures, revealing the differences between inequalities in clinical measures (e.g. the number of teeth) and how people report their own health (e.g. oral health related quality of life). This is a time of great change in dental services, so these will provide benchmarks against which policy interventions can be assessed. Secondly, this project will investigate the interactions and influences of a range of indicators of social position and wealth on oral health. These are often complex and unless they are understood it is difficult to develop policies to improve health for everyone, but understanding them means that it is possible to intervene to improve health. Thirdly, the project will investigate how these myriad social and economic influences lead to inequalities. This means that any intervention or policy change intended to improve health, improves health for those who most need it. The final element will be to look at the time trend of oral health inequality, comparing recent data (2009) with data from the decades previously (1988 and 1998). This is a unique possibility with the data we have and will give a richer understanding of how the world of oral health is changing and how urgent any intervention may be.