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The individual and contextual pathways between oral health and income inequality in Brazilian adolescents and adults

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The individual and contextual pathways between oral health and income inequality in Brazilian adolescents and adults

Auteurs : Roger Keller Celeste [Brésil, Suède] ; Paulo Nadanovsky [Brésil] ; Antonio Ponce De Leon [Brésil, Suède] ; Johan Fritzell [Suède]

Source :

Social science & medicine : (1982) [ 0277-9536 ] ; 2009.

RBID : Pascal:09-0470736

Descripteurs français

Pascal (Inist)
- Pathologie dentaire, Homme, Cavité buccale, Santé bucco-dentaire, Santé publique, Inégalité sociale, Aspect social, Etat sanitaire, Revenu individuel, Aspect économique, Revenu économique, Brésil, Adolescent, Adulte, Statut socioéconomique, Effet modifiant, Médiateur, Médecine sociale.
Wicri :
- geographic : Brésil.
- topic : Homme, Santé publique, Inégalité sociale, Adulte, Médiateur, Médecine sociale.

English descriptors

KwdEn :
- Adolescent, Adult, Brazil, Bucco-dental health, Dental disease, Economic aspect, Health status, Human, Income, Mediator, Modifier effect, Oral cavity, Personal income, Public health, Social Inequality, Social aspect, Social medicine, Socioeconomic status.

Abstract

We evaluate the association between income inequality (Gini index) and oral health and in particular the role of alternative models in explaining this association. We also studied whether or not income at the individual level modifies the Gini effect. We used data from an oral health survey in Brazil in 2002-2003. Our analysis included 23,568 15-19 and 22,839 35-44 year-olds nested in 330 municipalities. Different models were fitted using multilevel analysis. The outcomes analysed were the number of untreated dental caries (count), having at least one missing tooth (dichotomous) and being edentulous (dichotomous). To assess interaction as a departure from additivity we used the Synergy Index. For this, we dichotomized the Gini coefficient (high vs low inequality) by the median value across municipalities and the individual income in the point beyond which it showed roughly no association with oral health. Adjusted rate ratio of mean untreated dental caries, respectively for the 15-19 and 35-44 age groups, was 1.12 and 1.16 for each 10 points increase in Gini scale. Adjusted odds ratio of a 15-19 year-old having at least one missing tooth or a 35-44 year-old being edentulous was, respectively, 1.19 and 1.01. High income inequality had no statistically significant synergistic effect with being poor or living in a poor municipality. Higher levels of income inequality at the municipal level were associated with worse oral health and there was an unexplained residual effect after controlling for potential confoundings and mediators. Municipal level income inequality had a similar, detrimental effect, among individuals with lower or higher income.

Affiliations:

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Le document en format XML

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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adolescent</term>
<term>Adult</term>
<term>Brazil</term>
<term>Bucco-dental health</term>
<term>Dental disease</term>
<term>Economic aspect</term>
<term>Health status</term>
<term>Human</term>
<term>Income</term>
<term>Mediator</term>
<term>Modifier effect</term>
<term>Oral cavity</term>
<term>Personal income</term>
<term>Public health</term>
<term>Social Inequality</term>
<term>Social aspect</term>
<term>Social medicine</term>
<term>Socioeconomic status</term>
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<keywords scheme="Pascal" xml:lang="fr"><term>Pathologie dentaire</term>
<term>Homme</term>
<term>Cavité buccale</term>
<term>Santé bucco-dentaire</term>
<term>Santé publique</term>
<term>Inégalité sociale</term>
<term>Aspect social</term>
<term>Etat sanitaire</term>
<term>Revenu individuel</term>
<term>Aspect économique</term>
<term>Revenu économique</term>
<term>Brésil</term>
<term>Adolescent</term>
<term>Adulte</term>
<term>Statut socioéconomique</term>
<term>Effet modifiant</term>
<term>Médiateur</term>
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<term>Médiateur</term>
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<front><div type="abstract" xml:lang="en">We evaluate the association between income inequality (Gini index) and oral health and in particular the role of alternative models in explaining this association. We also studied whether or not income at the individual level modifies the Gini effect. We used data from an oral health survey in Brazil in 2002-2003. Our analysis included 23,568 15-19 and 22,839 35-44 year-olds nested in 330 municipalities. Different models were fitted using multilevel analysis. The outcomes analysed were the number of untreated dental caries (count), having at least one missing tooth (dichotomous) and being edentulous (dichotomous). To assess interaction as a departure from additivity we used the Synergy Index. For this, we dichotomized the Gini coefficient (high vs low inequality) by the median value across municipalities and the individual income in the point beyond which it showed roughly no association with oral health. Adjusted rate ratio of mean untreated dental caries, respectively for the 15-19 and 35-44 age groups, was 1.12 and 1.16 for each 10 points increase in Gini scale. Adjusted odds ratio of a 15-19 year-old having at least one missing tooth or a 35-44 year-old being edentulous was, respectively, 1.19 and 1.01. High income inequality had no statistically significant synergistic effect with being poor or living in a poor municipality. Higher levels of income inequality at the municipal level were associated with worse oral health and there was an unexplained residual effect after controlling for potential confoundings and mediators. Municipal level income inequality had a similar, detrimental effect, among individuals with lower or higher income.</div>
</front>
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<name sortKey="Nadanovsky, Paulo" sort="Nadanovsky, Paulo" uniqKey="Nadanovsky P" first="Paulo" last="Nadanovsky">Paulo Nadanovsky</name>
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<name sortKey="Fritzell, Johan" sort="Fritzell, Johan" uniqKey="Fritzell J" first="Johan" last="Fritzell">Johan Fritzell</name>
<name sortKey="Ponce De Leon, Antonio" sort="Ponce De Leon, Antonio" uniqKey="Ponce De Leon A" first="Antonio" last="Ponce De Leon">Antonio Ponce De Leon</name>
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The individual and contextual pathways between oral health and income inequality in Brazilian adolescents and adults

The individual and contextual pathways between oral health and income inequality in Brazilian adolescents and adults

Source :

Descripteurs français

English descriptors

Abstract

Links toward previous steps (curation, corpus...)

Le document en format XML

Pour manipuler ce document sous Unix (Dilib)

Pour mettre un lien sur cette page dans le réseau Wicri