Comparing the magnitude of oral health inequality over time in Canada and the United States

TY - JOUR

T1 - Comparing the magnitude of oral health inequality over time in Canada and the United States

AU - Chari, Malini

AU - Ravaghi, Vahid

AU - Sabbah, Wael

AU - Gomaa, Noha

AU - Singhal, Sonica

AU - Quiñonez, Carlos

N1 - Funding Information: This research was supported through the generous funding of the Canadian Dental Protective Association and Green Shield Canada. Publisher Copyright: © 2021 The Authors. Journal of Public Health Dentistry published by Wiley Periodicals LLC on behalf of American Association of Public Health Dentistry.

PY - 2021/11/25

Y1 - 2021/11/25

N2 - OBJECTIVES: To assess the magnitude of, and changes in, absolute and relative oral health inequality in Canada and the United States, from the 1970s till the first decade of the new millennium.METHODS: Data were obtained from four national surveys; two Canadian (NCNS 1970-1972 and CHMS 2007-2009) and two American (HANES 1971-1974 and NHANES 2007-2008). The slope and relative index of inequality were used to measure absolute and relative inequality, respectively. Percentage change in inequality was also calculated.RESULTS: Relative inequality for untreated decay increased by 91% in Canada and 189% in the United States, while for filled teeth it declined by 63% in Canada and 16% in the United States. Relative inequality in edentulism rose by 200% and 78% in Canada and United States, respectively. Absolute inequality declined in both countries.CONCLUSIONS: There was persistent absolute and relative inequality in Canada and the United States. An increase in relative inequality for adverse outcomes suggests that improvements in oral health were occurring primarily among the rich, while reductions in relative inequality for filled teeth indicate higher utilization of restorative services among the poor. These results point to the necessity of tackling the sociopolitical determinants of health to mitigate oral health inequality in Canada and the United States.

AB - OBJECTIVES: To assess the magnitude of, and changes in, absolute and relative oral health inequality in Canada and the United States, from the 1970s till the first decade of the new millennium.METHODS: Data were obtained from four national surveys; two Canadian (NCNS 1970-1972 and CHMS 2007-2009) and two American (HANES 1971-1974 and NHANES 2007-2008). The slope and relative index of inequality were used to measure absolute and relative inequality, respectively. Percentage change in inequality was also calculated.RESULTS: Relative inequality for untreated decay increased by 91% in Canada and 189% in the United States, while for filled teeth it declined by 63% in Canada and 16% in the United States. Relative inequality in edentulism rose by 200% and 78% in Canada and United States, respectively. Absolute inequality declined in both countries.CONCLUSIONS: There was persistent absolute and relative inequality in Canada and the United States. An increase in relative inequality for adverse outcomes suggests that improvements in oral health were occurring primarily among the rich, while reductions in relative inequality for filled teeth indicate higher utilization of restorative services among the poor. These results point to the necessity of tackling the sociopolitical determinants of health to mitigate oral health inequality in Canada and the United States.

KW - country comparisons

KW - dental care

KW - dental health surveys

KW - income distribution

KW - inequality

KW - oral health

KW - political factors

UR - http://www.scopus.com/inward/record.url?scp=85120653384&partnerID=8YFLogxK

U2 - 10.1111/jphd.12486

DO - 10.1111/jphd.12486

M3 - Article

C2 - 34821390

AN - SCOPUS:85120653384

SN - 0022-4006

JO - Journal of Public Health Dentistry

JF - Journal of Public Health Dentistry

ER -