Background While inequalities in oral health are documented, little is known about the extent to which they are attributable to potentially modifiable factors. We examined the role of behavioural and dental attendance pathways in explaining oral health inequalities among adults in England, Wales and Northern Ireland.
Methods Using nationally representative data, we analysed inequalities in self-rated oral health and number of natural teeth. Highest educational attainment, equivalised household income and occupational social class were used to derive a latent socioeconomic position (SEP) variable. Pathways were dental attendance and behaviours (smoking and oral hygiene). We used structural equation modelling to test the hypothesis that SEP influences oral health directly and also indirectly via dental attendance and behavioural pathways.
Results Lower SEP was directly associated with fewer natural teeth and worse self-rated oral health (standardised path coefficients, −0.21 (SE=0.01) and −0.10 (SE=0.01), respectively). We also found significant indirect effects via behavioural factors for both outcomes and via dental attendance primarily for self-rated oral health. While the standardised parameters of total effects were similar between the two outcomes, for number of teeth, the estimated effect of SEP was mostly direct while for self-rated oral health, it was almost equally split between direct and indirect effects.
Conclusion Reducing inequalities in dental attendance and health behaviours is necessary but not sufficient to tackle socioeconomic inequalities in oral health.
- oral health
- health inequalities
- health services
Data availability statement
ADHS 2009 data are provided upon request by the Office for National Statistics’ under the UK Data Service’s End User Licence at https://beta.ukdataservice.ac.uk/datacatalogue/studies/study?id=6884.
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Contributors All authors meet the ICMJE authorship criteria. CG-H contributed to conception, design, analysis and interpretation, drafted and critically revised the manuscript; SS contributed to analysis and interpretation, and critically revised the manuscript; AH, RO’C, EF, JS, RGW, SM critically revised the manuscript; JW contributed to data acquisition, analysis and interpretation, and critically revised the manuscript; GT contributed to conception, design, analysis and interpretation, and critically revised the manuscript. All authors approved the final manuscript.
Funding This work was supported by the UK Economic and Social Research Council [Grant Number ES/K004689/1] as part of the Secondary Data Analysis Initiative.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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