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

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  • Celeste, Roger Keller
  • Nadanovsky, Paulo
  • Ponce de Leon, Antonio
  • Fritzell, Johan

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.

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  • Celeste, Roger Keller & Nadanovsky, Paulo & Ponce de Leon, Antonio & Fritzell, Johan, 2009. "The individual and contextual pathways between oral health and income inequality in Brazilian adolescents and adults," Social Science & Medicine, Elsevier, vol. 69(10), pages 1468-1475, November.
    • Handle: RePEc:eee:socmed:v:69:y:2009:i:10:p:1468-1475
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    2. Ankur Singh & Jane Harford & José Leopoldo Ferreira Antunes & Marco A Peres, 2018. "Area-level income inequality and oral health among Australian adults—A population-based multilevel study," PLOS ONE, Public Library of Science, vol. 13(1), pages 1-17, January.
    3. Aida, Jun & Kondo, Katsunori & Kondo, Naoki & Watt, Richard G. & Sheiham, Aubrey & Tsakos, Georgios, 2011. "Income inequality, social capital and self-rated health and dental status in older Japanese," Social Science & Medicine, Elsevier, vol. 73(10), pages 1561-1568.
    4. Celeste, Roger Keller & Nadanovsky, Paulo, 2010. "How much of the income inequality effect can be explained by public policy? Evidence from oral health in Brazil," Health Policy, Elsevier, vol. 97(2-3), pages 250-258, October.
    5. Yang Hyun Kim & Kyungdo Han & David Vu & Kyung-Hwan Cho & Sang Hwa Lee, 2018. "Number of remaining teeth and its association with socioeconomic status in South Korean adults: Data from the Korean National Health and Nutrition Examination Survey 2012-2013," PLOS ONE, Public Library of Science, vol. 13(5), pages 1-12, May.
    6. Simone M. Costa & Carolina C. Martins & Maria de Lourdes C. Bonfim & Lívia G. Zina & Saul M. Paiva & Isabela A. Pordeus & Mauro H. N. G. Abreu, 2012. "A Systematic Review of Socioeconomic Indicators and Dental Caries in Adults," IJERPH, MDPI, vol. 9(10), pages 1-35, October.

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