The relationship between income and oral health among people with intellectual disabilities: a global perspective 公开
Hughes, Michael Joseph (2014)
Abstract
BACKGROUND
The scientific literature cites wide health disparities for people with intellectual disabilities compared to the general population. The burden of disease is highest amongst poorer individuals in this population, but little is known about the global state of oral health across income groups. This study seeks to gain an understanding of the effects of income status on oral health in a global population of people with intellectual disabilities.
METHODSData were collected between 2007 and 2013 during Special Olympics health screening events. 82,570 participants were screened and eligible for inclusion in this study. Participants were examined by a volunteer health professional who completed a survey of oral health signs and symptoms. The main exposure (income status) and selected outcomes (missing teeth, untreated decay, injury, gingivitis and mouth pain) were used to conduct a cross-sectional analysis. Prevalence odds ratios were obtained through logistic regression.
RESULTSCompared to high-income countries, there were higher odds of mouth pain among participants from upper middle- (OR 95% CI [1.5, 1.7]), lower middle- ([3.3, 3.7]), and low-income countries ([1.7, 2.1]). There were higher odds of untreated decay among participants from upper middle- (OR 95% CI [3.3, 3.5]), lower middle- ([4.6, 5.1]), and low-income countries ([1.3, 1.5]). There were lower odds of missing teeth among participants from upper middle- (OR 95% CI [0.7, 0.7]), lower middle- ([0.7, 0.8]), and low-income countries ([0.4, 0.5]). There were lower odds of injury among participants from upper middle- (OR 95% CI [0.8, 0.9]), lower middle- ([0.7, 0.8]), and low-income countries ([0.3, 0.5]). Finally, there were lower odds of gingivitis among participants from upper middle- (OR 95% CI [0.8, 0.9]), lower middle- ([0.9, 1.0]), and low-income countries ([0.5, 0.6]).
CONCLUSIONOral health problems are not exclusive to low-income study participants. Unexpectedly high odds of missing teeth, injury, and gingivitis in high-income countries may be attributed to the high proportion of participants from the United States, which is considered a high-income country but has large income disparities. Health-determining circumstances in low-income countries provide some protection from the hypothesized gradient of oral health for all measured outcomes. These results signal a need for consistent oral health screenings and etiologic studies for people with intellectual disabilities in all economic settings.
Table of Contents
1... BACKGROUND
1..... Defining and classifying intellectual disability
3..... Prevalence of intellectual disability
5..... Socioeconomic determinants of health
6..... Life expectancy and comorbidities
8..... Oral health
10... INTRODUCTION
11... METHODS
11..... Study background
11..... Study population
12..... Data collection
12..... Exposure, outcome, and covariate variables
13..... Statistical analysis
15... RESULTS
15..... Descriptive statistics
16..... Bivariate analysis
16..... Logistic regression
18... DISCUSSION
23... REFERENCES
29... TABLES AND FIGURES
34... APPENDICES
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