Social inequality in oral health and use of dental care in Sweden.
OBJECTIVE
To describe oral health and use of dental care in relation to socio-economic determinants over time in Sweden.


METHODS
Cross-sectional study based on interview data on two randomly sampled sequential populations consisting of 7,610 Swedish adult (25-64 years) residents and 4,315 children (3-15 years) in their households from the Survey of Living Conditions 1996-97, and 7,649 adult Swedish residents (25-64 years) from the survey of 1988-89.


RESULTS
Low educational level, having no cash margin and being born outside of Sweden was associated with higher odds of problems with chewing, wearing a prosthesis and not having been treated by a dentist during the 24 months preceding the interview, in a logistic regression analysis of data from the 1996-97 survey in the adult study population (adjusted odds ratios 1.6-2.9). The same socio-economic determinants were associated with caries in children (adjusted odds ratios 1.2-1.5). The socio-economic differences in dental treatment and problems with chewing were greater in the age group 45-64 years compared to 25-44-year-olds. The prevalence of problems with chewing increased from 7.1% (95% CI 6.5-8.1) in the 1988-89 survey to 9.1% (8.4-9.8) in the 1996-97 survey. A similar increase, from 2.4% (2.2-2.6) to 4.4% (3.9-4.9) was observed for individuals not having been in dental treatment during the last 24 months. The socio-economic distribution of oral health and use of dental care in the adult population was similar in the two surveys.


CONCLUSIONS
This study demonstrates that socio-economic differences in oral health and use of dental care are most marked in older (45-64 years) adults in Sweden, but are significant in young adults and, in terms of oral health, in children as well. A steep increase in user charges during the 1990s has been paralleled by a moderate increase in problems with chewing and the proportion of the population that has no regular dental care, which suggests a link that needs to be evaluated in further studies.
Hjern
A
A
Department of Clinical Sciences, Huddinge University Hospital, Karonlinska Institutet, Sweden. anders.hjern@sos.se
Grindefjord
M
M
Sundberg
H
H
Rośen
M
M
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003729:Dental Care / Q000706:statistics & numerical data*; D003731:Dental Caries / Q000453:epidemiology; D003753:Dental Health Surveys; D017266:Dental Prosthesis / Q000706:statistics & numerical data; D005250:Fees, Dental; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007347:Insurance, Dental / Q000191:economics; D016015:Logistic Models; D008297:Male; D008409:Mastication; D008875:Middle Aged; D009313:National Health Programs; D016017:Odds Ratio; D009909:Oral Health; D012494:Sampling Studies; D012923:Social Class; D013548:Sweden / Q000453:epidemiology