title: Socioeconomic inequalities in the use of dental care services in Europe: what is the role of public coverage?
abstract: OBJECTIVE
  The aim of this study was to analyse inequalities in the use of dental care services according to socioeconomic position (SEP) in individuals aged ≥50 years in European countries in 2006, to examine the association between the degree of public coverage of dental services and the extent of inequalities, and specifically to determine whether countries with higher public health coverage show lower inequalities.
  
  
  METHODS
  We carried out a cross-sectional study of 12 364 men and 14 692 women aged ≥50 years from 11 European countries. Data were extracted from the second wave of the Survey of Health, Ageing and Retirement in Europe (SHARE 2006). The dependent variable was use of dental care services within the previous year, and the independent variables were education level as a measure of SEP, whether services were covered to some degree by the country's public health system, and chewing ability as a marker of individuals' need for dental services. Age-standardized prevalence of the use of dental care as a function of SEP was calculated, and age-adjusted indices of relative inequality (RII) were computed for each type of dental coverage, sex and chewing ability.
  
  
  RESULTS
  Socioeconomic inequalities in the use of dental care services were higher in countries where no public dental care cover was provided than in countries where there was some degree of public coverage. For example, men with chewing ability from countries with dental care coverage had a RII of 1.39 (95%CI: 1.29-1.51), while those from countries without coverage had a RII of 1.96 (95%CI: 1.72-2.23). Women without chewing ability from countries with dental care coverage had a RII of 2.15 (95%CI: 1.82-2.52), while those from countries without coverage had a RII of 3.02 (95%CI: 2.47-3.69).
  
  
  CONCLUSIONS
  Dental systems relying on public coverage seem to show lower inequalities in their use, thus confirming the potential benefits of such systems.
authors.affiliation: CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Agència de Salut Pública de Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain.
authors.forename: Laia
authors.initials: L
authors.lastname: Palència
authors.forename: Albert
authors.initials: A
authors.lastname: Espelt
authors.forename: Marco
authors.initials: M
authors.lastname: Cornejo-Ovalle
authors.forename: Carme
authors.initials: C
authors.lastname: Borrell
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003729:Dental Care / Q000191:economics / Q000706:statistics & numerical data*; D004522:Educational Status; D005060:Europe / Q000453:epidemiology; D005260:Female; D054625:Healthcare Disparities / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage / Q000191:economics / Q000706:statistics & numerical data; D007347:Insurance, Dental / Q000191:economics / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics / Q000706:statistics & numerical data*; D009909:Oral Health / Q000706:statistics & numerical data; D012959:Socioeconomic Factors
keywords: dental health care; public coverage; socioeconomic factors