title: Income inequality, disinvestment in health care and use of dental services.
abstract: OBJECTIVE
  To explore the interrelationships between income inequality, disinvestment in health care, and use of dental services at country level.
  
  
  METHODS
  This study pooled national estimates for use of dental services among adults aged 18 years or older from the 70 countries that participated in the World Health Survey from 2002 to 2004, together with aggregate data on national income (GDP per capita), income inequality (Gini coefficient), and disinvestment in health care (total health expenditure and dentist-to-population ratio) from various international sources. Use of dental services was defined as having had dental problems in the last 12 months and having received any treatment to address those needs. Associations between variables were explored using Pearson correlation coefficients and linear regression.
  
  
  RESULTS
  Data from 63 countries representing the six WHO regions were analyzed. Use of dental services was negatively correlated with Gini coefficient (Pearson correlation coefficient -0.48, P < 0.001) and positively correlated with GDP per capita (0.40, P < 0.05), total health expenditure (0.45, P < 0.001), and dentist-to-population ratio (0.67, P < 0.001). The association between Gini coefficient and use of dental services was attenuated but remained significant after adjustments for GDP per capita, total health expenditure, and dentist-to-population ratio (regression coefficient -0.36; 95% CI -0.57, -0.15).
  
  
  CONCLUSIONS
  This study shows an inverse relationship between income inequality and use of dental services. Of the two indicators of disinvestment in health care assessed, only dentist-to-population ratio was associated with income inequality and use of dental services.
authors.affiliation: Division of Population and Patient Health, King's College London Dental Institute, London, UK.
authors.forename: Bishal
authors.initials: B
authors.lastname: Bhandari
authors.forename: Jonathan T
authors.initials: JT
authors.lastname: Newton
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bernabé
mesh_terms: D003752:Dental Health Services / Q000706:statistics & numerical data*; D014943:Global Health; D054625:Healthcare Disparities; D006801:Humans; D007182:Income
keywords: dental health services; health expenditures; socioeconomic factors; utilization