title: Income-related inequality in perceived oral health among adult Finns before and after a major dental subsidization reform.
abstract: Objectives In Finland, a dental subsidization reform, implemented in 2001-2002, abolished age restrictions on subsidized dental care. The aim of this study was to investigate income-related inequality in the perceived oral health and its determinants among adult Finns before and after the reform. Materials and methods Three identical cross-sectional nationally representative postal surveys, concerning perceived oral health and the use of dental services among people born before 1971, were conducted in 2001 (n = 2157), in 2004 (n = 1814) and in 2007 (n = 1671). Three measures of perceived oral health were used: toothache or oral discomfort during the past 12 months, current need for dental care and self-reported oral health status. Concentration index was used to analyse the income-related inequalities. Its decomposition was used to study factors related to the inequalities. Results The proportion of respondents reporting need for dental care decreased from 2001 to 2007, while no changes were seen in reports of toothache or self-reported oral health status. Income-related inequalities in reports of toothache and perceived need for care widened, while the inequality in self-reported oral health remained stable. Most of the inequalities were related to income itself, perceived general health and the time since the last visit to dental care. Conclusions It seems that the income-related inequalities in perceived oral health remained or even widened after the reform.
authors.affiliation: a University of Eastern Finland, Institute of Dentistry , Kuopio , Finland ;
authors.forename: Eero
authors.initials: E
authors.lastname: Raittio
authors.affiliation: b Institute for Health and Welfare (THL) , Helsinki , Finland ;
authors.forename: Arpo
authors.initials: A
authors.lastname: Aromaa
authors.affiliation: c Eli Lilly Finland Ab , Helsinki , Finland ;
authors.forename: Urpo
authors.initials: U
authors.lastname: Kiiskinen
authors.affiliation: d Social Insurance Institution , Helsinki , Finland ;
authors.forename: Sari
authors.initials: S
authors.lastname: Helminen
authors.affiliation: a University of Eastern Finland, Institute of Dentistry , Kuopio , Finland ;|b Institute for Health and Welfare (THL) , Helsinki , Finland ;|e Department of Oral and Maxillofacial Surgery , Kuopio University Hospital , Kuopio , Finland.
authors.forename: Anna Liisa
authors.initials: AL
authors.lastname: Suominen
mesh_terms: D000328:Adult; D001294:Attitude to Health; D003430:Cross-Sectional Studies; D003729:Dental Care / Q000706:statistics & numerical data; D005260:Female; D005387:Finland; D018166:Health Care Reform; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006304:Health Status; D054625:Healthcare Disparities; D006801:Humans; D007182:Income; D008297:Male; D008875:Middle Aged; D009909:Oral Health; D057566:Self Report; D014098:Toothache / Q000523:psychology; D019472:Universal Health Insurance
keywords: Inequality; dental care; perceived oral health; subsidization reform