Oral health status and its socio-economic conditionings

Transkrypt

HEALTH AND WELLNESS 2/2015
WELLNESS AND SOCIETY
CHAPTER XXVI
1
Non-public Health Care Centre Denticus 2, Szczecin
Niepubliczny Zakład Opieki Zdrowotnej Denticus 2, Szczecin
2
Institute of Engineering Materials and Biomaterials
Faculty of Mechanical Engineering, Silesian University of Technology
Instytut Materiałów Inżynierskich i Biomedycznych
Wydział Mechaniczny Technologiczny, Politechnika Śląska
JOLANTA ŚWIDERSKA1, PIOTR MALARA2,
WALDEMAR ŚWIDERSKI1
Stan zdrowia jamy ustnej i jego społeczno-ekonomiczne uwarunkowania
Key words: oral health, DMF Index, income, place of living
Słowa kluczowe: zdrowie jamy ustnej, wskaźnik PUW, dochód, miejsce zamieszkania
INTRODUCTION
Differences in health status between groups within societies cannot only be explained by insufficient medical care or individual behavioural risk factors [24]. The
biggest influence have socio-economic factors [1]. The lower the standard of living
indicated by income, education and other, the worse the health status measured by
mortality, morbidity or quality of life [20,24].
Oral health has a direct relationship with general physical health and well-being [12,19]. Evidence show that dental and oral diseases may be associated with
chronic diseases [7].
High prevalence of caries on a global scale, costly complications it creates and
direct relationship of caries and lifestyle make it an significant social problem [16,22].
In many highly developed countries medical care provided by both public and private entities, covers preventive and disease treatment [3,4,10,11]. Political system
transformations and changes in management of National Health Care of Central and
Eastern Europe countries, resulted in a growing number of citizens with limited access
to private health care, mainly because of economic reasons [23].
Wellness and society
Dental caries is commonly evaluated as the sum of decayed (D), missing (M), and
filled (F) number of teeth (DMF). This index has been widely used to assess the status
of oral cavity of societies across the globe [9]. The DMF Index indicates caries occurrence, including cured and recurring dental caries. The DMF Index remains one of the
most commonly used epidemiological index for evaluation of dental caries prevalence
[2].
Without gradual increase of funding, significant improvement of health care is not
possible. New sources of funding and increase of patient’s contribution in payment
for the treatment are needed to improve the health care status [5,8,10,15].
THE AIM OF RESEARCH, MATERIAL, METHODS
The aim of research was to evaluate oral health status regarding socio-economic
conditionings.
The research was conducted in 2012-2013 on 180 randomly chosen adult patients,
aged between 35 and 44 years, both genders living in the area of West Pomerania
region – in a big city of Szczecin (over 100.000 inhabitants), in smaller cities (under
100.000 inhabitants) and in villages. The analysis included dental examination of teeth
status of patients, prevalence of caries and evaluation of oral hygiene and was conducted among patients undertaking private dental treatment or treatment reimbursed
by the National Health Fund.
Clinical examination included non-invasive and secure diagnostic methods such
as using WHO scale probe and dental mirror under the artificial light. To evaluate the
health status of oral cavity the DMF Index and its components – D (decayed teeth),
M (missing teeth), and F (filled teeth) have been calculated.
The study was based on an anonymous survey, including single and multiple
choices close-ended and open-ended questions.
Following WHO recommendation, the research determined most important socioeconomic determinants of chosen groups of patients and also evaluated socio-demographic characteristics such as: gender and place of living. Socio-economic status and
education – factors acknowledged as one of the socio-medical indicators of health –
were subject of the research.
STATISTICAL ANALYSIS METHODS
All statistical calculations were performed with use of statistical software STATISTICA ver. 10.0 by StatSoft Inc. (2011) and Excel calculation sheet. Quantitative
variables were determined by arithmetical mean, standard deviation, median, minimum and maximum (range) and 95% CI (confidence interval). Qualitative variables
were determined by number and percentage. Significance of differences between two
groups (independent variables model) was tested with significance test: t-Student or
Mann-Whitney U test. Difference significance between more than two groups was
tested with F (ANOVA) or Kruskal-Wallis test. Independence chi-square test was
used for qualitative variables. To determine the relationship, strength and direction
326
Jolanta Świderska, Piotr Malara, Waldemar Świderski
between variables Pearson’s and/or Spearman’s correlation coefficients were calculated. The level of significance p=0.05 was chosen for conducted study.
RESULTS
The study involved 180 patients, 90 women and 90 men, who underwent dental
examination determining their teeth and oral hygiene status. Study was conducted in
a big city, smaller cities and villages. Each examined person completed a questionnaire on utilization of dental services, oral hygiene and access to dental services.
Tab. I. Gender of surveyed patients
Gender
Women
Men
Sum
N
90
90
180
%
50.0
50.0
100.0
The study involved 90 women and 90 men.
Tab. II. Place of living of surveyed patients
Place of living
Big city
Smaller cities
Villages
Sum
N
60
60
60
180
%
33.3
33.3
33.3
100.0
The survey involved 60 people from a big city, 60 from smaller cities and 60 from
villages.
Tab. III. Place of living and gender of surveyed patients
Place of living
Big city
Smaller cities
Villages
Sum
Women
N
%
30 33.3
30 33.3
30 33.3
90 100.0
N
30
30
30
90
Men
%
33.3
33.3
33.3
100.0
The study involved 30 women and 30 men from a big city, 30 women and 30 men
from smaller cities and also 30 women and 30 men from villages.
Tab. IV. Income per person in a household of surveyed patients
Income
Up to 300 PLN
301-500 PLN
501-800 PLN
801-1200 PLN
More than 1200 PLN
Sum
N
3
16
38
40
83
180
%
1.7
8.9
21.1
22.2
46.1
100.0
327
Most of the patients indicated income of more than 1200 PLN per person in a
household. Income of 801-1200 PLN was indicated by 40 patients and of 501-800
PLN by 38 patients. Among surveyed patients 16 people indicated income of 301-500
PLN and 3 people indicated income of up to 300 PLN per person in a household.
Tab. V. Income per person in a household and gender of surveyed patients
Income
Up to 300 PLN
301-500 PLN
501-800 PLN
801-1200 PLN
More than 1200 PLN
Sum
Women
N
%
3
3.3
12 13.3
24 26.7
22 24.4
29 32.2
90 100.0
Men
N
%
0
0.0
4
4.4
14 15.6
18 20.0
54 60.0
90 100.0
Women and men most often indicated income of more than 1200 PLN per person
in a household (respectively 29 and 54 patients).
Tab. VI. Income per person in a household and place of living of surveyed
patients
Income
Up to 300 PLN
301-500 PLN
501-800 PLN
801-1200 PLN
More than 1200 PLN
Sum
Big city
Smaller cities
N
%
N
%
3
5.0
0
0.0
6
10.0
1
1.7
10 16.7 13
21.7
14 23.3 16
26.7
27 45.0 30
50.0
60 100.0 60
100.0
Villages
N
%
0
0.0
9
15.0
15 25.0
10 16.6
26 43.3
60 100.0
Surveyed patients most often indicated income of more than 1200 PLN per person
in a household. Income of 801-1200 PLN was indicated by 40 patients and income of
501-800 PLN was indicated by 38 patients. Among surveyed patients 16 have indicated income of 301-500 PLN and 3 people have indicated income of up to 300 PLN
per person in a household.
Tab. VII. Mean values of DMF, D, M, F Indices of surveyed patients
DMF
D
M
F
328
N Mean
180 16.1
147 3.9
128 4.8
175 7.9
Mean value of DMF Index of examined patients was 16.1. On average examined
patient had 3.9 decayed teeth, 4.8 missing teeth and7.9 filled teeth.
Tab. VIII. Mean values of DMF, D, M, F Indices in relation to gender of surveyed
patients
Women
N Mean
DMF 90 15.8
D
74
3.5
M
64
4.5
F
89
8.1
N
90
73
64
86
Men
Mean
16.4
4.3
5.0
7.7
Men had higher mean value of DMF Index (16.4) than women (15.8). Women had
more filled teeth (8.1 for women and 7.7 for men) but less decayed teeth (3.5 for
women and 4.3 for men) and missing teeth (4.5 for women and 5.0 for men).
Tab. IX. Characteristics of surveyed group regarding gender and values of DMF,
D, M, F Indices
Women
Men
Sum
p value
mean±SD 15.8±6.3
16.4±6.0
16.1±6.1
range
5.0-32.0
5.0-32.0
5.0-32.0
Z=-0.88
DMF
p=0.3806
median
14.0
16.0
15.5
95%CI [14.5;17.1] [15.2;17.7] [15.2;17.0]
mean±SD
3.1±3.1
3.7±4.4
3.4±3.8
range
0.0-16.0
0.0-32.0
0.0-32.0
Z=-1.00
D
p=0.3194
median
2.0
3.0
3.0
95%CI
[2.5;3.8]
[2.8;4.7]
[2.9;4.0]
mean±SD
4.5±5.3
5.0±6.2
4.8±5.8
range
0.0-25.0
0.0-32.0
0.0-32.0
Z=-0.22
M
p=0.8256
median
3.0
3.5
3.0
95%CI
[3.4;5.7]
[3.6;6.3]
[3.9;5.6]
mean±SD
8.1±4.4
7.7±4.4
7.9±4.4
range
0.0-23.0
0.0-20.0
0.0-23.0
Z=0.47
F
p=0.6348
median
7.0
7.0
7.0
95%CI
[7.2;9.0]
[6.8;8.6]
[7.3;8.6]
There are no statistically significant differences between gender regarding values
of DMF, D, M, F Indices.
329
Tab. X. Mean values of DMF, D, M, F Indices in relation to place of living of
surveyed patients
DMF
D
M
F
Big city
Smaller cities
N Mean N
Mean
60 17.9 60
13.4
50
5.1
51
3.4
38
4.3
47
3.2
58
8.4
59
7.4
Villages
N Mean
60 17.1
46
3.1
43
6.7
58
8.0
Examined patients from smaller cities have lower mean value of DMF Index
(13.4) than patients from a big city (17.9) and villages (17.1). Patients from villages
have significantly higher number of missing teeth (6.7) than patients from a big city
(4.3) and smaller cities (3.2). Examined patients from a big city had higher mean number of decayed teeth (5.1) than patients from both smaller cities (3.4) and villages
(3.1).
Tab. XI. Characteristics of surveyed group regarding place of living and values
of DMF, D, M, F Indices
mean±SD
range
DMF
median
95%CI
mean±SD
range
D
median
95%CI
mean±SD
range
M
median
95%CI
mean±SD
range
F
median
95%CI
Big city Smaller cities
Villages
17.9±6.8
13.4±4.3
17.1±6.2
5.0-32.0
6.0-27.0
5.0-32.0
18.01
13.01.2
16.02
[16.1;19.6] [12.3;14.5] [15.5;18.6]
5.1±5.5
2.9±2.1
2.4±2.3
0.0-32.0
0.0-9.0
0.0-9.0
3.51
3.0
2.01
[3.7;6.5]
[2.3;3.4]
[1.8;3.0]
4.3±4.8
3.2±4.1
6.7±7.4
0.0-16.0
0.0-25.0
0.0-32.0
2.0
2.0
4.5
[3.1;5.5]
[2.2;4.3]
[4.8;8.6]
8.4±5.7
7.4±2.9
8.0±4.1
0.0-23.0
0.0-15.0
0.0-22.0
8.0
7.0
7.0
[7.0;9.9]
[6.6;8.1]
[6.9;9.0]
p value
F=12.27
p=0.0001
H=11.06
p=0.0040
H=5.63
p=0.0600
H=0.31
p=0.8567
The values of DMF Index were significantly higher among people from a big city
comparing to people from smaller cities. The values of DMF Index were significantly
lower among people from smaller cities comparing to people from villages. Values of
D Index were significantly higher among people from a big city comparing to people
from villages.
330
Tab. XII. Mean values of DMF, D, M, F Indices in relation to income per person
in a household of surveyed patients
Up to 300
PLN
N Mean
DMF 3
18.7
D 2
2.5
M 2
7.0
F
3
10.0
301-500
PLN
N Mean
16 17.3
15 3.1
12 7.4
16 6.4
501-800
PLN
N Mean
38 18.1
34 4.2
27 7.1
35 6.5
801-1200
PLN
N Mean
40 16.0
31 3.6
34 4.5
38 8.3
More than
1200 PLN
N Mean
83 14.9
65 4.0
53 3.2
81 8.5
Patients with income of more than 1200 PLN have the lowest mean value of DMF
Index (14.9). Patients with lower income have higher mean number of missing teeth.
Tab. XIII. Characteristics of surveyed group regarding income per person in a
household and values of DMF Index
Up to 300
PLN
mean±SD 18.7±12.1
range
5.0-28.0
median
23.0
95%CI [-11.4;48.7]
301-500
PLN
17.3±5.9
8.0-26.0
19.0
[14.2;20.5]
501-800
PLN
18.1±6.1
5.0-32.0
17.5
[16.1;20.1]
801-1200
PLN
16.0±6.4
6.0-32.0
13.0
[14.0;18.1]
More than
p value
1200 PLN
14.9±5.7
5.0-32.0 H=8.97
p=0.0619
14.0
[13.7;16.2]
There are no statistically significant differences in values of DMF Index in relation
to income of surveyed patients.
Tab. XIV. Characteristics of surveyed group regarding income per person in a
household and values of D Index
Up to 300
PLN
mean±SD 2.5±1.5
range
0.0-3.0
median
2.0
95%CI [-2.1;5.5]
301-500
PLN
3.1±2.9
0.0-10.0
2.5
[1.9;5.0]
501-800 801-1200 More than
p value
PLN
PLN
1200 PLN
4.2±3.1 3.6±4.2
4.0±4.2
0.0-10.0 0.0-20.0 0.0-32.0 H=8.97
p=0.0619
4.0
2.0
2.0
[3.5;5.5] [1.9;4.6] [2.2;4.1]
There are no statistically significant differences in values of D Index in relation to
income of surveyed patients.
Tab. XV. Characteristics of surveyed group regarding income per person in a
household and values of M Index
Up to 300 301-500
PLN
PLN
mean±SD
7.0±7.5
7.4±5.6
range
0.0-15.0
0.0-16.0
median
6.0
9.0
95%CI [-11.8;25.8] [4.5;10.4]
501-800
PLN
7.1±8.0
0.0-32.0
5.5
[4.4;9.7]
801-1200 More than
p value
PLN
1200 PLN
4.5±5.5
3.2±4.0
0.0-24.0 0.0-20.0 H=12.15
p>0.05
2.0
2.0
[2.7;6.2] [2.3;4.1]
331
There are no statistically significant differences in values of M Index in relation
to income of surveyed patients.
Tab. XVI. Characteristics of surveyed group regarding income per person in a
household and values of F Index
Up to 300
PLN
mean±SD 10.0±8.7
range
5.0-20.0
median
5.0
95%CI [-11.5;31.5]
301-500
PLN
6.4±3.8
1.0-16.0
6.0
[4.4;8.5]
501-800
PLN
6.5±4.5
0.0-23.0
6.51
[5.0;8.0]
801-1200 More than
p value
PLN
1200 PLN
8.3±4.4
8.5±4.2
1.0-22.0 0.0-20.0 H=10.90
p=0.0277
8.0
8.01
[6.9;9.7] [7.6;9.4]
Value of F was significantly lower in a group of people with income of 501-800
PLN comparing to people with income of more than 1200 PLN.
Tab. XVII. Mean values of DMF, D, M, F Indices in relation to place of living
and gender of surveyed patients
Big city
Women
Men
N Mean N Mean
DMF 30 18.3 30 17.4
D 25 4.4 25 5.7
M 19 4.3 19 4.3
F 30 9.5 28 7.4
Smaller cities
Women
Men
N Mean N Mean
30 13.5 30 13.4
24 3.4 27 3.3
25 4.0 22 2.4
29 6.8 30 8.0
Villages
Women
Men
N Mean N Mean
30 15.6 30 18.5
25 2.6 21 3.7
20 5.3 23 8.1
30 8.1 28 7.8
Men (18.5) living in villages have higher DMF Index value than women (15.6).
Women and men from smaller cities have similar value of DMF Index (respectively
13.5 and 13.4). Women (4.4) and men (5.7) from a big city have higher mean number
of decayed teeth than patients from respective groups from smaller cities and villages.
Tab. XVIII. Mean values of DMF, D, M, F Indices in relation to income per
person in a household of surveyed patients from a big city
Up to 300
PLN
N Mean
DMF 3 18.7
D
2
2.5
M
2 10.5
F
3
4.0
332
Income of patients from a big city
301-500 501-800 801-1200
PLN
PLN
PLN
N Mean N Mean N Mean
6 15.7 10 17.6 14 18.4
6 2.2 10 4.4 10 5.0
4 5.0
3 5.3 11 4.0
6 5.7 10 8.0 14 7.1
More than
1200 PLN
N Mean
27 18.1
22 6.4
18 5.3
25 7.2
Patients with income of 501-800 PLN have the highest mean number of filled
teeth. Patients from a big city with income of up to 300 PLN have almost twice as
many missing teeth as patients from any other group.
Tab. XIX. Mean values of DMF, D, M, F Indices in relation to income per person
in a household of surveyed patients from smaller cities
Up to 300
PLN
N Mean
DMF 0
D
0
M
0
F
0
-
Income of patients from smaller cities
301-500 501-800 801-1200 More than
PLN
PLN
PLN
1200 PLN
N Mean N Mean N Mean N Mean
1 21.0 13 16.2 16 12.8 30 12.3
1 8.0 13 4.7 13 2.6 24
2.8
1 9.0 10 7.4 16 2.4 20
3.1
1 4.0 12 4.8 16 8.3 30
7.1
Patients from smaller cities with income of 801-1200 PLN (8.3) and more than
1200 PLN (7.1) have higher mean number of filled teeth than patients from other
groups.
Tab. XX. Mean values of DMF, D, M, F Indices in relation to income per person
in a household of surveyed patients from villages
Up to
300 PLN
N Mean
DMF 0
D 0
M 0
F
0
-
Income of patients from villages
301-500 501-800 801-1200
PLN
PLN
PLN
N Mean N Mean N Mean
9 18.0 15 20.1 10 18.0
8 3.1 11 3.5 8
3.3
7 11.6 14 8.3 7
7.7
9 5.2 13 7.1 10 7.2
More than
1200 PLN
N Mean
26 14.6
19 2.7
15 4.9
26 8.4
Patients from villages with income of more than 1200 PLN have the lowest value
of DMF Index (14.6), the lowest mean numbers of decayed teeth (2.7) and missing
teeth (4.9) and the highest mean number of filled teeth (8.4).
DISCUSSION
National Health Fund has established fixed list of reimbursed health care services.
Insured patients have entitled health services, ranging from preventive activities and
early detection to complex dental treatment. Patients’ economic status and economic
condition of the entire country greatly influence on the health of society [14,18,25].
Study has shown that men had higher mean value of DMF Index than women.
Women had more filled teeth but less decayed teeth and missing teeth.
Many authors have noticed a relationship between health and socio-economic status. Socio-economic factors, occupation and living conditions influence on health behaviour of patients [13,17,21].
333
Carried out research showed, that considering the place of living of surveyed patients, the lowest mean value of DMF Index and the lowest mean number of missing
teeth were noticed amongst patients from smaller cities. Examined patients from
smaller cities have lower mean value of DMF Index than patients from a big city and
villages. Patients from villages have significantly higher number of missing teeth than
patients from a big city and smaller cities. Examined patients from a big city had
higher mean number of decayed teeth than patients from both smaller cities and villages.
Gmyrek-Marciniak [6] also confirmed the influence of patient’s income on the
decision about extracting the tooth. Her studies showed, that the amount of extractions
was highest among patients with lowest incomes.
This study confirms that statement. There is a visible connection between income
of patients and the status of their teeth. Patients with income of more than 1200 PLN
have the lowest mean value of DMF Index. Patients with lower incomes have higher
mean number of missing teeth.
CONCLUSIONS
Following conclusions were drawn from the study:
1. Women have better values of oral health indices than man – they have lower
value of DMF Index, less decayed and missing teeth.
2.
Patients from a big city have higher value of DMF Index, more decayed and
filled teeth than patients from smaller cities and villages.
3.
Patients with the highest income have the lowest value of DMF Index and
the lowest number of missing teeth.
4.
Patients from smaller cities and villages with the highest income have lower
mean value od DMF Index than patients from other income groups.
5.
Patients from smaller cities have lower mean value of DMF Index than patients from a big city and villages.
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ABSTRACT
The aim of research was to evaluate oral health status regarding socio-economic
conditionings. Study included 180 patients, 90 women and 90 men, aged 35-44 from
a big city, smaller cities and villages of West Pomerania region. Dental examination
was performed, which allowed to evaluate oral health status. Questionnaire including
utilization of dental services, oral hygiene and access to dental services was completed
by patients. The research showed that women have lower value of DMF Index, less
decayed and missing teeth than man. Patients from smaller cities have lower mean
value of DMF Index than patients from a big city and villages. The higher the income
of patients, the lower the value of DMF Index.
STRESZCZENIE
Celem pracy była ocena stanu zdrowia jamy ustnej z uwzględnieniem uwarunkowań społeczno-ekonomicznych. Grupę badawczą stanowiło 180 pacjentów, 90 kobiet
i 90 mężczyzn w wieku 35-44 lata z dużego miasta, małych miejscowości i wsi województwa zachodniopomorskiego. Przeprowadzono lekarskie badanie stomatologiczne, które pozwoliło określić stan zdrowia jamy ustnej pacjentów oraz badanie ankietowe dotyczące między innymi korzystania przez pacjentów ze świadczeń stomatologicznych, higieny jamy ustnej, dostępu do opieki stomatologicznej. Z przeprowadzonego badania wynika, że kobiety mają niższą wartość wskaźnika PUW, mniej zębów z próchnicą i mniej zębów usuniętych, niż mężczyźni. Pacjenci z małych miejscowości mają niższą wartość wskaźnika PUW niż pacjenci z dużego miasta i ze wsi.
Im wyższy dochód badanych pacjentów, tym niższa średnia wartość wskaźnika PUW.
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Oral health status and its socio-economic conditionings

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