Dissertation committee:
Κωλέτση-Κουνάρη Χαριτίνη, Αν. Καθηγήτρια, Τμήμα Οδοντιατρικής, Σχολή Επιστημών Υγείας, ΕΚΠΑ.
Μαμάη-Χωματά Ελένη, Αν. Καθηγήτρια, Τμήμα Οδοντιατρικής, Σχολή Επιστημών Υγείας, ΕΚΠΑ.
Παπαϊωάννου Βασίλειος, Αν. Καθηγητής, Τμήμα Οδοντιατρικής, Σχολή Επιστημών Υγείας, ΕΚΠΑ.
Πολυχρονοπούλου Αργυρώ, Καθηγήτρια, Τμήμα Οδοντιατρικής, Σχολή Επιστημών Υγείας, ΕΚΠΑ.
Γκιζάνη Σωτηρία, Αν. Καθηγήτρια, Τμήμα Οδοντιατρικής, Σχολή Επιστημών Υγείας, ΕΚΠΑ.
Κοσιώνη Αναστασία, Καθηγήτρια, Τμήμα Οδοντιατρικής, Σχολή Επιστημών Υγείας, ΕΚΠΑ.
Μητσέα Αναστασία, Αν. Καθηγήτρια, Τμήμα Οδοντιατρικής, Σχολή Επιστημών Υγείας, ΕΚΠΑ.
Summary:
It is very well-established that there are social inequalities affecting health and mortality. Longevity for those at the lower end of the social status ladder is considerably less attainable than those higher up the ladder; the higher one climbs up the social ladder, the better one’s health. In spite of the well-documented differences in morbidity and mortality across the social spectrum, the amount and level of the gradient varies depending on the stage of life, gender, country, indicators of health and indicators of social inequality. These social class inequalities exist for almost all chronic diseases in industrial countries; similarly, these inequalities are also apparent in oral health. However, there is relatively little research available regarding these issues, for both clinical and subjective measures, in the ageing population of industrialized countries. Interest in ageing populations and social inequalities has increased in recent years. Ageing populations and chronic diseases are both concerns for all industrial countries.
This study is a cross-sectional epidemiological study in Athens and the Greater area of Athens. The principal aim of the study is to explore the impact of complex socioeconomic, psychometric and behavioural factors and the social gradient in clinical measures, tooth loss, sum of Decayed Missing Filled Teeth (DMFT), Oral Health Index Simplified (OHIS), as well as subjective measures such as self-reported oral and self-reported general health in a Greek population aged 65 years old and over. More specifically, the purpose is to explore and investigate the association between perceived, subjective and clinical measures of oral health and wellbeing for these older adults, and the extent to which these relationships vary according to socioeconomic indicators (education, occupation, income and subjective social status). Psychosocial factors such as acute and chronic stress, stressful experiences at work, loneliness, social organization, social networks and social support affect health; thus, the study assess whether the social inequalities and the gradient in oral health are influenced by psychometric factors such as: social networks, cognitive ability, life satisfaction, and loneliness. Inequalities in health are unfair differences that are preventable, discriminating, and unsatisfactory in a present-day society. Reducing these social inequalities in health is a priority for public health officials and epidemiologists in prosperous societies, including many European countries.
Methodology: This is a cross-sectional study especially designed for adults 65 years old and over. The study has ethical approval from the Dental School of Athens, Greece. Participants were residents of Athens and Peireuas Municipalities, members of Day Clubs, who volunteered to participate in the study. Participants were included in the study only after successfully completing a pre-test of four simple cognitive screening questions; this was an indicator that participants were able to communicate and reply accurately and effectively. Data were collected through structured, face-to-face interviews and clinical examinations. Associations were considered as significant when p<0.05. Statistical analysis carried out using the Statistical Package for Social Sciences (SPSS) version 24.0 programme
Results: The main results of the present study are the existence of the social gradient in oral health of older adults from two municipalities of Attica region (Municipality of Athens and Municipality of Piraeus). Socioeconomic factors impact perceptions of health and show inequalities and educational, income and occupation gradients. Education, occupation, and income are predictors for Self-Rated Oral Health (SROH) and Self-Rated Health (SRH), and are statistically significantly associated with both SROH and SRH. Oral health hygiene, sum of Decayed Missing Filled Teeth (DMFT), tooth loss, and SROH and SRH in older Greek adults visiting Day Clubs have significant differences according to income, education, occupation and SSS. Associations between oral hygiene Oral Hygiene Index Simplified (OHI-S) and household income is statistically significant. Similarly, these associations are statistically significant for education, occupation and Subjective Social Status (SSS). Subjective social status is the strongest predictor and verified to be a valid measure for examining health inequalities. Gender, years in pension, marital status, Oral Health Related Quality of Life (OHRQL), and cognitive ability (Mini Mental State Examination test) have an effect on missing teeth. Education, occupation and SSS are also significant predictors for missing teeth and their associations with the number of missing teeth are statistically significant. Participants who reported last main occupation as being manual workers, less educated, in the low steps of the social ladder -subjective social status- (SSS), and with less money were more likely to have a higher number of missing teeth. There are socioeconomic inequalities for DMFT index; the results are significant for household income, education level, occupation, and SSS. All explanatory variables are significantly associated with DMFT, in the examined population. The results are significant for all participants in the analysis; and remained statistically significant when only dentate participants were included. Thus, those with more money, higher level of education, in non-manual occupations and with higher subjective social status are more likely to have lower scores of the DMFT index. Tooth loss, DMFT, OHI-S, SROH and SRH are associated with cognitive ability (MMSE score) in elders, visiting Day Clubs in Athens and Piraeus, Greece. In the examined population those with higher scores of MMSE test experienced fewer missing teeth. Also, those who were older, males, with less years of education, lower income, and felt dryness in the mouth had significantly more missing teeth. Participants who brushed their teeth or dentures less than once a day, visited the dentist only when they had trouble or pain and were manual workers with lower income experienced significantly more missing teeth. Psychometric factors have a significant impact and contribute to explaining inequalities and the gradient; cognitive ability, SWL, loneliness and social network impact and partly explained inequalities and the social gradient.
Conclusions: The results are summarized as confirming oral health gradient inequalities in older adults in Greece, in the examined population. The social gradient in health and oral health exist and these inequalities do not diminish with age, and psychosocial factors (Satisfaction with life, social networks, loneliness and cognitive ability) partly explain the gradient. These results are significant and help to understand oral health inequalities and the gradient in older people; they are also important for policy makers to identify the nature of oral health inequalities’ affecting factors and the gradient; therefore this is helpful for those planning and implementing oral health promotion, and supporting for implementing healthy public policy and legislation for reducing social and health inequalities in adults and evaluating community preventive actions for older people.
