J Korean Acad Oral Health.  2013 Dec;37(4):208-215.

The relationship between regional socioeconomic position and oral health behavior: A multilevel approach analysis

• Kim CS
• Han SY
• Kim CW

Abstract

OBJECTIVES
This study was conducted to identify discrepancies in oral health behaviors among communities in cities, counties, and districts (si , gun, and gu administrative divisions of South Korea) and to determine their correlations with socioeconomic status, examined in terms of the social deprivation index.
METHODS
Data for 220,258 individuals, covering 247 communities, were extracted from a 2008 community health survey, and the frequency of brushing the teeth after lunch, flossing and interdental brushing was calculated and analyzed. Considering the characteristics of the data collected at individual and regional levels, a multilevel random-intercept logistic regression model was used for the analysis.
RESULTS
A regional-level discrepancy was found in after-lunch brushing and the use of auxiliary oral hygiene items, with interclass correlations of 0.03 and 0.04, respectively. In particular, the odds ratio of using auxiliary oral hygiene items in the communities with the lowest socioeconomic status was as low as 0.49, compared to the highest level, thus demonstrating a conspicuous intercommunity difference.
CONCLUSIONS
The regional-level correlation between socioeconomic status and oral health behaviors indicates the need for the establishment of oral health-related intervention policies based on community characteristics.

Keyword

Multilevel analysis; Oral health behavior; Socioeconomic position

MeSH Terms

Health Surveys
Logistic Models
Lunch
Multilevel Analysis
Odds Ratio
Oral Health*
Oral Hygiene
Social Class
Tooth

Reference

References

1. Forbes A, Wainwright SP. On the methodological, theoretical and philosophical context of health inequalities research: a critique. Soc Sci Med. 2001; 53:801–816.

2. Newton JT, Bower EJ. The social determinants of oral health: new approaches to conceptualizing and researching complex causal networks. Community Dent Oral Epidemiol. 2005; 33:25–34.

3. Singh A, Rouxel P, Watt RG, Tsakos G. Social inequalities in clustering of oral health related behaviors in a national sample of British adults. Prev Med. 2013; 57:102–106.

4. Sheiham A, Watt RG. The common risk factor approach: a rational basis for promoting oral health. Community Dent Oral Epidemiol. 2000; 28:399–406.

5. Tada A, Matsukubo T. Relationship between oral health behaviors and general health behaviors in a Japanese adult population. J Public Health Dent. 2003; 63:250–254.

6. Berkman LF, Kawachi I. Social epidemiology. 1st ed.New York: Oxford University Press;2000. p. 28–29.

7. Kim HY. Oral health status and behavior according to socio-economic status [dissertation]. Seoul: Seoul National University;2002. [Korean].

8. Shin SJ, Ahn YS, Jung SH. The relation between dental health behaviors and socioeconomic status among Korean adolescents. J Korean Acad Oral Health. 2008; 32:223–230.

9. Jung SW, Cho YT. Neighborhood characteristics and individual health under Korean context. J Prev Med Public Health. 2005; 38:259–266.

10. Yen IH, Syme SL. The social environment and health : a discussion of the epidemiologic literature. Annu Rev Public Health. 1999; 20:287–308.

11. Pattussi MP, Hardy R, Sheiham A. The potential impact of neighborhood empowerment on dental caries among adolescents. Community Dent Oral Epidemiol. 2006; 34:344–350.

12. Turrell G, Sanders AE, Slade GD, Spencer AJ, Marcenes W. The independent contribution of neighborhood disadvantage and individual-level socioeconomic position to self-reported oral health: a multilevel analysis. Community Dent Oral Epidemiol. 2007; 35:195–206.

13. Emmons KM. Health behaviors in a social context. Berkman LF, Kawachi I, editors. Social epidemiology. 1st ed.New York: Oxford University Press Inc;2000. p. 242–266.

14. The Korean Society for Equity in Health. Methods in health inequalities measurement. 1st ed. Seoul: Hanul Publishing Group;2007. p. 84–86.

15. Pickett KE, Pearl M. Multilevel analyses of neighbourhood so-cieconomic contest and health outcomes: a critical review. J Epidemiol Community Health. 2001; 55:111–122.

16. Bower E, Gulliford M, Steele J, Newton T. Area deprivation and oral health in Scottish adults: a multilevel study. Community Dent Oral Epidemiol. 2007; 35:118–129.

17. Lumme S, Leyland AH, Keskimäki I. Multilevel modeling of regional variation in equity in health care. Med Care. 2008; 46:976–983.

18. Antunes JL, Peres MA, de Campos Mello TR, Waldman EA. Multilevel assessment of determinants of dental caries experience in Brazil. Community Dent Oral Epidemiol. 2006; 34:146–152.

19. Aida J, Ando Y, Oosaka M, Niimi K, Morita M. Contributions of social context to inequality in dental caries: a multilevel analysis of Japanese 3-year-old children. Community Dent Oral Epidemiol. 2008; 36:149–156.

20. Hox JJ. Multilevel analysis: techniques and applications. 2nd ed. Mahwah: Lawrence Erlbaum Associates;2002. p. 1–36.

21. Salmond C, Crampton P, Atkinson J. NZDep2006 index of deprivation user’s manual. Wellington: Depratment of Public Health University of Otago;2007. p. 1–16.

22. Shin YJ, Yoon TH, Kim MH. Health promotion strategies and programs development for health inequalities alleviation. Seoul: Industry-University Cooperation Foundation Hanyang University·Korea Health Promotion Foundation;2009. p. 228–233.

23. Locker D. Deprivation and oral health: a review. Community Dent Oral Epidemiol. 2000; 28:161–169.

24. Von Korff M, Koepsell T, Curry S, Diehr P. Multi-level analysis in epidemiologic research on health behaviors and outcomes. Am J Epidemiol. 1992; 135:1077–1082.

25. Kim SI, Lee HR, Ma DS, Park DY, Jung SH. The differences of oral health-related behaviors by type of school among high school students in Gangneung city. J Korean Acad Oral Health. 2012; 36:309–314.

26. Macintyre S, Ellaway A. Ecological approaches: rediscovering the role of the physical and social environment. Berkman LF, Kawach I, editors. Social Epidemiology. 1st ed.New York: Oxford University Press Inc;2000. p. 345.