SOCIOECONOMIC INEQUALITIES IN ORAL HEALTH AND HEALTH-RELATED BEHAV IOURS: LITHUANIAN HAPIEE STUDY

Abstract

Aims: To assess the (1) prospective association between socioeconomic position (SEP) and oral health (OH) in Lithuanian adults and (2) role of behavioural factors in this association.

Methods: Data from the Health, Alcohol and Psychosocial factors In Eastern Europe (HAPIEE) study were used. The study obtained ethical approval from Ethics Committees at University College London and the Lithuanian University of Health Sciences and participants provided informed consent. A representative sample of 7,161 adults aged 45-75 years at baseline (2006-2008), stratified by sex and 5- year age groups, was randomly selected from the Kaunas population register (response rate: 67%). Baseline SEP (education, material deprivation), socio-demographic (sex, age, marital status and possession of household items), general health (long-term health problems and self-rated health) and behavioural (smoking, sugar and alcohol consumption) information was obtained from participants. Self-reported OH outcomes (edentulousness, self-rated oral health (SrOH) and Oral Impacts on Daily Performances–OIDP) were obtained from 5,057 adults through follow-up postal questionnaires in 2012 (response rate: 70.6%). Multivariable logistic regression models assessed the associations between SEP indicators and OH outcomes, sequentially adjusting for demographic, general health and behavioural factors.

Results: There were social gradients for edentulism with a higher proportion of edentate at each lower SEP level for both SEP markers (p<0.001), with a more than two-fold increase in the odds of edentulousness between the highest and lowest education categories. Both SEP measures were also significantly associated with SrOH (OR=2.4, 95% CI=1.6-3.7 for the highest deprivation group) and OIDP (OR=2.1, 95% CI=1.3-3.2 for the highest deprivation group). Adjustment for behaviours resulted in small attenuation of the socioeconomic inequalities in edentulousness only but not SrOH or OIDP, with smoking contributing most to this attenuation.

Conclusions: Consistent and significant socioeconomic inequalities were observed in the OH of Lithuanian middleaged and older adults with behavioural factors having a minor role explaining these associations.