Socioeconomic-related inequalities in oral hygiene behaviors: a cross-sectional analysis of the PERSIAN cohort study

  1. Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
  2. Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
  3. School of Health Administration, Faculty of Health, Dalhousie University, Halifax, Canada.
  4. Liver and Pancreatobiliary Disease Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
  5. Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
  6. Department of Internal Medicine, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
  7. Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
  8. Social Determinants of Health Research Center, Urmia University of Medical Sciences, Urmia, Iran.
  9. Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran.
  10. Digestive Disease Research Center, Ardabil University of Medical Sciences, Ardabil, Iran.
  11. Molecular Medicine Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
  12. Department of Biostatistics and Epidemiology, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
  13. Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran.
  14. Department of Anesthesiology, Sabzevar University of Medical Sciences, Sabzevar, Iran.
  15. Vice-Chancellor for Health, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
  16. Department of Oral and Maxillofacial of Radiology, Faculty of Dentistry, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
  17. Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran.
  18. Modeling in Health Research Center and School of Public Health, Department of Epidemiology and Biostatistics, Shahrekord University of Medical Sciences, Shahrekord, Iran.
  19. Nutrition Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
  20. Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
  21. Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
  22. Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran. fnajafi@kums.ac.ir.
  23. Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran. fnajafi@kums.ac.ir.
bmj open

Abstract

Background: Socioeconomic-related inequality in oral hygiene behaviors in Iran is poorly understood. This study aims to measure and decompose socioeconomic-related inequalities in oral hygiene behaviors among middle-aged and elderly adults in Iran.

Methods: A cross-sectional analysis was performed using data from the Prospective Epidemiological Research Studies in IrAN (PERSIAN), a large national cohort study. A total of 130,016 individuals aged 35 years and above from 17 cohort centers in Iran were included in the study. The normalized concentration index (Cn) was used to measure the magnitude of inequality in oral hygiene behaviors, i.e. brushing at least twice and flossing once daily, among middle-aged and elderly Iranian adults included in the cohort centers. Decomposition analysis was performed to quantify the contribution of each determinant to the observed inequality in oral hygiene behaviors.

Results: Totally, 65.5% of middle-aged and elderly adults brushed their teeth twice a day or more, 7.6% flossed at least once a day and 3.48% had both habits. The estimated Cn of the two habits combined, i.e. tooth brushing and dental flossing, for all provinces taken part in the PERSIAN cohort study was 0.399 (95% confidence interval [CI]: 0.383 to 0.417), indicating that the prevalence of the two habits combined is more concentrated among individuals with higher socioeconomic status. Inequality in oral hygiene behaviors was pro-rich in all cohort centers. The decomposition results suggested socioeconomic status as the main factor contributing to the overall inequality, followed by the level of education, and the province of residence.

Conclusion: A low prevalence of oral hygiene behaviors among middle-aged and elderly Iranian adults was observed. There was also a pro-rich inequality in oral hygiene behaviors among middle-aged and elderly adults in all cohort centers. These results suggest an urgent need for targeted policy interventions to increase the prevalence of preventive oral hygiene behaviors among the poor and less-educated middle-aged and elderly adults in Iran.

Keywords: Concentration index; Decomposition analysis; Iran; Oral hygiene behaviors; PERSIAN cohort; Socioeconomic inequalities.

How to Cite

Soofi M, Pasdar Y, Karami Matin B, Hamzeh B, Rezaei S, Kazemi Karyani A, Moradi Nazar M, Soltani S, Hajizadeh M, Salimi Y, Zangeneh A, Poustchi H, Sharafkhah M, Haghdoust AA, Shirzad Ahoodashti M, Mohammadkarimi V, Aghazadeh-Attari J, Mansour-Ghanaei F, Yazdanbod A, Eftekhar E, Rahimi Z, Bahramali E, Moslem A, Jamalizadeh A, Ardakani FE, Zanganeh M, Ahmadi A, Ostadrahimi A, Tohidinezhad F, Rahimi Kazerooni S, Najafi F. Socioeconomic-related inequalities in oral hygiene behaviors: a cross-sectional analysis of the PERSIAN cohort study. BMC Oral Health. 2020 Feb 28;20(1):63. doi: 10.1186/s12903-020-1036-6. PMID: 32111212; PMCID: PMC7048098.