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Choi and Kim: Effects of socioeconomic level on dental scaling experience in the community: a multilevel analysis
Original Article

J Korean Acad Oral Health 2016;40(2):118-125.

Published online: 15 June 2016

DOI: https://doi.org/10.11149/jkaoh.2016.40.2.118

Effects of socioeconomic level on dental scaling experience in the community: a multilevel analysis

Eun Sil Choi1, Hae-Young Kim1, 2,

1BK21 PLUS Program in Embodiment: Health-Society Interaction, Department of Public Health Sciences, Graduate School, Korea University, Seoul, Korea

2Department of Health Policy and Management, College of Health Sciences, Korea University, Seoul, Korea

Corresponding Author: Hae-Young Kim Department of Health Policy and Management, College of Health Sciences, Korea University, 145 Anam-ro, Dongdaemun-gu, Seoul 02841, Korea Tel: +82-2-3290-5667 Fax: +82-2-940-2879 E-mail: hykim_dental@hotmail.com

Received 26 April 2016       Revised 27 May 2016       Accepted 13 June 2016

Copyright © 2016 by Journal of Korean Academy of Oral Health

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives

The purpose of this study was to investigate the associations between a community-level factor and dental scaling experience and to confirm the associations with individual factors in Korea.

Methods

In total, 203,088 individuals from 243 communities participated in the 2013 Community Health Survey. A dichotomized response of experiences with dental scaling was used as the outcome and the regional deprivation index was used as the explanatory community-level factor. In addition, various individual factors were included as covariates. In the bivariate analysis, the chi-square test was used. Multilevel multivariate logistic regression was also performed where in four models were applied. The bivariate analysis showed that all factors at the individual and community level showed significant associations with an individual's experience with dental scaling.

Results

The factors that were significantly associated with the dental scaling experience were being male, being 40-49 years old, having a higher income level, being economically active, having a higher education level, being a non-smoker, being a drinker, having good periodontal health, using oral hygiene products, tooth-brushing after lunch, and residing in less deprived regions (P<0.01). As with the results of multilevel logistic regression analysis, the regional deprivation index was significantly associated with scaling experience after adjusting for individual factors with an adjusted odds ratio of 0.98 (95% CI: 0.97-0.99), demonstrating an association between a lack of experience with scaling and lower socioeconomic status in the community.

Conclusions

This study indicated that the scaling experience was affected not only by individual factors, but also by factors at the community level. Future studies are required to examine the detailed relationships between oral health and other community factors such as medical and social capital.

Keywords: Community Level, Contextual Effect, Dental Scaling

References

1. National wage data: Health insurance statistical yearbook 2011 . [Internet]. [cited 2016 April 14]. Abailable from:. http://khiss.go.kr/board/bbs_read.jsp?tname=MINBOARD358&bbsid=B301&cat_bbsid=&bbs_seq=350&jkey=&jword=&pg=7&htxt_code=12536978062659050219061516896964&wj_vcs=&reverseNum=1&forwardNum=-1.
2. National health insurence servic. [Internet]. [cited 2016 April 14]. Abailable from. https://www.khiss.go.kr/board/bbs_read.jsp?tname=MINBOARD358&bbsid=B301&cat_bbsid=&bbs_seq=374&jkey=&jword=&pg=6&htxt_code=12536978062659050219061516896964&wj_vcs=&reverseNum=122&forwardNum=51.
3. Ministry of health and welfare. [Internet]. [cited 2016 April 14]. Abailable from:. http://rulesvc.hira.or.kr/lmxsrv/law/joHis-toryContent.srv?SEQ=52&SEQ_CONTENTS=48074&DATE_START=20001230&DATE_END=20130627&PAGE_MODE=print.
4. Um HS, Chang BS. Scaling and root planing. The Journal of the Korean Dental Association. 2000; 38:1019–1025.
5. Chung HJ, Kim YJ. Scaling and root planing. The Journal of the Korean Dental Association. 1995; 33:548–554.
6. Slots J, Mashimo P, Levine MJ, Genco RJ. Periodontal therapy in humans. 1. Microbiological and clinical effects of a single course of periodontal scaling and root planing, and of adjunctive teracycle therapy. J periodontol. 1979; 50:495–509.
7. Badersten A, Nilveus R, Egelberg J. Effect of nonsurgical periodontal therapy. II. Severely advanced periodontitis. J Clin Periodontol. 1984; 11:63–76.
crossref
8. Jang YE, Lee MY, Park SK, Kim YJ, Lee GY, Kim CB, et al. A 7-year study of the regional distribution of differences in scaling experience rate among Koreans. J Korean Acad Oral Health. 2015; 39:201–206.
crossref
9. Macintyre S, Ellaway A, Cummins S. Place effects on health: how can we conceptualise, operationalise and measure them? Soc Sci Med (1982). 2002; 55:125–139.
crossref
10. Kim YH, Cho YT. Impact of area characteristics on the health of vulnerable populations in Seoul. Korea Journal of Population Studies. 2008; 31:5–30.
11. Park EO. Cardiovascular disease-specific standardized mortality and the related factor in South Korea. Health and Social Welfare Review. 2013; 34:257–271.
12. No BI, Gwan HG. A multi-level study on the effect of community poverty and social ties on depression of urban residents. Mental Health & Social Work. 2003; 16:180–209.
13. Kim HY. Community inequalities in health: The contextual effect of social capital. Korean Journal of Sociology. 2010; 44:59–92.
14. Pickett KE, Pearl M. Multilevel analyses of neighbourhood socioeconomic context and health outcomes: a critical review. J Epidemiolo Community Health. 2001; 55:111–122.
crossref
15. Aida J, Kondo K, Kondo N, Watt RG, Sheiham A, Tsakos G. Income inequality, social capital and self-rated health and dental status in older Japanese. Soc Sci Med (1982). 2011; 73:1561–1568.
crossref
16. Lamarca GA, Leal Mdo C, Leao AT, Sheiham A, Vettore MV. The different roles of neighbourhood and individual social capital on oral health-related quality of life during pregnancy and postpartum: a multilevel analysis. Community Dent Oral Epidemiol. 2014; 42:139–150.
crossref
17. Kim MH, Cho YT. Social determinants of oral pain and dental service utilization among the elderly Seoul residents: a multilevel study. J Korean Acad Oral Health. 2007; 31:103–114.
18. Kim CS, Han SY, Kim CW. The relationship between regional socioeconomic position and oral health behavior: A multilevel approach analysis. J Korean Acad Oral Health. 2013; 37:208–215.
crossref
19. Kim Y. Factors associated with thyroid cancer screening of Korea using a multi-level analysis: Results from community health survey 2012 [master’s thesis]. Seoul: Yonsei University;2015. [Korea].
20. Peugh JL. A practical guide to multilevel modeling. J Sch Psychol. 2010; 48:85–112.
crossref
21. Raudenbush SW, Bryk AS. Hierarchical Linear Models. 1st ed.CA: Sage;2002. p. 68–94.
22. Tom A, Sinijiders Role J, Bosker RJ. Multilevel analysis: An introduction to basic and advanced multilevel modeling. 2nd ed.CA: Sage;2003. p. 354–355.
23. Sellstrom E, Bremberg S. Is there a “school effect” on pupil outcomes? A review of multilevel studies. J Epidemiol Community Health. 2006; 60:149–155.
crossref
24. Wamala S, Merlo J, Bostrom G. Inequity in access to dentalcare service explains current socioeconomic disparities in oral health: The Swedish National Surveys of Public Health 2004-2005. J Epidemiol Community Health. 2006; 60:1027–1033.
25. Palencia L, Espelt A, Comefo-Ovalle M, Borrell C. Socioeconomic inequalities in the use of dental care services in Europe: what is the role of public coverage? Community Dent Oral Epidemiol. 2014; 42:97–105.
crossref
26. Lang IA, Gibbs SJ, Steel N, Melzer D. Neighbourhood deprivation and dental service use: across-sectional analysis of older people in England. J Public Health. 2008; 30:472–478.
27. Kim TH, Kwon SW, Lee YJ. Health inequality of Seoul citizens by individual effects and community effects. Seoul Studies. 2012; 13:15–35.
28. Kim HY. Evaluation of effects of health behaviors and dental service use on the association between socioeconomic status and unmet dental treatment needs. J Korean Acad Oral Health. 2006; 30:85–94.
29. Lee WY. The role of selected health-related behaviors in the socioeconomic disparities in oral health among adults. Korean Journal of Health Education and Promotion. 2009; 26:129–140.
30. Jang JE. The Relationship of periodontal health reognition and self oral hygiene behaviors of dental clinic inpatient. J Den Hyg Sci. 2015; 15:666–672.
31. Shin BM, Jung SH. Sosio-economic inequalities in dental caries in Korea. J Korean Acad Oral Health. 2012; 36:144–152.
32. Hwang YJ, Cho YS, Lee SY. Awareness and satisfaction of health insurance coverage of dental scaling. J Den Hyg Sci. 2015; 15:620–627.
crossref
33. Choi ES, Jeong SR, Cho HA. Factors affection the use of oral hygiene devices in adults. J Den Hyg Sci. 2015; 15:775–7854.

Table 1.
The variables of this study
Classification The contents of variables
Dependent variables Scaling experience (last year)
Level Variables
Individual level Demographic factor: gender, age
Socioeconomic factors: income, economic activity, education
Health related factor: smoking, drinking
Oral health related factor: periodontal health, using of oral hygiene product, tooth brush after lunch
Community level Regional deprivation index
Table 2.
Scaling experience according to individual-level and community-level factors
Variable N (%) Scaling experience % Non-Scaling experience % P
Gender
Female 110,927 (54.6) 29.5 70.5 <0.001
Male 92,161 (45.4) 30.5 69.5
Age * 50.47±16.37
19-29 23,313 (11.5) 32.4 67.6 <0.001
30-39 33,014 (16.3) 35.3 64.7
40-49 41,057 (20.2) 35.7 64.3
50-59 42,860 (21.1) 35.0 65.0
60-69 31,917 (15.7) 26.3 73.7
≥70 30,927 (15.7) 11.4 88.6
Income
≤100 44,319 (21.8) 15.8 84.2 <0.001
≤250 55,098 (27.1) 26.9 73.1
≤400 49,264 (24.3) 33.9 66.1
>400 54,407 (26.8) 40.9 59.1
Economic activity
No 70,911 (34.9) 25.9 74.1 <0.001
Yes 132,177 (65.1) 32.1 67.9
Education level
≤Primary school 46,134 (22.7) 13.6 86.4 <0.001
Middle school 23,410 (11.5) 26.1 73.9
High school 61,015 (30.0) 32.3 67.7
≥College 72,529 (35.7) 39.6 60.4
Smoking
No 161,572 (79.6) 30.2 69.8 <0.001
Yes 41,516 (20.4) 28.9 71.1
Drinking
No 63,852 (31.4) 23.9 76.1 <0.001
Yes 139,236 (68.6) 32.7 67.3
Periodontal health
Poor 60,211 (29.6) 26.2 73.8 <0.001
Good 142,877 (70.4) 31.5 68.5
Using of oral hygiene product
No 152,584 (75.1) 23.1 76.9 <0.001
Yes 50,504 (24.9) 50.5 49.5
Tooth brush after lunch
No 85,402 (42.1) 22.2 77.8 <0.001
Yes 117,686 (57.9) 35.5 64.5
Community SES (range of RDI) * 0.485±3.849
Lowest (2.79-9.89) 50,336 (24.8) 25.8 74.2 <0.001
Lower (―0.16-2.78) 50,967 (25.1) 29.4 70.6
Higher (―2.93-―0.15) 50,249 (24.7) 28.7 71.3
Highest (―10.37-―2.92) 51,536 (25.4) 35.7 64.3

*Mean±SD. P-values by the chi-square test; SES (socio-economic status); RDI (regional deprivation index).

Table 3.
Multilevel logistic regression analysis for having scaling experience during last year
Fixed effects Model 1 Model 2 OR (95%CI) Model 3 OR (95%CI) Model 4 OR (95%CI)
Individual level
Gender
Female 1 1
Male 1.08 (1.06-1.05) 1.08 (1.06-1.05)
Age
19-29 1 1
30-39 1.06 (1.02-1.11) 1.06 (1.02-1.11)
40-49 1.20 (1.15-1.25) 1.20 (1.15-1.25)
50-59 1.57 (1.51-1.64) 1.57 (1.51-1.64)
60-69 1.57 (1.49-1.66) 1.57 (1.49-1.66)
≥70 0.82 (0.76-0.88) 0.82 (0.76-0.88)
Household income
≤100 1 1
≤250 1.21 (1.16-1.26) 1.21 (1.16-1.26)
≤400 1.36 (1.31-1.42) 1.36 (1.31-1.42)
>400 1.59 (1.31-1.42) 1.59 (1.31-1.42)
Economic activity
No 1 1
Yes 1.11 (1.01-1.14) 1.11 (1.01-1.14)
Education level
≤Primary school 1 1
Middle school 1.45 (1.38-1.52) 1.45 (1.38-1.52)
High school 1.67 (1.60-1.75) 1.67 (1.60-1.75)
≥Colleage 1.99 (1.88-2.01) 1.99 (1.90-2.01)
Smoking
No 1 1
Yes 0.91 (0.88-0.93) 0.91 (0.88-0.93)
Drinking
No 1 1
Yes 1.09 (1.06-1.12) 1.09 (1.06-1.12)
Periodontal health
Poor 1 1
Good 1.17 (1.14-1.21) 1.18 (1.15-2.21)
Using of oral hygiene product
No 1 1
Yes 2.44 (2.38-2.51) 2.45 (2.40-2.52)
Tooth brush after lunch
No 1 1
Yes 1.41 (1.38-1.45) 1.41 (1.38-1.45)
Community level
RDI 0.96 (0.95-0.97) 0.98 (0.97-0.99)
Random effects
Community level variance Tau 0.218*** 0.189*** 0.085*** 0.078***
ICC 0.062 0.056 0.025 0.023
Deviance (-2LL) 574,648.0 574,608.8 571,091.8 571,071
Number of parameters 1 2 19 20
Likelihood ratio test Model 1 vs. 2 Model 1 vs. 3 Model 3 vs. 4
Δ-2LL (Δdf) 39.2 (1)*** 3556.2 (18)*** 20.8 (1)***

***P<.001.

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