Inequities in Unmet Oral Care Needs after a Swedish Subsidization Reform: An Intersectional Analysis.

IF 2.2 Q2 DENTISTRY, ORAL SURGERY & MEDICINE
C Anticona, A L Suominen, J L Bastos, P Lif Holgerson, P E Gustafsson
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引用次数: 0

Abstract

Introduction: The main strategy to achieve equal provision of oral care in Sweden has been to offer partial subsidies for the adult population. However, their effects on unmet oral care needs (UOCNs) have not been extensively assessed.

Objective: This study used an intersectionality framework to examine 1) the overall frequency of UOCNs, 2) single-indicator inequities, and 3) intersectional inequities in total UOCNs and financial-related UOCNs (FUOCNs) in Sweden before and after implementation of a partial subsidization reform in 2008.

Methods: Data from 12 national surveys conducted over 2004 to 2018 were divided into 3 periods: prereform (2004 to 2007), early postreform (2008 to 2011), and late postreform (2012 to 2018). The analytic sample consisted of 98,177 respondents aged 24 to 84 y. Changes in the prevalence of UOCNs were estimated by inferential statistics. Single-indicator and intersectional inequities were examined by intersectional analysis of individual heterogeneity and discriminatory accuracy, across 48 strata defined by gender, age, educational level, income, and immigrant status.

Results: The prevalence of total UOCNs and FUOCNs decreased significantly early after the reform, followed by a slight rebound. Relative inequities increased by education, income, and immigrant status after the reform and decreased for age. The discriminatory accuracy for both types of UOCNs was moderate and improved marginally but significantly with the inclusion of the intersectional strata. Most intersectional strata showed greater FUOCN inequities after the reform.

Conclusions: Contrary to expected, larger inequities in FUOCNs were identified in most intersectional strata after the reform. The moderate discriminatory accuracy suggested that Sweden could benefit from future strategies to foster equity that are universal but proportionately more intense among the intersectional strata with greater inequities (proportionate universalism).

Knowledge transference statement: This analysis highlighted the benefit of adopting the principle of proportionate universalism as a strategy to reduce unmet oral care needs in Sweden. This would mean implementing universal strategies and specific support measures for the most vulnerable social groups as a future oral care policy change in Sweden.

瑞典补贴改革后未满足口腔护理需求的不公平:交叉分析。
引言:在瑞典实现平等提供口腔护理的主要策略是为成年人口提供部分补贴。然而,它们对未满足的口腔护理需求(uocn)的影响尚未得到广泛评估。目的:本研究使用交叉性框架来检验瑞典在2008年实施部分补贴改革前后uocn总数和财政相关uocn (fuocn)的交叉不平等:1)uocn的总体频率,2)单指标不平等,以及3)交叉不平等。方法:2004 - 2018年12项全国调查数据分为改革前(2004 - 2007年)、改革初期(2008 - 2011年)和改革后期(2012 - 2018年)3个阶段。分析样本包括98,177名年龄在24岁至84岁之间的受访者。通过推论统计估计UOCNs患病率的变化。通过交叉分析个体异质性和歧视准确性来检验单指标和交叉不平等,跨越48个由性别、年龄、教育水平、收入和移民身份定义的阶层。结果:改革后早期总uocn和fuocn患病率明显下降,随后略有回升。改革后,相对不平等随着教育、收入和移民身份的增加而增加,随着年龄的增加而减少。这两种类型的uocn的区分精度都是中等的,并且在包含相交地层后略有提高,但显著提高。改革后,大多数相交阶层表现出更大的FUOCN不平等。结论:与预期相反,改革后在大多数交叉层中发现了更大的fuocn不平等。适度的歧视性准确性表明,瑞典可以从未来的战略中获益,以促进普遍的平等,但在更不平等的交叉阶层中比例更强烈(比例普遍主义)。知识转移声明:该分析强调了采用比例普遍主义原则作为减少瑞典未满足的口腔护理需求的策略的好处。这将意味着实施普遍的战略和具体的支持措施,为最脆弱的社会群体作为未来的口腔护理政策在瑞典的变化。
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来源期刊
JDR Clinical & Translational Research
JDR Clinical & Translational Research DENTISTRY, ORAL SURGERY & MEDICINE-
CiteScore
6.20
自引率
6.70%
发文量
45
期刊介绍: JDR Clinical & Translational Research seeks to publish the highest quality research articles on clinical and translational research including all of the dental specialties and implantology. Examples include behavioral sciences, cariology, oral & pharyngeal cancer, disease diagnostics, evidence based health care delivery, human genetics, health services research, periodontal diseases, oral medicine, radiology, and pathology. The JDR Clinical & Translational Research expands on its research content by including high-impact health care and global oral health policy statements and systematic reviews of clinical concepts affecting clinical practice. Unique to the JDR Clinical & Translational Research are advances in clinical and translational medicine articles created to focus on research with an immediate potential to affect clinical therapy outcomes.
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