Changes in Socioeconomic Inequalities in the Use of Dental Care Following Major Healthcare Reform in Chile, 2004–2009
Abstract
:1. Introduction
2. Methods
- Variables related to the use of dental care:
- •
- Prevalence of the use of dental care defined as the percentage of individuals who reported that they had used dental care in the previous two years.
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- Intensity of use, measured as the mean number of visits to dentist in the previous two years.
- Demographic and socioeconomic variables:
- •
- Sex
- •
- Age, categorized as 20–39, 40–59, 60–63, and ≥64 years. As a proxy for the target population of AUGE-preg, we used women aged 20–39 years, since 84% of pregnant women fall into this age group at the time of pregnancy (mean 27 years old) [12]. Allowing for the fact that the survey asked for dental care received in the previous two years, individuals aged 60 to 63 years are expected to be incorporated into the AUGE-60 group.
- •
- Educational level was assigned according to the International Standard Classification of Education (ISCED-97) as primary (complete primary or less), secondary (partial or complete), or higher (university or higher technical complete or incomplete).
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- Socioeconomic status (SES) was also assigned as quintiles of a continuous variable representing standard of living according to an asset-index, considering data on households durable and non-durable goods. This index has been proposed by the World Bank [13] and is often preferred to income or expenditure data, as it gives a measure of long-run (permanent) income than current income, which is subject to short-run variations that may distort SES ranking. Other SES variables, such as geographical location were not considered, as they are strongly related to material welfare [14].
- •
3. Results and Discussion
3.1. Results
Characteristics | Total | Men | Women | ||||
---|---|---|---|---|---|---|---|
2004 (n = 16,560) % | 2009 (n = 14,353) % | 2004 (n = 8290) % | 2009 (n = 7017) % | 2004 (n = 8270) % | 2009 (n = 7335) % | ||
Total | 100 | 100 | 50 | 49 | 50 | 51 | |
Age | 20–39 | 38.5 | 37.9 | 39.1 | 39.3 | 38.8 | 35.0 |
40–59 | 40.0 | 41.2 | 39.3 | 40.9 | 39.7 | 42.0 | |
60–63 | 5.0 | 6.2 | 5.0 | 6.5 | 5.0 | 6.0 | |
≥64 years | 16.5 | 14.7 | 16.3 | 13.3 | 16.9 | 17.0 | |
Educational level | Primary | 37.1 | 36.9 | 37.8 | 35.7 | 37.6 | 37.6 |
Secondary | 42.9 | 44.0 | 42.1 | 43.1 | 43.4 | 45.0 | |
Higher | 20.0 | 19.1 | 20.1 | 21.2 | 19.0 | 17.4 | |
Insurance & | Uninsured | 9.0 | 5.1a | 12.0 | 6.0a | 8.0 | 3.1a |
Public | 75.0 | 80.9 | 70.9 | 76.9 | 76.9 | 84.9 | |
Private | 16.0 | 14.0 | 17.1 | 17.1 | 15.1 | 12.0 | |
Socioeconomic quintile | 1 | 22.7 | 22.6 | 24.0 | 23.7 | 21.5 | 21.6 |
2 | 20.7 | 21.1 | 20.3 | 20.2 | 20.9 | 22.0 | |
3 | 19.6 | 20.2 | 18.5 | 19.5 | 20.8 | 20.9 | |
4 | 19.5 | 19.3 | 18.9 | 19.2 | 20.0 | 19.2 | |
5 (better-off) | 17.5 | 16.8 | 18.3 | 17.4 | 16.8 | 16.3 |
Variable | Total | Men | Women | |||||||
---|---|---|---|---|---|---|---|---|---|---|
2004 % | 2009 % | Absolute Change in Prevalence 2009–2004 % | 2004 % | 2009 % | Absolute Change in Prevalence 2009–2004 % | 2004 % | 2009 % | Absolute Change in Prevalence 2009–2004 % | ||
Age | 20–39 | 18.3 | 23.8 | 5.5 | 16.2 | 22.1 | 5.9 | 20.3 | 25.7 | 5.4 |
40–59 | 13.6 | 19.3 | 5.7 | 10.4 | 16.4 | 6.0 | 16.3 | 21.9 | 5.6 | |
60–63 | 12.7 | 21.9 | 9.2 | 10.4 | 17.2 | 6.8 | 14.9 | 26.4 | 11.5 | |
≥64 | 10.9 | 12.2 | 1.3 | 9.2 | 9.8 | 0.6 | 12.5 | 13.7 | 1.2 | |
Educational level | Primary | 8.5 | 13.4 | 4.9 | 6.9 | 10.4 | 3.5 | 10.0 | 15.8 | 5.8 |
Secondary | 14.8 | 20.2 | 5.4 | 11.6 | 17.9 | 6.3 | 17.5 | 22.0 | 4.5 | |
Higher | 27.4 | 30.5 | 3.1 | 24.7 | 27.0 | 2.3 | 30.1 | 34.5 | 4.4 | |
Insurance & | Uninsured | 9.9 | 12.9 | 3.0 | 7.3 | 10.4 | 3.1 | 13.8 | 17.9 | 4.1 |
Public | 13.1 | 18.6 | 5.5 | 10.8 | 16.1 | 5.3 | 15.0 | 20.7 | 5.7 | |
Private | 27.3 | 30.6 | 3.3 | 24.0 | 27.1 | 3.1 | 30.8 | 35.1 | 4.3 | |
Socioeconomic quintile | 1 | 7.7 | 13.5 | 5.8 | 5.9 | 11.4 | 5.5 | 9.6 | 16.5 | 6.9 |
2 | 10.2 | 15.9 | 5.7 | 7.6 | 14.2 | 6.6 | 12.5 | 17.3 | 4.8 | |
3 | 13.0 | 18.2 | 5.2 | 10.3 | 16.0 | 5.7 | 15.2 | 20.0 | 4.8 | |
4 | 17.5 | 23.9 | 6.4 | 14.7 | 20.7 | 6.0 | 20.0 | 27.1 | 7.1 | |
5 (better-off) | 26.4 | 28.5 | 2.1 | 24.0 | 26.0 | 2.0 | 28.9 | 31.0 | 2.1 | |
Total | 14.9 | 19.9 | 5.0 | 12.5 | 17.4 | 4.9 | 17.1 | 22.2 | 5.1 |
Variable | Total | Men | Women | |||||||
---|---|---|---|---|---|---|---|---|---|---|
2004 Mean | 2009 Mean | Absolute Change in Mean Number 2009–2004 | 2004 Mean | 2009 Mean | Absolute Change in Mean Number 2009–2004 | 2004 Mean | 2009 Mean | Absolute Change in Mean Number 2009–2004 | ||
Age | 20–39 | 0.874 | 1.084 | 0.210 | 0.666 | 0.826 | 0.160 | 1.077 | 1.360 | 0.283 |
40–59 | 0.624 | 0.809 | 0.185 | 0.386 | 0.605 | 0.219 | 0.831 | 0.995 | 0.164 | |
60–63 | 0.470 | 0.881 | 0.411 | 0.404 | 0.661 | 0.257 | 0.530 | 1.091 | 0.561 | |
≥64 | 0.521 | 0.427 | –0.094 | 0.411 | 0.436 | 0.025 | 0.617 | 0.421 | –0.196 | |
Educational level | Primary | 0.320 | 0.812 | 0.492 | 0.232 | 0.445 | 0.213 | 0.400 | 1.111 | 0.711 |
Secondary | 0.719 | 1.367 | 0.648 | 0.488 | 1.465 | 0.977 | 0.920 | 1.285 | 0.365 | |
Higher | 1.360 | 1.750 | 0.390 | 1.028 | 1.213 | 0.185 | 1.678 | 2.366 | 0.688 | |
Insurance & | Uninsured | 0.405 | 0.690 | 0.285 | 0.228 | 0.247 | 0.019 | 0.674 | 1.587 | 0.913 |
Public | 0.606 | 1.162 | 0.556 | 0.445 | 0.856 | 0.411 | 0.738 | 1.414 | 0.676 | |
Private | 1.344 | 2.454 | 1.110 | 0.973 | 2.353 | 1.380 | 1.730 | 2.583 | 0.853 | |
Socioeconomic quintile | 1 | 0.318 | 1.140 | 0.822 | 0.203 | 1.293 | 1.090 | 0.433 | 0.989 | 0.556 |
2 | 0.434 | 0.892 | 0.458 | 0.268 | 0.734 | 0.466 | 0.582 | 1.019 | 0.437 | |
3 | 0.557 | 1.327 | 0.770 | 0.417 | 0.750 | 0.333 | 0.668 | 1.828 | 1.160 | |
4 | 0.866 | 1.355 | 0.489 | 0.509 | 0.927 | 0.418 | 1.170 | 1.783 | 0.613 | |
5 (better-off) | 1.331 | 1.835 | 0.504 | 1.103 | 1.425 | 0.322 | 1.564 | 2.228 | 0.664 | |
Total | 0.696 | 0.860 | 0.164 | 0.503 | 0.677 | 0.174 | 0.871 | 1.030 | 0.159 |
Sex | Prevalence of Visiting the Dentist | Average Number of Visits to the Dentist | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
2004 | 2009 | Absolute Change in CIndex 2009–2004 | 2004 | 2009 | Absolute Change in CIndex 2009–2004 | |||||
CIndex | sd | CIndex | sd | CIndex | sd | CIndex | sd | |||
Men | ||||||||||
20–39 | 0.238 | 0.022 | 0.140 | 0.023 | −0.098 | 0.280 | 0.034 | 0.222 | 0.035 | −0.058 |
40–59 | 0.316 | 0.027 | 0.240 | 0.022 | −0.077 | 0.336 | 0.035 | 0.306 | 0.044 | −0.030 |
60–63 | 0.427 | 0.072 | 0.133 | 0.058 | −0.293 | 0.547 | 0.094 | 0.177 | 0.087 | −0.370 |
64 and over | 0.428 | 0.042 | 0.123 | 0.050 | −0.305 | 0.564 | 0.078 | 0.179 | 0.108 | −0.385 |
Total men | 0.309 | 0.015 | 0.192 | 0.014 | −0.117 | 0.364 | 0.024 | 0.260 | 0.044 | −0.104 |
Women | ||||||||||
20–39 | 0.173 | 0.020 | 0.146 | 0.021 | −0.027 | 0.255 | 0.034 | 0.175 | 0.052 | −0.080 |
40–59 | 0.227 | 0.022 | 0.128 | 0.020 | −0.099 | 0.216 | 0.041 | 0.142 | 0.037 | −0.074 |
60–63 | 0.307 | 0.061 | −0.003 | 0.051 | −0.310 | 0.313 | 0.076 | 0.031 | 0.071 | −0.281 |
64 and over | 0.273 | 0.036 | 0.123 | 0.039 | −0.149 | 0.406 | 0.051 | 0.124 | 0.129 | −0.282 |
Total women | 0.219 | 0.013 | 0.142 | 0.013 | −0.077 | 0.268 | 0.023 | 0.177 | 0.028 | −0.091 |
Total | 0.255 | 0.010 | 0.162 | 0.009 | −0.093 | 0.299 | 0.017 | 0.206 | 0.019 | −0.093 |
3.2. Discussion
4. Conclusions
Acknowledgments
Author Contributions
Conflicts of Interest
References
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Share and Cite
Cornejo-Ovalle, M.; Paraje, G.; Vásquez-Lavín, F.; Pérez, G.; Palència, L.; Borrell, C. Changes in Socioeconomic Inequalities in the Use of Dental Care Following Major Healthcare Reform in Chile, 2004–2009. Int. J. Environ. Res. Public Health 2015, 12, 2823-2836. https://doi.org/10.3390/ijerph120302823
Cornejo-Ovalle M, Paraje G, Vásquez-Lavín F, Pérez G, Palència L, Borrell C. Changes in Socioeconomic Inequalities in the Use of Dental Care Following Major Healthcare Reform in Chile, 2004–2009. International Journal of Environmental Research and Public Health. 2015; 12(3):2823-2836. https://doi.org/10.3390/ijerph120302823
Chicago/Turabian StyleCornejo-Ovalle, Marco, Guillermo Paraje, Felipe Vásquez-Lavín, Glòria Pérez, Laia Palència, and Carme Borrell. 2015. "Changes in Socioeconomic Inequalities in the Use of Dental Care Following Major Healthcare Reform in Chile, 2004–2009" International Journal of Environmental Research and Public Health 12, no. 3: 2823-2836. https://doi.org/10.3390/ijerph120302823