RESEARCH PAPER
Socio-economic inequalities in the use of dental care in urban and rural areas in Poland
 
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1
Department of Public Health, Medical University, Białystok, Poland
2
Medical Centre, Łomza, Poland
3
Department of Statistics and Medical Informatics, Medical University, Białystok, Poland
4
Department of Medical Law and Medical Deontology, Medical University, Białystok, Poland
5
Department of Epidemiology and Biostatistics, Institute of Rural Health, Lublin, Poland
CORRESPONDING AUTHOR
Dorota Elżbieta Piotrowska   

Department of Public Health, Medical University of Bialystok, UL.Szpitalna 37, 15-295 Białystok, Poland
 
Ann Agric Environ Med. 2018;25(3):512–516
KEYWORDS
TOPICS
ABSTRACT
Introduction:
The issue of inequalities in the use of health services and health inequalities between urban and rural dwellers is a subject of numerous scientific reports, but similar publications on dental health are scarce.

Objective:
The aim of this study is to assess the correlations between the use or non-use of dental services and the classical socio-economic factors (SES) in urban and rural groups in a representative population of Poland.

Material and methods:
The analysis consisted in desk research based on a questionnaire survey conducted by the Central Statistical Office of Poland on 12,532 individuals (urban areas – 6411, rural areas – 6121) in 2013. The chi-squared test, multivariate and univariate logistic regression models were applied.

Results:
There were major differences in the use of dental services depending on income level, education and source of income among rural and urban populations, as well as differences between these populations. Urban dwellers had 1.34 times greater odds of using dental services than rural ones (95% CI: 1.20–1.51). In the case of the highest income group, the odds were 3.26 (95% CI 2.21–4.83) times greater in cities and 2.07 (95% CI 1.51–2.85) times greater in villages than the odds in the lowest income group. In the highest education group, the odds were 1.58 (95% CI 1.17–2.13) times greater in urban areas and 2.08 (95% CI 1.48–2.91) times greater in rural areas than the odds in the lowest education group.

Conclusions:
There are considerable inequalities in the use of dental services, yet the differences in non-use, despite such a need, are less evident. This could imply that health disparities arise not only from economic constraints and unavailability of health care, but also from health attitudes and behaviours.

 
REFERENCES (29)
1.
Costa SM, Martins CC, Bonfim MdeLC, Zina LG, Paiva S, Pordeus I, Abreu M. A Systematic review of socioeconomic indicators and dental caries in adults. Int J Environ Res Public Health 2012; 9: 3540–3574.
 
2.
Veugelers P J, Yip A M. Socioeconomic disparities in health care use: Does universal coverage reduce inequalities in health? J Epidemiol Community Health 2003; 57: 424–428.
 
3.
Wojtyniak B, Stokwiszewski J, Goryński P, Zdrojewski T. Długość życia i umieralność ludności Polski. In: Wojtyniak B, Goryński P. editors. Sytuacja zdrowotna ludności Polski i jej uwarunkowania. NIZP-PZH, Warszawa; 2016. p. 49–60.
 
4.
Central Statistical Office in Poland; Health status of population in Poland 2014. https://stat.gov.pl/en/topics/....
 
5.
Eurostat. Self-reported unmet needs for medical examination by sex, age, main reason declared and degree of urbanization. http://ec.europa.eu/eurostat/w....
 
6.
WHO. Social ineqalities in health in Poland. WHO Regional Office for Europe; 2012. p. 79–113.
 
7.
Laskowska I. Availability of health services vs. health condition of residents of rural areas in Poland – Analysis performed on the basis of EHIS 2009. Ann Agric Environ Med. 2015; 22(4): 700–703.
 
8.
Panasiuk L, Kosiniak-Kamysz W, Horoch A, Paprzycki P, Karwat D. Tooth loss among adult rural and urban inhabitants of the Lublin Region. Ann Agric Environ Med. 2013; 20(3): 637–641.
 
9.
Mazur J. Inequalities in the health of the school-aged children based on the results of the health behavior in school-aged children HBSC 2014 – In: Wojtyniak B, Mazur J. editors Social inequalities in child and adolescent health in Poland in light of population studies. NIZP-PZH, Warsaw 2016; 2016. p. 129–138.
 
10.
Zieliński A. Nierówności w zdrowiu a polityka społeczna. Przegl Epidemiol. 2015; 69: 817 – 822.
 
11.
Raittio E, Kiiskinen U, Helminen S, Aromaa A, Suominen AL. Income-related inequality and inequity in the use of dental services in Finland after a major subsidization reform. Community Dent Oral Epidemiol. 2015; 43: 240–254.
 
12.
Petersen PE, Kwan S. Equity, social determinants and public health programs – the case of oral health. Community Dent Oral Epidemiol. 2011; 39: 481–487.
 
13.
Devaux M. Income-related inequalities and inequities in health care services utilisation in 18 selected OECD countries. Eur J Health Econ. 2015; 16: 21–33.
 
14.
Marmot M. Health inequalities in the EU — Final report of a consortium. Consortium lead: Sir Michael Marmot; European Comission Directorate-General for Health and Consumer; European Union; 2013. p. 40–56.
 
15.
Bachanek T, Klichowska-Palonka M, Wolańska E, Orłowski M. Comparative study of the permanent dentition among 12-year-old children in the Lublin Region. Zdr Publ. 2009; 119(4): 391–394.
 
16.
Wójcicka A, Zalewska M, Czerech M, Jabłoński R, Grabowska SZ, Maciorkowska E. Dental caries of the developmental age as a civilization disease. Przegl Epidemiol. 2012; 66: 705–711.
 
17.
Kamińska A, Szalewski L, Batkowska J, Wallner J, Wallner E, Szabelska A, Borowicz J. The dependence of dental caries on oral hygiene habits in preschool children from urban and rural areas in Poland. Ann Agric Environ Med. 2016; 23(4): 660–665.
 
18.
Gaszyńska E, Wierzbicka M, Marczak M, Szatko F. Thirty years of evolution of oral health behaviours and dental caries in urban and rural areas in Poland. Ann Agric Environ Med. 2014; 21(3): 557–561.
 
19.
Stolarska A. Changes of income situation of Polish rural families after EU accession. Zeszyty Naukowe Szkoły Głównej Gospodarstwa Wiejskiego Ekonomika i Organizacja Gospodarki Żywnościowej nr 107, 2014: 5–17.
 
20.
Piotrowska D, Pędziński B, Szpak A. Public and non-public financing of dental care services in Poland. Hygeia Public Health 2016; 51(1): 12–17.
 
21.
Regulation of Minister of Health from 6 November 2013 r. regarding guaranteed benefits in the field of dental treatment (Dz.U. 2013 poz. 1462 z późn. zm.).
 
24.
Bernabé E, Suominen AL, Nordblad A, Vehkalahti MM, Hausen H, Knuuttila M, Kivimäki M, Watt RG, Sheiham A, Tsakos G. Education level and oral health in Finnish adults: evidence from different life course models. J Clin Periodontol. 2011; 38: 25–32.
 
25.
Tsakos G, Sheiham A, Iliffe S, Kharicha K, Harari D, Swift CG, Gillman G, Stuck AE. The impact of educational level on oral health-related quality of life in older people in London. Eur J Oral Sci. 2009; 117: 286–292.
 
26.
Bartnik E, Biedrzycki K, Bracisiewicz J, Chłoń-Domińczak A,Choińska-Mika J, Czajkowska M, Dąbrowski M, et al. Raport o stanie edukacji 2010.Społeczeństwo w drodze do wiedzy. Instytut Badań Edukacyjnych, Warszawa; 2011. p. 24.
 
27.
Gomes AP, da Silva EG, Gonçalves SH, Huhtala MF, Martinho FC, Gonçalves SE, et al. Relationship between patient’s education level and knowledge on oral health preventive measures. Int Dent Med J Adv Res. 2015; 1: 1–7.
 
28.
Paulander J, Axelsson P, Lindhe J. Association between level of education and oral health status in 35-, 50-, 65- and 75-year-olds. J Clin Periodontol. 2003; 30: 697–704.
 
29.
Grembowski D, Spiekerman C, Milgrom P. Disparities in regular source of dental care among mother of Medicaid-enrolled preschool children. J Healt Care Poor Underserved 2007; 18(4): 789–813.
 
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