Sophie Franziska Reda|Seif Reda|W. Murray Thomson|Falk Schwendicke
Inequality in Utilization of Dental Services: A Systematic Review and Meta-analysis
Charité - Universitätsmedizin Berlin|University of Otago|Charité - Universitätsmedizin Berlin|University of Otago|Charité - Universitätsmedizin Berlin|University of Otago|Charité - Universitätsmedizin Berlin|University of Otago
background dental diseases among prevalent conditions worldwide universal access dental care one key tackling systematic quantification inequalities dental service utilization needed identify pronounced assess factors underlying inequalities evaluate changes inequalities time objectives evaluate presence extent inequalities dental services utilization search methods performed systematic review metaanalysis searching 3 electronic databases medline embase cochrane central database covering period january 2005 april 2017 selection criteria included observational studies investigating association regular dental service utilization sex ethnicity place living educational income occupational position insurance coverage status two reviewers undertook independent screening studies made decisions consensus data collection analysis primary outcome presence extent inequalities dental service utilization measured relative estimates usually odds ratios ors comparing different high low utilization groups performed random effects metaanalysis subgroup analyses region used metaregression assess whether associations changed time main results total 117 studies met inclusion criteria basis 7 830 810 participants dental services utilization lower male female participants 085 95 confidence interval ci 074 095 p lt 001 ethnic minorities immigrants ethnic majorities natives 071 95 ci 059 082 p lt 001 living rural living urban places 087 95 ci 076 097 p 011 lower higher educational position 061 95 ci 055 068 p lt 001 income 066 95 ci 054 079 p lt 001 among without insurance coverage status status 058 95 ci 049 068 p lt 001 occupational status 095 95 ci 081 109 p 356 significant impact utilization observed inequalities significantly change assessed 12year period universally present authors conclusions inequalities dental service utilization considerable globally consistent public health implications observed inequalities dental services utilization assumed significantly cause aggravate existing dental health inequalities policymakers address physical socioeconomic psychological causes underlying inequalities utilization