Trends in socioeconomic inequality of periodontal health status among Dutch adults: a repeated cross-sectional analysis over two decades.

BACKGROUND: Studies exclusively focusing on trends in socioeconomic inequality of oral health status in industrialized countries are relatively sparse. This study aimed to assess possible differences in oral hygiene and periodontal status among people of different socioeconomic status (SES) in the Netherlands over two decades. METHODS: A repeated cross-sectional analysis of 3083 participants aged 25-54 years was conducted on the Dutch National Oral Health Surveys of 1995, 2002, 2007, and 2013. Plaque-free was defined according to the Simplified Oral Hygiene Index (OHI-S = 0). Periodontal status was classified in two different ways, either periodontal health/disease (probing pocket depth index [PDI] = 0/ ≥ 1) or with/without deep pockets (PDI = 2). We used the regression-based absolute and relative effect index to measure the absolute and relative socioeconomic inequalities. Multivariable logistic regressions were used to explore temporal trends in oral hygiene and periodontal status by low- and high-SES groups. RESULTS: Age-standardized percentages of individuals with plaque-free increased in the whole population from 1995 to 2013 (12.7% [95% CI 10.5-14.9] to 28.1% [24.8-31.5]). Plaque-free showed significant socioeconomic differences in absolute and relative inequalities in 2007 and 2013. Between 1995 and 2013, age-standardized percentage of periodontal health increased (from 51.4% [48.1-54.7] to 60.6% [57.0-64.1]). The significant absolute inequalities for periodontal health were seen in 2002 and 2013. The relative scale presented a similar pattern. Regarding deep pockets, there was little difference in the age-standardized overall prevalence in 1995 versus 2013 (from 6.5% [4.9-8.2] to 5.4% [3.7-7.0]). The significant absolute and relative inequalities in deep pockets prevalence were found in 1995. Yet, all interaction terms between survey year and SES did not reach significance (plaque-free: P = .198; periodontal health: P = .490; deep pockets: P = .678). CONCLUSIONS: Socioeconomic inequalities in oral hygiene and periodontal status were present in the Netherlands in the last two decades.

Oral health and oral health behaviour of adolescents with mild or borderline intellectual disabilities compared with a national representative sample of 17-year-olds in the Netherlands.

BACKGROUND: People with intellectual disabilities have worse health outcomes compared to their peers without. However, regarding oral health parameters, recent systematic reviews reported conflicting evidence. The aim was to assess whether adolescents with MBID differ from their peers in oral health and oral health behaviour. METHODS: Ninety seven adolescents with MBID participated in this comparative study. Outcomes were compared to data of 17-year-old Dutch adolescents (n = 581) from a national epidemiological study on oral health and oral health behaviour. RESULTS: Adolescents with MBID showed worse oral health outcomes and poorer oral hygiene than their peers from the general population. Furthermore, they visit the dentist less regularly, brush less frequently, eat main-dishes less frequently and have higher levels of dental anxiety. CONCLUSION: Adolescents with MBID have poorer oral health and show worse oral health-promoting behaviours than their peers in the general population. Targeted interventions to reach this vulnerable group are necessary.

Estimating a Dutch Value Set for the Pediatric Preference-Based CHU9D Using a Discrete Choice Experiment with Duration.

OBJECTIVE: This article presents the development of the Dutch value set for the Child Health Utility 9D, a pediatric preference-based measure of quality of life that can be used to generate quality-adjusted life-years. METHODS: A large online survey was conducted using a discrete choice experiment including a duration attribute with adult members of the Netherlands general population (N = 1276) who were representative in terms of age, gender, marital status, employment, education, and region. Respondents were asked which of two health states they prefer, where each health state was described using the nine dimensions of the Child Health Utility 9D (worried, sad, pain, tired, annoyed, school work/homework, sleep, daily routine, able to join in activities) and duration. The data were modeled using conditional logit with robust standard errors to produce utility values for every health state described by the Child Health Utility 9D. RESULTS: The majority of the dimension level coefficients were monotonic, leading to a decrease in utility as severity increases. There was, however, evidence of some logical inconsistencies, particularly for the school work/homework dimension. The value set produced was based on the ordered model and ranges from -0.568 for the worst state to 1 for the best state. CONCLUSION: The valuation of the Child Health Utility 9D using online discrete choice experiment with duration with adult members of the Dutch general population was feasible and produced a valid model for use in cost utility analysis. Normative questions are raised around the valuation of pediatric preference-based measures, including the appropriate perspective for imagining hypothetical pediatric health states.