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Stewart Williams, Jennifer
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Publications (10 of 42) Show all publications
Kriit, H. K., Stewart Williams, J., Lindholm, L., Forsberg, B. & Sommar, J. (2019). Health economic assessment of a scenario to promote bicycling as active transport in Stockholm, Sweden. BMJ Open, 9(9), Article ID e030466.
Open this publication in new window or tab >>Health economic assessment of a scenario to promote bicycling as active transport in Stockholm, Sweden
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2019 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 9, article id e030466Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To conduct a health economic evaluation of a proposed investment in urban bicycle infrastructure in Stockholm County, Sweden.

DESIGN: A cost-effectiveness analysis is undertaken from a healthcare perspective. Investment costs over a 50-year life cycle are offset by averted healthcare costs and compared with estimated long-term impacts on morbidity, quantified in disability-adjusted life years (DALYs). The results are re-calculated under different assumptions to model the effects of uncertainty.

SETTING: The Municipality of Stockholm (population 2.27 million) committed funds for bicycle path infrastructure with the aim of achieving a 15% increase in the number of bicycle commuters by 2030. This work is based on a previously constructed scenario, in which individual registry data on home and work address and a transport model allocation to different modes of transport identified 111 487 individuals with the physical capacity to bicycle to work within 30 min but that currently drive a car to work.

RESULTS: Morbidity impacts and healthcare costs attributed to increased physical activity, change in air pollution exposure and accident risk are quantified under the scenario. The largest reduction in healthcare costs is attributed to increased physical activity and the second largest to reduced air pollution exposure among the population of Greater Stockholm. The expected net benefit from the investment is 8.7% of the 2017 Stockholm County healthcare budget, and 3.7% after discounting. The economic evaluation estimates that the intervention is cost-effective and each DALY averted gives a surplus of €9933. The results remained robust under varied assumptions pertaining to reduced numbers of additional bicycle commuters.

CONCLUSION: Investing in urban infrastructure to increase bicycling as active transport is cost-effective from a healthcare sector perspective.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
Keywords
DALY, commuting, health economic evaluation, health impacts, transport mode shift
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-163491 (URN)10.1136/bmjopen-2019-030466 (DOI)31530609 (PubMedID)
Available from: 2019-09-23 Created: 2019-09-23 Last updated: 2019-09-26Bibliographically approved
Lu, S. S., Stewart Williams, J. & Nilsson Sommar, J. (2019). Inequalities in early childhood mortality in Myanmar: Association between parents' socioeconomic status and early childhood mortality. Global Health Action, 12(1), Article ID 1603516.
Open this publication in new window or tab >>Inequalities in early childhood mortality in Myanmar: Association between parents' socioeconomic status and early childhood mortality
2019 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 12, no 1, article id 1603516Article in journal (Refereed) Published
Abstract [en]

Background: Despite global achievements in reducing early childhood mortality, disparities remain. There have been empirical studies of inequalities conducted in low- and middle-income countries. However, there have been no epidemiological studies on socioeconomic inequalities and early childhood survival in Myanmar.

Objective: To estimate associations between two measures of parental socioeconomic status - household wealth and education - and age-specific early childhood mortality in Myanmar.

Methods: Using cross-sectional data obtained from the Myanmar Demographic Health Survey (2015-2016), univariate and multiple logistic regressions were performed to investigate associations between household wealth and highest attained parental education, and under-5, neonatal, post-neonatal and child mortality. Data for 10,081 children born to 5,932 married women (aged 15-49 years) 10 years prior to the survey, were analysed.

Results: Mortality during the first five years was associated with household wealth. In multiple logistic models, wealth was protective for post-neonatal mortality. After adjusting for individual proximate determinants, the odds of post-neonatal mortality in the richest households were 85% lower (95% CI: 50-96%) than in the poorest households. However, significant association was not found between wealth and neonatal mortality. Parental education was important for early childhood mortality; the highest benefit from parental education was for child mortality in the one- to five-year age bracket. After adjusting for proximate determinants, children with a higher educated parent had 95% (95% CI 77-99%) lower odds of death in this age group compared with children whose parents' highest educational attainment was at primary level. The association between parental education and neonatal mortality was not significant.

Conclusions: In Myanmar, household wealth and parental education are important for childhood survival before five years of age. This study identified nuanced age-related differences in associations. Health policy must take socioeconomic determinants into account in order to address unfair inequalities in early childhood mortality.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2019
Keywords
Household wealth, parental education, neonatal mortality, post-neonatal mortality, under-5 mortality
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-159641 (URN)10.1080/16549716.2019.1603516 (DOI)000467824000001 ()31066344 (PubMedID)
Available from: 2019-06-03 Created: 2019-06-03 Last updated: 2019-06-12Bibliographically approved
Kailembo, A., Quiñonez, C., Lopez Mitnik, G. V., Weintraub, J. A., Stewart Williams, J., Preet, R., . . . Dye, B. A. (2018). Income and wealth as correlates of socioeconomic disparity in dentist visits among adults aged 20 years and over in the United States, 2011–2014. BMC Oral Health, 18(1), Article ID 147.
Open this publication in new window or tab >>Income and wealth as correlates of socioeconomic disparity in dentist visits among adults aged 20 years and over in the United States, 2011–2014
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2018 (English)In: BMC Oral Health, ISSN 1472-6831, E-ISSN 1472-6831, Vol. 18, no 1, article id 147Article in journal (Refereed) Published
Abstract [en]

Background: Most studies in the United States (US) have used income and education as socioeconomic indicators but there is limited information on other indicators, such as wealth. We aimed to assess how two socioeconomic status measures, income and wealth, compare as correlates of socioeconomic disparity in dentist visits among adults in the US.

Methods: Data from the National Health and Nutrition Examination Survey (NHANES) 2011–2014 were used to calculate self-reported dental visit prevalence for adults aged 20 years and over living in the US. Prevalence ratios using Poisson regressions were conducted separately with income and wealth as independent variables. The dependent variable was not having a dentist visit in the past 12 months. Covariates included sociodemographic factors and untreated dental caries. Parsimonious models, including only statistically significant (p < 0.05) covariates, were derived. The Akaike Information Criterion (AIC) measured the relative statistical quality of the income and wealth models. Analyses were additionally stratified by race/ethnicity in response to statistically significant interactions.

Results: The prevalence of not having a dentist visit in the past 12 months among adults aged 20 years and over was 39%. Prevalence was highest in the poorest (58%) and lowest wealth (57%) groups. In the parsimonious models, adults in the poorest and lowest wealth groups were close to twice as likely to not have a dentist visit (RR 1.69; 95%CI: 1.51–1.90) and (RR 1.68; 95%CI: 1.52–1.85) respectively. In the income model the risk of not having a dentist visit were 16% higher in the age group 20–44 years compared with the 65+ year age group (RR 1.16; 95%CI: 1.04–1.30) but age was not statistically significant in the wealth model. The AIC scores were lower (better) for the income model. After stratifying by race/ethnicity, age remained a significant indicator for dentist visits for non-Hispanic whites, blacks, and Asians whereas age was not associated with dentist visits in the wealth model.

Conclusions: Income and wealth are both indicators of socioeconomic disparities in dentist visits in the US, but both do not have the same impact in some populations in the US.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
dental utilization, dental visits, disparities, income, inequalities, socioeconomic position, wealth
National Category
Dentistry Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-151112 (URN)10.1186/s12903-018-0613-4 (DOI)000442838700002 ()30139349 (PubMedID)
Available from: 2018-08-27 Created: 2018-08-27 Last updated: 2018-09-07Bibliographically approved
Tarekegne, F. E., Padyab, M., Schröders, J. & Stewart Williams, J. (2018). Sociodemographic and behavioral characteristics associated with self-reported diagnosed diabetes mellitus in adults aged 50+ years in Ghana and South Africa: results from the WHO-SAGE wave 1. BMJ Open Diabetes Research & Care, 6(1), Article ID e000449.
Open this publication in new window or tab >>Sociodemographic and behavioral characteristics associated with self-reported diagnosed diabetes mellitus in adults aged 50+ years in Ghana and South Africa: results from the WHO-SAGE wave 1
2018 (English)In: BMJ Open Diabetes Research & Care, ISSN 2052-4897, Vol. 6, no 1, article id e000449Article in journal (Refereed) Published
Abstract [en]

Objective: The objective is to identify and describe thesociodemographic and behavioral characteristics of adults,aged 50 years and over, who self-reported having beendiagnosed and treated for diabetes mellitus (DM) in Ghanaand South Africa.

Research design and methods: This is a cross-sectionalstudy based on the WHO Study on global AGEing and adulthealth (SAGE) wave 1. Information on sociodemographicfactors, health states, risk factors and chronic conditionsis captured from questionnaires administered in face-tofaceinterviews. Self-reported diagnosed and treated DM isconfirmed through a ‘yes’ response to questions regarding1having previously been diagnosed with DM, and2 havingtaken insulin or other blood sugar lowering medicines.Crude and adjusted logistic regressions test associationsbetween candidate variables and DM status. Analysesinclude survey sampling weights. The variance inflationfactor statistic tested for multicollinearity.

Results: In this nationally representative sample ofadults aged 50 years and over in Ghana, after adjustingfor the effects of sex, residence, work status, bodymass index, waist-hip and waist-height ratios, smoking,alcohol, fruit and vegetable intake and householdwealth, WHO-SAGE survey respondents who were older,married, had higher education, very high-risk waistcircumference measurements and did not undertakehigh physical activity, were significantly more likelyto report diagnosed and treated DM. In South Africa,respondents who were older, lived in urban areas andhad high-risk waist circumference measurements weresignificantly more likely to report diagnosed andtreated DM.

Conclusions: Countries in sub-Saharan Africa arechallenged by unprecedented ageing populations andtransition from communicable to non-communicablediseases such as DM. Information on those who arealready diagnosed and treated needs to be combinedwith estimates of those who are prediabetic or, as yet,undiagnosed. Multisectoral approaches that includesocioculturally appropriate strategies are needed toaddress diverse populations in SSA countries.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2018
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-144737 (URN)10.1136/bmjdrc-2017-000449 (DOI)29503732 (PubMedID)
Available from: 2018-02-12 Created: 2018-02-12 Last updated: 2018-06-09Bibliographically approved
Kailembo, A., Preet, R. & Stewart Williams, J. (2018). Socioeconomic inequality in self-reported unmet need for oral health services in adults aged 50 years and over in China, Ghana, and India. International Journal for Equity in Health, 17, Article ID 99.
Open this publication in new window or tab >>Socioeconomic inequality in self-reported unmet need for oral health services in adults aged 50 years and over in China, Ghana, and India
2018 (English)In: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 17, article id 99Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The 2015 Global Burden of Disease Study estimated that oral conditions affect 3.5 billion people worldwide with a higher burden among older adults and those who are socially and economically disadvantaged. Studies of inequalities in the use of oral health services by those in need have been conducted in high-income countries but evidence from low- and middle-income countries (LMICs) is limited. This study measures and describes socioeconomic inequality in self-reported unmet need for oral health services in adults aged 50 years and over, in China, Ghana and India.

METHODS: A cross-sectional analysis of national survey data from the WHO SAGE Wave 1 (2007-2010) was conducted. Study samples in China (n = 1591), Ghana (n = 425) and India (n = 1307) were conditioned on self-reported need for oral health services in the previous 12 months. The binary dependent variable, unmet need for oral health services, was derived from questions about self-reported need and service use. Prevalence was estimated by country. Unmet need was measured and compared in terms of relative levels of education and household wealth. The methods were logistic regression and the relative index of inequality (RII). Models were adjusted for age, sex, area of residence, marital status, work status and self-rated health.

RESULTS: The prevalence of unmet need was 60, 80, and 62% in China, Ghana and India respectively. The adjusted RII for education was statistically significant for China (1.5, 95% CI:1.2-1.9), Ghana (1.4, 95% CI: 1.1-1.7), and India (1.5, 95% CI:1.2-2.0), whereas the adjusted RII for wealth was significant only in Ghana (1.3, 95% CI:1.1-1.6). Male sex was significantly associated with self-reported unmet need for oral health services in India.

CONCLUSIONS: Given rapid population ageing, further evidence of socioeconomic inequalities in unmet need for oral health services by older adults in LMICs is needed to inform policies to mitigate inequalities in the availability of oral health services. Oral health is a universal public health issue requiring attention and action on multiple levels and across the public private divide.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
Access to care, Ageing, Dental, Inequalities, Low-and middle-income countries, Oral health policy, Socioeconomic status
National Category
Public Health, Global Health, Social Medicine and Epidemiology Dentistry
Identifiers
urn:nbn:se:umu:diva-150616 (URN)10.1186/s12939-018-0812-2 (DOI)000438430100001 ()29996847 (PubMedID)2-s2.0-85049807540 (Scopus ID)
Available from: 2018-08-14 Created: 2018-08-14 Last updated: 2018-08-27Bibliographically approved
Gwatidzo, S. D. & Stewart Williams, J. (2017). Diabetes mellitus medication use and catastrophic healthcare expenditure among adults aged 50+ years in China and India: results from the WHO study on global AGEing and adult health (SAGE). BMC Geriatrics, 17, Article ID 14.
Open this publication in new window or tab >>Diabetes mellitus medication use and catastrophic healthcare expenditure among adults aged 50+ years in China and India: results from the WHO study on global AGEing and adult health (SAGE)
2017 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 17, article id 14Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Expenditure on medications for highly prevalent chronic conditions such as diabetes mellitus (DM) can result in financial impoverishment. People in developing countries and in low socioeconomic status groups are particularly vulnerable. China and India currently hold the world's two largest DM populations. Both countries are ageing and undergoing rapid economic development, urbanisation and social change. This paper assesses the determinants of DM medication use and catastrophic expenditure on medications in older adults with DM in China and India.

METHODS: Using national standardised data collected from adults aged 50 years and above with DM (self-reported) in China (N = 773) and India (N = 463), multivariable logistic regression describes: 1) association between respondents' socio-demographic and health behavioural characteristics and the dependent variable, DM medication use, and 2) association between DM medication use (independent variable) and household catastrophic expenditure on medications (dependent variable) (China: N = 630; India: N = 439). The data source is the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) Wave 1 (2007-2010).

RESULTS: Prevalence of DM medication use was 87% in China and 71% in India. Multivariable analysis indicates that people reporting lifestyle modification were more likely to use DM medications in China (OR = 6.22) and India (OR = 8.45). Women were more likely to use DM medications in China (OR = 1.56). Respondents in poorer wealth quintiles in China were more likely to use DM medications whereas the reverse was true in India. Almost 17% of people with DM in China experienced catastrophic healthcare expenditure on medications compared with 7% in India. Diabetes medication use was not a statistically significant predictor of catastrophic healthcare expenditure on medications in either country, although the odds were 33% higher among DM medications users in China (OR = 1.33).

CONCLUSIONS: The country comparison reflects major public policy differences underpinned by divergent political and ideological frameworks. The DM epidemic poses huge public health challenges for China and India. Ensuring equitable and affordable access to medications for DM is fundamental for healthy ageing cohorts, and is consistent with the global agenda for universal healthcare coverage.

Keywords
Non communicable diseases, NCDs, Out-of-pocket, OOP, Ageing, Aging, Developing countries, Low- and middle-income countries, Universal healthcare coverage, UCC, Financing, Impoverishment, Medicines
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-131032 (URN)10.1186/s12877-016-0408-x (DOI)000392023400002 ()28077072 (PubMedID)
Available from: 2017-02-02 Created: 2017-02-02 Last updated: 2018-06-09Bibliographically approved
Stewart Williams, J., Norström, F. & Ng, N. (2017). Disability and ageing in China and India – decomposing the effects of gender and residence: Results from the WHO study on global ageing and adult health (SAGE). BMC Geriatrics, 17, Article ID 197.
Open this publication in new window or tab >>Disability and ageing in China and India – decomposing the effects of gender and residence: Results from the WHO study on global ageing and adult health (SAGE)
2017 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 17, article id 197Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: China and India are the world's two most populous countries. Although their populations are growing in number and life expectancies are extending they have different trajectories of economic growth, epidemiological transition and social change. Cross-country comparisons can allow national and global insights and provide evidence for policy and decision-making. The aim of this study is to measure and compare disability in men and women, and in urban and rural dwellers in China and India, and assess the extent to which social and other factors contribute to the inequalities.

METHODS: National samples of adults aged 50 to 79 years in China (n = 11,694) and India (n = 6187) from the World Health Organization (WHO) longitudinal Study on global AGEing and adult health (SAGE) Wave 1 were analysed. Stratified multiple linear regressions were undertaken to assess disability differences by sex and residence, controlling for other biological and socioeconomic determinants of disability. Oaxaca-Blinder decomposition partitioned the two-group inequalities into explained and unexplained components.

RESULTS: In both countries women and rural residents reported more disability. In India, the gender inequality is attributed to the distribution of the determinants (employment, education and chronic conditions) but in China about half the inequality is attributed to the same. In India, more than half of the urban rural inequality is attributed to the distribution of the determinants (education, household wealth) compared with under 20% in China.

CONCLUSIONS: Education and employment were important drivers of these measured inequalities. Overall inequalities in disability among older adults in China and India were shaped by gender and residence, suggesting the need for policies that target women and rural residents. There is a need for further research, using both qualitative and quantitative methods, to question and challenge entrenched practices and institutions and grasp the implications of global economic and social changes that are impacting on population health and ageing in China and India.

Place, publisher, year, edition, pages
BioMed Central, 2017
Keywords
Inequalities, Residence, Rural, Developing countries, Oaxaca-Blinder, Decomposition
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-139574 (URN)10.1186/s12877-017-0589-y (DOI)000408762800001 ()28859630 (PubMedID)
Available from: 2017-09-19 Created: 2017-09-19 Last updated: 2018-06-09Bibliographically approved
Kunna, R., San Sebastian, M. & Stewart Williams, J. (2017). Measurement and decomposition of socioeconomic inequality in single and multimorbidity in older adults in China and Ghana: results from the WHO study on global AGEing and adult health (SAGE). International Journal for Equity in Health, 16(1), Article ID 79.
Open this publication in new window or tab >>Measurement and decomposition of socioeconomic inequality in single and multimorbidity in older adults in China and Ghana: results from the WHO study on global AGEing and adult health (SAGE)
2017 (English)In: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 16, no 1, article id 79Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Globally people are living longer and enduring non-communicable diseases (NCDs) many of which co-occur as multimorbidity. Demographic and socioeconomic factors are determinants of inequalities and inequities in health. There is a need for country-specific evidence of NCD inequalities in developing countries where populations are ageing rapidly amid economic and social change. The study measures and decomposes socioeconomic inequality in single and multiple NCD morbidity in adults aged 50 and over in China and Ghana.

METHODS: The data source is the World Health Organization Study on Global AGEing and Adult Health (SAGE) Wave 1 (2007-2010). Nationally representative cross-sectional data collected from adults in China (n = 11,814) and Ghana (n = 4,050) are analysed. Country populations are ranked by a socioeconomic index based on ownership of household assets. The study uses a decomposed concentration index (CI) of single and multiple NCD morbidity (multimorbidity) covering arthritis, diabetes, angina, stroke, asthma, depression, chronic lung disease and hypertension. The CI quantifies the extent of overall inequality on each morbidity measure. The decomposition utilises a regression-based approach to examine individual contributions of demographic and socioeconomic factors, or determinants, to the overall inequality.

RESULTS: In China, the prevalence of single and multiple NCD morbidity was 64.7% and 53.4%, compared with 65.9% and 55.5% respectively in Ghana. Inequalities were significant and more highly concentrated among the poor in China (single morbidity CI = -0.0365: 95% CI = -0.0689,-0.0040; multimorbidity CI = -0.0801: 95% CI = -0.1233,-0.0368;). In Ghana inequalities were significant and more highly concentrated among the rich (single morbidity CI = 0.1182; 95% CI = 0.0697, 0.1668; multimorbidity CI = 0.1453: 95% CI = 0.0794, 0.2083). In China, rural residence contributed most to inequality in single morbidity (36.4%) and the wealth quintiles contributed most to inequality in multimorbidity (39.0%). In Ghana, the wealth quintiles contributed 24.5% to inequality in single morbidity and body mass index contributed 16.2% to the inequality in multimorbidity.

CONCLUSIONS: The country comparison reflects different stages of economic development and social change in China and Ghana. More studies of this type are needed to inform policy-makers about the patterning of socioeconomic inequalities in health, particularly in developing countries undergoing rapid epidemiological and demographic transitions.

Place, publisher, year, edition, pages
BioMed Central, 2017
Keywords
Inequalities, Inequities, LMICs, Low-and middle-income countries, Multi-morbidity, NCDs, Non-communicable diseases, Social determinants, Wealth
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-135043 (URN)10.1186/s12939-017-0578-y (DOI)000403969900001 ()28506233 (PubMedID)
Available from: 2017-05-17 Created: 2017-05-17 Last updated: 2018-06-09Bibliographically approved
Preet, R., Khan, N., Blomstedt, Y., Nilsson, M. & Stewart Williams, J. (2016). Assessing dental professionals' understanding of tobacco prevention and control: a qualitative study in Västerbotten County, Sweden. BDJ Open (2), 1-6, Article ID 16009.
Open this publication in new window or tab >>Assessing dental professionals' understanding of tobacco prevention and control: a qualitative study in Västerbotten County, Sweden
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2016 (English)In: BDJ Open, ISSN 2056-807X, no 2, p. 1-6, article id 16009Article in journal (Refereed) Published
Abstract [en]

Aim: To assess dental professionals’ understanding of tobacco prevention and control.

Materials and methods: In Sweden dental hygienists receive training in tobacco prevention and control. The study setting is Västerbotton County in the north of Sweden where a number of successful tobacco control initiatives have been established. A purposeful sample comprising five male and four female dental professionals and trainees was selected. Data were collected through in-depth semi-structured individual interviews and analysed using content analysis.

Results: Informants acknowledged limited adherence to tobacco prevention. They were not confident of their knowledge of tobacco and non-communicable disease prevention and had limited awareness of global oral health policies. Reasons for poor adherence included professional fragmentation, lack of training, and the absence of reimbursement for time spent on prevention activities.

Discussion: The success of efforts to reduce smoking in Västerbotton County is attributed to the network of local public health initiatives with very limited involvement by local dental professionals.

Conclusions: The findings highlight the need to more actively engage the dental workforce in tobacco control and prevention. Moreover, it is important to recognise that dental professionals can be public health advocates for tobacco control and prevention at global, national and local levels.

Keywords
Health care, Oral cancer
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-129790 (URN)10.1038/bdjopen.2016.9 (DOI)
Available from: 2017-01-09 Created: 2017-01-09 Last updated: 2019-05-16Bibliographically approved
Kailembo, A., Preet, R. & Stewart Williams, J. (2016). Common risk factors and edentulism in adults, aged 50 years and over, in China, Ghana, India and South Africa: results from the WHO Study on global AGEing and adult health (SAGE). BMC Oral Health, 17, Article ID 29.
Open this publication in new window or tab >>Common risk factors and edentulism in adults, aged 50 years and over, in China, Ghana, India and South Africa: results from the WHO Study on global AGEing and adult health (SAGE)
2016 (English)In: BMC Oral Health, ISSN 1472-6831, E-ISSN 1472-6831, Vol. 17, article id 29Article in journal (Refereed) Published
Abstract [en]

Background: Edentulism (loss of all teeth) is a final marker of disease burden for oral health common among older adults and poorer populations. Yet most evidence is from high-income countries. Oral health has many of the same social and behavioural risk factors as other non-communicable diseases (NCDs) which are increasing rapidly in low- and middle-income countries with ageing populations. The "common risk factor approach" (CRFA) for oral health addresses risk factors shared with NCDs within the broader social and economic environment. Methods: The aim is to improve understanding of edentulism prevalence, and association between common risk factors and edentulism in adults aged 50 years and above using nationally representative samples from China (N = 11,692), Ghana (N = 4093), India (N = 6409) and South Africa (N = 2985). The data source is the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) Wave 1 (2007-2010). Multivariable logistic regression describes association between edentulism and common risk factors reported in the literature. Results: Prevalence of edentulism: in China 8.9 %, Ghana 2.9 %, India 15.3 %, and South Africa 8.7 %. Multivariable analysis: in China, rural residents were more likely to be edentulous (OR 1.36; 95 % CI 1.09-1.69) but less likely to be edentulous in Ghana (OR 0.53; 95 % CI 0.31-0.91) and South Africa (OR 0.52; 95 % CI 0.30-0.90). Respondents with university education (OR 0.31; 95 % CI 0.18-0.53) and in the highest wealth quintile (OR 0.68; 95 % CI 0.52-0.90) in China were less likely to be edentulous. In South Africa respondents with secondary education were more likely to be edentulous (OR 2.82; 95 % CI 1.52-5.21) as were those in the highest wealth quintile (OR 2.78; 95 % CI 1.16-6.70). Edentulism was associated with former smokers in China (OR 1.57; 95 % CI 1.10-2.25) non-drinkers in India (OR 1.65; 95 % CI 1.11-2.46), angina in Ghana (OR 2.86; 95 % CI 1.19-6.84) and hypertension in South Africa (OR 2.75; 95 % CI 1.72-4.38). Edentulism was less likely in respondents with adequate nutrition in China (OR 0.68; 95 % CI 0.53-0.87). Adjusting for all other factors, compared with China, respondents in India were 50 % more likely to be edentulous. Conclusions: Strengthening the CRFA should include addressing common determinants of health to reduce health inequalities and improve both oral and overall health.

Place, publisher, year, edition, pages
BioMed Central, 2016
Keywords
Oral health, Tooth loss, Periodontal, Caries, Common risk factor approach, CRFA, Non-communicable seases, NCDs, Low- and middle-income countries, LMICs
National Category
Dentistry Surgery
Identifiers
urn:nbn:se:umu:diva-125552 (URN)10.1186/s12903-016-0256-2 (DOI)000381733200001 ()27465011 (PubMedID)
External cooperation:
Available from: 2016-09-15 Created: 2016-09-13 Last updated: 2018-06-07Bibliographically approved
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