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- Merlo, Juan, et al.
(författare)
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Social inequalities in health- do they diminish with age? Revisiting the question in Sweden 1999.
- 2003
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Ingår i: International Journal for Equity in Health. - : Springer Science and Business Media LLC. - 1475-9276. ; 2:1, s. 2-2
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Individuals with low income have poorer health and should, therefore, have higher health expenditure than people with high income particularly in countries with a universal health care system. However, it has been discussed if social inequities in health diminish with age and we, hence, aimed to analyse this question. METHODS: We performed an age stratified cross-sectional analysis using averages, logistic and linear regression modelling of health care contacts, health care expenditures and mortality in relation to individual income in five groups by quintiles. The population consisted of all the 249,855 men aged 40 to 80 years living in the county of Skane, Sweden during 1999. RESULTS: For working-age people (40-59 year old) we find a clear socioeconomic gradient with increasing probability of health care contact, relative expenditure and mortality as income decreased. The point estimations for 1st (highest)-2nd-3rd-4th and 5th (lowest) income groups were: (1.00-1.13-1.21-1.42 and 1.15), (1.00-1.16-1.29-1.69 and 1.89) and (1.00-1.35-1.44-2.82 and 4.12) for health care contact, relative expenditure and mortality respectively. However, in the elderly (75-80 year old) these point estimates were (1.00-0.83-0.59-0.61 and 0.39), (1.00-1.04-1.05-1.02 and 0.96) and (1.00-1.06-1.30-1.33 and 1.49). CONCLUSIONS: As expected among working-age individuals, lower income was associated with higher health care contact, relative expenditure and mortality. However, the existence of opposite socioeconomic gradients in health care utilisation and mortality in the elderly suggests that factors related to a high income might condition allocation of resources, or that current medical care is ineffective to treat determinants of income differences in mortality occurring earlier in the lifecourse.
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- Axelsson, Susanna, et al.
(författare)
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Economic aspects of the detection of occlusal dentine caries.
- 2009
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Ingår i: Acta odontologica Scandinavica. - : Informa UK Limited. - 1502-3850 .- 0001-6357. ; 67:1, s. 38-43
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To evaluate the cost of true-positive occlusal dentine caries detection in permanent molars assessed by: (I) visual-tactile examination, (II) visual-tactile examination combined with bitewing radiographs, and (III) selective radiographic examination of patients with lesions detected clinically. A second aim was to analyse the different strategies when the costs of the subsequent restorative care are considered. METHODS: A model analysis was applied owing to the lack of original articles. Sensitivity and specificity were calculated from a systematic review and included in vitro and in vivo studies of medium and high quality. The direct costs for examinations and restorative care were extracted from the costs of the Public Dental Service in Sweden (2006). RESULTS: The diagnostic costs per true-positive finding were dependent on the occurrence of occlusal caries and increased with decreasing prevalence. The strategy by which radiographs were exposed selectively on the basis of findings from visual-tactile examination resulted in higher initial costs compared with the first and second strategies. When the costs of the subsequent restorative care were added, the selective strategy was most beneficial by up to 26% savings per true-positive diagnosis. However, with this selective strategy, more cases of true-positive dentine caries were assumed would remain undetected as compared with the combined strategy with visual-tactile examination and radiographs for all. CONCLUSIONS: The cost for a true-positive caries diagnosis was inversely related to caries occurrence, and different diagnostic strategies may display contrasting outcomes when subsequent restorative care is taken into account.
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- Axelsson, Susanna, et al.
(författare)
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Effect of combined caries-preventive methods: a systematic review of controlled clinical trials.
- 2004
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Ingår i: Acta odontologica Scandinavica. - : Informa UK Limited. - 0001-6357 .- 1502-3850. ; 62:3, s. 163-9
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Forskningsöversikt (refereegranskat)abstract
- The aim of this systematic review was to evaluate the caries-preventive effect of combined caries-preventive methods, defined as two or more different interventions in combination, each expected to prevent dental caries. The Medline database was searched for articles published in the period January 1966 to June 2003. Twenty-four controlled studies met the inclusion criteria, and their value as evidence was assessed according to predetermined criteria. The level of evidence for the overall conclusion regarding each method was graded according to the protocol of the Swedish Council on Technology Assessment in Health Care. The scientific evidence for the combination of treatments involving fluoride that had a preventive effect on caries in children and adolescents was graded as moderate. However, for elderly patients the scientific evidence for the caries-preventive effect of different combinations of treatments was found to be incomplete. No conclusion could be drawn regarding the evidence for combinations of treatments being effective for groups at high caries risk, as the results from the identified clinical studies were conflicting.
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