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- Celeste, R. K., et al.
(author)
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Social Mobility and Tooth Loss : A Systematic Review and Meta-analysis
- 2022
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In: Journal of Dental Research. - : SAGE Publications. - 0022-0345 .- 1544-0591. ; 101:2, s. 143-150
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Research review (peer-reviewed)abstract
- This study systematically reviews the evidence of the association between life course social mobility and tooth loss among middle-aged and older people. PubMed, Scopus, Embase, and Web of Science were systematically searched in addition to gray literature and contact with the authors. Data on tooth loss were collated for a 4-category social mobility variable (persistently high, upward or downward mobility, and persistently low) for studies with data on socioeconomic status (SES) before age 12 y and after age 30 y. Several study characteristics were extracted to investigate heterogeneity in a random effect meta-analysis. A total of 1,384 studies were identified and assessed for eligibility by reading titles and abstracts; 21 original articles were included, of which 18 provided sufficient data for a meta-analysis with 40 analytical data sets from 26 countries. In comparison with individuals with persistently high social mobility, the pooled odds ratios (ORs) for the other categories were as follows: upwardly mobile, OR = 1.73 (95% CI, 1.53 to 1.95); downwardly mobile, OR = 2.52 (95% CI, 2.19 to 2.90); and persistently low, OR = 3.96 (95% CI, 3.13 to 5.03). A high degree of heterogeneity was found(I2 > 78%), and subgroup analysis was performed with 17 study-level characteristics; however, none could explain heterogeneity consistently in these 3 social mobility categories. SES in childhood and adulthood is associated with tooth loss, but the high degree of heterogeneity prevented us from forming a robust conclusion on whether upwardly or downwardly mobile SES may be more detrimental. The large variability in effect size among the studies suggests that contextual factors may play an important role in explaining the difference in the effects of low SES in different life stages (PROSPERO CRD42018092427).
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- Celeste, R. K., et al.
(author)
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Socioeconomic Life Course Models and Oral Health : A Longitudinal Analysis
- 2020
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In: Journal of Dental Research. - : SAGE Publications. - 0022-0345 .- 1544-0591. ; 99:3, s. 257-263
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Journal article (peer-reviewed)abstract
- We compared socioeconomic life course models to decompose the direct and mediated effects of socioeconomic status (SES) in different periods of life on late-life oral health. We used data from 2 longitudinal Swedish studies: the Level of Living Survey and the Swedish Panel Study of Living Conditions of the Oldest Old. Two birth cohorts (older, 1925 to 1934; younger, 1944 to 1953) were followed between 1968 and 2011 with 6 waves. SES was measured with 4 indicators of SES and modeled as a latent variable. Self-reported oral health was based on a tooth conditions question. Variables in the younger and older cohorts were grouped into 4 periods: childhood, young/mid-adulthood, mid /late adulthood, late adulthood/life. We used structural equation modeling to fit the following into lagged-effects life course models: 1) chain of risk, 2) sensitive period with late-life effect, 3) sensitive period with early- and late-life effects, 4) accumulation of risks with cross-sectional effects, and 5) accumulation of risks. Chain of risk was incorporated into all models and combined with accumulation, with cross-sectional effects yielding the best fit (older cohort: comparative fit index = 0.98, Tucker-Lewis index = 0.98, root mean square error of approximation = 0.04, weighted root mean square residual = 1.51). For the older cohort, the chain of SES from childhood -> mid-adulthood -> late adulthood -> late life showed the following respective standardized coefficients: 053, 0.92, and 0.97. The total effect of childhood SES on late-life tooth loss (standardized coefficient: -0.23 for older cohort, -0.17 for younger cohort) was mediated by previous tooth loss and SES. Cross-sectional effects of SES on tooth loss were observed throughout the life course, but the strongest coefficients were at young/mid-adulthood (standardized coefficient: -0.41 for older cohort, -0.45 for younger cohort). SES affects oral health cumulatively over the life course and through a chain of risks. Actions to improve socioeconomic conditions in early life might have long-lasting effects on health if they help prevent people from becoming trapped in a chain of risks.
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| 4. |
- Celeste, R. K., et al.
(author)
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The individual and contextual pathways between oral health and income inequality in Brazilian adolescents and adults
- 2009
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In: Social Science and Medicine. - : Elsevier BV. - 0277-9536 .- 1873-5347. ; 69:10, s. 1468-1475
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Journal article (peer-reviewed)abstract
- We evaluate the association between incomeinequality (Gini index) and oralhealth and in particular the role of alternative models in explaining this association. We also studied whether or not income at the individual level modifies the Gini effect. We used data from an oralhealth survey in Brazil in 2002–2003. Our analysis included 23,568 15–19 and 22,839 35–44 year-olds nested in 330 municipalities. Different models were fitted using multilevel analysis. The outcomes analysed were the number of untreated dental caries (count), having at least one missing tooth (dichotomous) and being edentulous (dichotomous). To assess interaction as a departure from additivity we used the Synergy Index. For this, we dichotomized the Gini coefficient (high vs low inequality) by the median value across municipalities and the individualincome in the point beyond which it showed roughly no association with oralhealth. Adjusted rate ratio of mean untreated dental caries, respectively for the 15–19 and 35–44 age groups, was 1.12 and 1.16 for each 10 points increase in Gini scale. Adjusted odds ratio of a 15–19 year-old having at least one missing tooth or a 35–44 year-old being edentulous was, respectively, 1.19 and 1.01. High incomeinequality had no statistically significant synergistic effect with being poor or living in a poor municipality. Higher levels of incomeinequality at the municipal level were associated with worse oralhealth and there was an unexplained residual effect after controlling for potential confoundings and mediators. Municipal level incomeinequality had a similar, detrimental effect, among individuals with lower or higher income.
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| 5. |
- Celeste, R. K., et al.
(author)
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Trends in socioeconomic disparities in oral health in Brazil and Sweden
- 2011
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In: Community Dentistry and Oral Epidemiology. - : Wiley. - 0301-5661 .- 1600-0528. ; 39:3, s. 204-212
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Journal article (peer-reviewed)abstract
- Objectives: To describe the dynamics of trends in socioeconomic disparities in oral health in Brazil and Sweden among adults, to assess whether trends follow expected patterns according to the inverse equity hypothesis.Methods: In Sweden, we obtained nationally representative data for the years 1968, 1974, 1981, 1991 and 2000, and in Brazil, for 16 state capitals in 1986 and in 2002. Trends in the prevalence of ‘edentulism’ and of ‘teeth in good conditions’ were described in two groups aged 35–44 with lower and higher economic standards, respectively.Results: There was an annual decline in disparities in ‘edentulism’ of 0.4 percentage points (pp) (95% CI = 0.2–0.7) in Brazil and 0.7pp (95% CI = 0.5–0.9) in Sweden, as a result of improvements in both income groups. Concerning ‘teeth in good conditions’, in Brazil, there was improvement only in the higher income group and absolute disparities have increased (0.5pp annually), while in Sweden, there was a nonsignificant decrease (0.3pp annually) with improvements in both groups. Since 1991 in Sweden and in 2002 in Brazil, our measures of socioeconomic disparities in ‘edentulism’ were not statistically significant. Trends did not differ by sex or dental visit.Conclusions: Despite improvements in both income groups and a decrease in disparities in ‘edentulism’, the poorer group in Brazil has seen no improvement in ‘teeth in good conditions’ and disparities have increased. It appears that Brazil and Sweden reflect different stages of trend for ‘teeth in good conditions’ and the same stages for ‘edentulism’, represented by the inverse equity hypothesis.
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- Clement, R. Carter, et al.
(author)
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A proposed set of metrics for standardized outcome reporting in the management of low back pain
- 2015
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In: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3682 .- 1745-3674. ; 86:5, s. 523-533
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Journal article (peer-reviewed)abstract
- Background and purpose - Outcome measurement has been shown to improve performance in several fields of healthcare. This understanding has driven a growing interest in value-based healthcare, where value is defined as outcomes achieved per money spent. While low back pain (LBP) constitutes an enormous burden of disease, no universal set of metrics has yet been accepted to measure and compare outcomes. Here, we aim to define such a set. Patients and methods - An international group of 22 specialists in several disciplines of spine care was assembled to review literature and select LBP outcome metrics through a 6-round modified Delphi process. The scope of the outcome set was degenerative lumbar conditions. Results - Patient-reported metrics include numerical pain scales, lumbar-related function using the Oswestry disability index, health-related quality of life using the EQ-5D-3L questionnaire, and questions assessing work status and analgesic use. Specific common and serious complications are included. Recommended follow-up intervals include 6, 12, and 24 months after initiating treatment, with optional follow-up at 3 months and 5 years. Metrics for risk stratification are selected based on preexisting tools. Interpretation - The outcome measures recommended here are structured around specific etiologies of LBP, span a patient's entire cycle of care, and allow for risk adjustment. Thus, when implemented, this set can be expected to facilitate meaningful comparisons and ultimately provide a continuous feedback loop, enabling ongoing improvements in quality of care. Much work lies ahead in implementation, revision, and validation of this set, but it is an essential first step toward establishing a community of LBP providers focused on maximizing the value of the care we deliver.
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| 8. |
- Forsberg, A., et al.
(author)
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Once-only colonoscopy or two rounds of faecal immunochemical testing 2 years apart for colorectal cancer screening (SCREESCO): preliminary report of a randomised controlled trial
- 2022
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In: Lancet Gastroenterology & Hepatology. - : Elsevier BV. - 2468-1253. ; 7:6, s. 513-521
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Journal article (peer-reviewed)abstract
- Background Screening for colorectal cancer is done with lower gastrointestinal endoscopy or stool-based tests. There is little evidence from randomised trials to show primary colonoscopy reduces mortality in colorectal cancer We aimed to investigate the effect of screening with once-only colonoscopy or two rounds of faecal immunochemical test screening on colorectal cancer mortality and incidence. Methods We did a randomised controlled trial in Sweden (SCREESCO). Residents in 18 of 21 regions who were age 60 years in the year of randomisation were identified from a population register maintained by the Swedish Tax Agency. A statistician with no further involvement in the trial used a randomised block method to assign individuals to once-only colonoscopy, two rounds of faecal immunochemical testing (OC-Sensor; 2 years apart), or a control group (no intervention; standard diagnostic pathways), in a ratio of 1:6 for colonoscopy versus control and 1:2 for faecal immunochemical testing versus control. Masking was not possible due to the nature of the trial. The primary endpoints of the trial are colorectal cancer mortality and colorectal cancer incidence. Here, we report preliminary participation rates, baseline findings, and adverse events from March, 2014, to December, 2020, in the two intervention groups after completion of recruitment and screening, up to the completion of the second faecal immunochemical testing round. Analyses were done in the intention-to-screen population, defined as all individuals who were randomly assigned to the respective study group. This study is registered with Clinical Trials.gov, NCT02078804. Findings Between March 1, 2014, and Dec 31, 2020, 278 280 people were induded in the study; 31 140 were assigned to the colonoscopy group, 60 300 to the faecal immunochemical test group, and 186 840 to the control group. 10 679 (35.1%) of 30 400 people who received an invitation for colonoscopy participated. 33 383 (55.5%) of 60 137 people who received a postal faecal immunochemical test participated. In the intention-to-screen analysis, colorectal cancer was detected in 49 (0.16%) of 31140 people in the colonoscopy group versus 121 (0. 20%) of 60 300 in the faecal immunochemical test group (relative risk [RR] 0.78, 95% CI 0.56-1.09). Advanced adenomas were detected in 637 (2.05%) people in the colonoscopy group and 968 (1.61%) in the faecal immunochemical test group (RR 1.27, 95% CI 1.15-1.41). Colonoscopy detected more right-sided advanced adenomas than faecal immunochemical testing. There were two perforations and 15 major bleeds in 16 555 colonoscopies. No intervention-related deaths occurred. Interpretation The diagnostic yield and the low number of adverse events indicate that the design from this trial, both for once-only colonoscopy and faecal immunochemical test screening, could be transferred to a population-based screening service if a benefit in disease-specific mortality is subsequently shown. Copyright (C) 2022 Elsevier Ltd. All rights reserved.
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