Oral sundhed hos etniske grupper i social og epidemiologisk

Transcription

Oral sundhed hos etniske grupper
i social og epidemiologisk
kontekst
Poul Erik Petersen
Professor, dr.odont., BA, MSc (Sociology)
School of Dentistry, CSS
Department for Global Oral Health and Community Dentistry
and
Chief, Global Oral Health Programme
Prevention of Non-communicable
World Health Organization, Geneva, Switzerland
Objectives of this intervention
•
To highlight the oral health status of
populations across the globe
•
To describe oral health of ethnic
minority groups in Denmark
•
To examine the importance of
behavioural factors in oral health
•
To discuss the needs for future research
Dental caries in a 6-year-old child of
Madagascar
Dental caries of an adult –
upper jaw front teeth
Dental caries Tooth 37
Filled with no decay Tooth 36
Measures of dental caries
experience
Primary dentition
decayed, missing due to caries, and filled teeth
dmft
decayed, missing due to caries and filled tooth surfaces
dmfs
Permanent dentition
Decayed, Missing due to caries, and Filled Teeth DMFT
Decayed, Missing due to caries, Filled tooth Surfaces
DMFS
Dental caries experience of
12-year-olds by WHO Regions 2011
DMFT
Gingivitis-bleeding gums
Periodontitis –with
pocketing
Social determinants
Social inequality
•
Gender
•
Location: urban - rural
•
Education
•
Employment
•
Personal or household income
•
Poverty
•
Migration
Oral health status in relation to
ethnicity of children in the
Municipality of Copenhagen,
Denmark
Sundby A, Petersen PE. Int J Paediatr
Dent 2003; 13: 150-7
Pct. children aged 3 and 5 years with dental caries by
ethnic background
100
%
90
80
70
60
3 yrs
5 yrs
50
40
30
20
10
0
Danish
Turkish
Pakistani
Albanian
Somali
Arabian
Mean dental caries experience (dmfs/DMFS) in 7and 15- year-olds by ethnic group
16
14
fs/ FS
dmfs/DMFS
12
10
ms/MS
8
6
ds/DS
4
2
0
7 years
15 years
Pct. of children 7 and 15 years of age who consume soft drinks
daily among ethnic groups
Pct. parents of children attending school grade 1 who
brush their child’s teeth daily by ethnic group
100
%
90
80
70
60
50
40
30
20
10
0
Danish
Turkish
Pakistani
Albanian
Somali
Arabian
Tandsundhed hos børn og unge med
forskellig etnisk baggrund i
Københavns kommune
Københavns kommune
Børne og Ungdomsforvaltningen, 2008
Gennemsnitlig cariesforekomst (dmfs) blandt 5 årige børn
i Københavns kommune (2006)
Dansk
Vestlige lande
Tidl. Jugoslavien
Tyrkiet
Marocco
Somalia
Irak
Libanon
Pakistan
Øvrige ikke-vestlige lande
0
ds + DS
1
2
3
ms + MS
4
5
fs + FS
6
7
8
Gennemsnitlig cariesforekomst (dmfs+DMFS) blandt 12
årige i Københavns kommune (2006)
Dansk
Vestlige lande
Tidl. Jugoslavien
Tyrkiet
Marocco
Somalia
Irak
Libanon
Pakistan
0
ds + DS
1
2
3
ms + MS
4
5
fs + FS
6
7
8
Carieserfaring (dmfs+DMFS) hos københavnske børn i
relation til moders statsborgerskab
6
5
4
3
5 år
12 år
2
1
0
Mor dansk statsborger
Mor statsborger i
vestligt land
Mor statsborger i ikkevestligt land
relation til moders etniske status
4,5
4
3,5
3
2,5
5 år
12 år
2
1,5
1
0,5
0
Mor er dansk
statsborger
Mor er efterkommer
Mor er indvandrer
relation til antal børn i familien
7
6
5
4
3
2
1
0
1 barn
2 børn
3 børn
4 børn
5+ børn
Oral health situation of asylum
seekers and refugees in Denmark
Torres AM, Petersen PE. Mundgesundheit von
Asylsuchenden und Flüchtlingen in Dänemark. Im:
Scheller T, Salman R, Christiane G. Handbuch OralProphylaxe und Mundgesundheit bei Migranten. Bonn:
DAJ, 2001; 249-63.
Dental caries experience (DMFS) among asylum seekers and refugees
aged 20-50 years (1999), and in adult Danes aged 35-44
100
90
80
70
60
50
DMFS
40
30
20
10
0
Danish
Iraq
Somalia
F. Yugoslavia
Asylum seekers
F. Yugoslavia
Refugees
Dental caries experience (DMFS) of adults aged 25-50
years by nationality (1999)
70
60
50
40
F
M
D
30
20
10
0
Iraq
Somalia
F. Yugoslavia
Asylum seekers
F. Yugoslavia
Refugees
Dental caries experience (dmfs/DMFS) among children of
asylum seekers by nationality (1999)
Iraq
20
18
16
14
12
10
8
6
4
2
0
Former Yugoslavia
fs/FS
ms/MS
ds/DS
5-6 yrs
11-13 yrs
20
18
16
14
12
10
8
6
4
2
0
fs/FS
ms/MS
ds/DS
5-6 yrs
11-13 yrs
Pct. of asylum seekers and refugees aged 20-50 years
having sugary food items several times a day
100 %
90
80
70
60
50
40
30
20
10
0
Iraqi
Somali
Asylum seekers
Torres & Petersen, 1999
F. Yugoslavia
F. Yugoslavia
Refugees
Pct. of asylum seekers and refugees aged 20-50 years with
tooth cleaning habits twice a day
100 %
90
80
70
60
50
40
30
20
10
0
Iraqi
Somali
Asylum seekers
F. Yugoslavia
F. Yugoslavia
Refugees
Pct. of persons with severe periodontal health (CPI 3+4)
by nationality (1999)
30
%
25
20
15
10
5
0
Iraq
Somalia
Asylum seekers
F. Yugoslavia
F. Yugoslavia
Refugees
Pct. of asylum seekers and refugees aged 20-50 years who
reported reasons of past dental visit
100
90
80
70
60
Something wrong
Pain/troubles
Check-up
50
40
30
20
10
0
Iraq
Somalia
F. Yugoslavia
Asylum seekers
F. Yugoslavia
Refugees
Pct. of asylum seekers and refugees aged 20-50 years who
saw a dentist during the past year
100 %
90
80
70
60
Dental visit during the past
year
Never received dental care
in Denmark
50
40
30
20
10
0
Iraqi
Somali
F. Yugoslavia
Asylum seekers
F. Yugoslavia
Refugees
Pct. of asylum seekers and refugees (20-50 years) having received
certain dental treatment in their homeland
100 %
90
80
70
60
Tooth extraction
Dental fillings
50
40
30
20
10
0
Iraqi
Somali
F. Yugoslavia
Asylum seekers
F. Yugoslavia
Refugees
Dental visits
Odds Ratio for having visited a dentist and having received an oral
examination one or more times during the past 5 years
Christensen, Petersen, Steding-Jessen, 2007
Dental visit
Oral examination
Western countries
0.54
0.60
Other countries
0.31
0.41
Western countries
0.75
0.80
Other countries
0.33
0.34
-
-
Immigrants
Descendants
Danish
Pct. of 35-44-year-olds in Copenhagen (DEN) who consume preventive
dental services over the past 3 years
100 %
90
80
70
60
50
40
30
20
10
0
Danish origin
2nd world
Immigrants
3rd world
2nd world
3rd world
Descendants
Behavioural factors
Acculturation
•
Culture and social norms
•
Health beliefs
•
Attitudes to oral health
•
Knowledge about oral disease, prevention
and health promotion
•
Communication and sharing of experiences
•
The role of oral health services
Dentists per 100,000 population by
country income groups
80
70
60
50
40
30
20
10
0
Source:
WHR, 2006
Low income
Lower middle
income
Upper middle
income
High income
Tobacco use
• Smoking
• Smokeless tobacco
• Qat
Cancer of the tongue
Incidence of oral cavity cancer (ICD-10: C00-C08)
Age-Standardized Rate (ASR) per 100 000 world standard population
World, Male (all ages)
No data available
Based on GLOBOCAN 2008 International Agency for Research on Cancer http://globocan.iarc.fr/ (Accessed 30 Dec 2010)
WHA Resolutions on oral
health
WHA22.30 Fluoridation and dental health, 1969
WHA28.64 Fluoridation and dental health, 1975
WHA31.50 Fluorides and the prevention of dental caries, 1978
WHA36.14 Oral health in the strategy for health for all, 1983
WHA42.39 Oral health, 1994
WHA 60.17 Oral health – action plan for
promotion and integrated disease prevention, 2007
Thank you very much
for your attention
Tandsundhed hos børn og unge med
forskellig etnisk baggrund i
Københavns kommune, 2008
x
*
x
*
x
*
x
*
x
*
x
*
x
*
x
*
x
*
Oral healthcare (%) in adults 18+ yrs
with expressed need by wealth
quintiles
%
World Health Survey
Published in JDR (2012)
Household
wealth quintiles
Mean oral healthcare coverage in adults 18+
years with expressed need, by country income
level
%
World Health Survey
Published in JDR 2012
x
*
Gennemsnitlig cariesforekomst (dmfs+DMFS) blandt 7
årige børn i Københavns kommune (2006)
Dansk
Vestlige lande
Tidl. Jugoslavien
Tyrkiet
Marocco
Somalia
Irak
Libanon
Pakistan
0
ds + DS
2
4
ms + MS
6
8
fs + FS
10
12
Gennemsnitlig cariesforekomst (DMFS) blandt 15 årige i
Københavns kommune (2006)
Dansk
Vestlige lande
Tidl. Jugoslavien
Tyrkiet
Marocco
Somalia
Irak
Libanon
Pakistan
0
1
DS
2
MS
3
4
FS
5
6
7
8
Basic epidemiologic
measures
Prevalence Proportion rate PP
Cumulative Incidence Proportion CIP
Relative Risk RR
Odds
RRatio
OR
Oral epidemiological
measures
Dental caries indices
Periodontal disease indices
Indices of tooth wear (erosion,
abrasion)
*
*
*
*
*
*
*
*
*
Global trends in oral
health
Developing
countries
Dental caries is low Dental care = tooth extraction
Diet/nutrition in transition
Low exposure to fluorides
Poor access to community care, PHC, and oral health
services
HIV/AIDS pandemic
Growing use of tobacco
Oral cancer prevalent (Asia)
Need for prevention and oral health promotion
programmes
Poor water, sanitation, hygiene
Global trends in oral
health
- Developed countries
* Decline in dental caries of children
* More adults preserve natural, functional teeth
* General health - oral health - quality of life: ageing
populations
* Diet related oral disease e.g. dental erosion - soft
drinks
* Tobacco and alcohol: Oral cancer, periodontal
disease
* Poor oral health in deprived communities, migrant
Dental care in adults
Christensen LB, Petersen PE,
Steding-Jessen M.
Consumption of dental services
among adults in Denmark 19942003. EurJ Oral Sci 2007;115:
174-9
Pct. of 7 and 15-year-olds with dental caries in relation to
ethnic group
100
%
90
80
70
60
7 yrs
15 yrs
50
40
30
20
10
0
Danish
Turkish
Pakistani
Albanian
Somali
Arabian
relation til moders uddannelsesniveau (ISCED)
5
4,5
4
3,5
3
5 år
12 år
2,5
2
1,5
1
0,5
0
<10 år
10 år
11-12 år
13-14 år
15 år +
relation til familiens bruttoindkomst (DKK)
4
3,5
3
2,5
2
5 år
12 år
1,5
1
0,5
0
Indkomst
<199.999
200.000
-399.999
400.000
-599.999
600.000
-799.999
800.000 +

Oral sundhed hos etniske grupper i social og epidemiologisk

Transcription

Similar documents