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    • hsp70 inhibitor Our results provide information on contribut

    2018-10-26

    Our results provide information on contributors unique to different oral health outcomes, in different countries, and at different times. As identified in our analysis, the contribution of age to inequalities in edentulism may be explained by the inverse relationship between retention of teeth and increasing age and diminishing income (Shen, Wildman, & Steele, 2013). The ability to afford dental care treatment after retirement has been cited as a cost-barrier for older adult populations, which is ascribed to the loss of employment-based dental insurance as well as the hsp70 inhibitor in income after retirement (Bhatti et al., 2007; Manski et al., 2009, 2010; Kiyak & Reichmuth, 2005). In the United States and Canada, dental insurance coverage for older adults ranges from 14.5 to 46.8 per cent (Health Canada, 2010; Kiyak & Reichmuth, 2005). However, the effect of income and dental insurance coverage on dental care utilisation and cost-barriers to dental care cannot be determined from our analysis. Our analyses revealed the contribution of sex to oral health inequalities in the Canadian population. Sex differences are rarely explored or identified in the dental literature, where the mechanisms underlying these differences remain unclear (Wamala, Merlo, & Bostrom, 2006; Ravaghi, Quiñonez, & Allison, 2013). Ravaghi et al. (2013) suggest that access and lifestyle may explain these differences, where lower income women in Canada might have more limited access leading to worse oral health outcomes. On the contrary, Tapp (2009) identified that men were more likely to be self-employed, and have higher unemployment rates than female counterparts, which may suggest affordability as an issue to accessing care for this group. Overall, our results suggest that further investigation is merited into the role of sex in determining inequalities. Our findings coincide with existing literature on income gradients and the contribution of income to inequalities oral health outcomes. In this regard, cost is often cited as a predominant barrier to accessing dental care, where lower income individuals are more likely to express unmet treatment need or difficulty accessing care and decreased likelihood of reporting dental insurance (Mejia et al., 2014; Manski et al., 2012; Thompson, Cooney, Lawrence, Ravaghi, & Quiñonez, 2014). Thus, the rise in non-standard, temporary, part-time employment has diminished the availability of employment-based dental insurance for many low- and middle-income Canadians and Americans. Our findings support this statement as untreated dental disease is concentrated among the worse-off who may be unable to afford dental care in an environment of insurance scarcity. The contribution of education to oral health outcomes has been reported in different countries, regardless of the type of social policy around dental care (Pickett & Wilkinson, 2015). It may be argued the knowledge and skills gained through education affect cognitive function, receptiveness to health education message, or better oral health literacy. People from low socioeconomic background, including education as a determinant, are reportedly more likely to engage in unhealthy behaviours, such as poor diet choices (Guarnizo-Herreno et al., 2013a, 2013b). Therefore, actin is logical to assume those with high school attainment or more would be less likely to exhibit oral disease and more likely to report oral health or treated disease. Our results provide valuable insight for generating hypotheses on how societal conditions shape individual-level determinants of oral health inequalities. For example, differences in the contribution of educational attainment to inequalities over time may be a result of shifts in general knowledge and conceptualisation of oral health care since the 1970s. As well, variations in the contribution of educational attainment to inequalities between countries may be due to differences in labour force participation trends for those with less than high school education, which could impact their ability to afford care. In the United States, approximately 45% of individuals with less than high school education participate in the labour force compared to 55% in Canada as of 2009 (Quiñonez et al., 2007; McGinn-Shapiro, 2008).