{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,26]],"date-time":"2026-07-26T01:14:25Z","timestamp":1785028465658,"version":"3.55.0"},"reference-count":34,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,7,17]],"date-time":"2024-07-17T00:00:00Z","timestamp":1721174400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,7,17]],"date-time":"2024-07-17T00:00:00Z","timestamp":1721174400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100004484","name":"Tehran University of Medical Sciences and Health Services","doi-asserted-by":"publisher","award":["1402-33-32-33"],"award-info":[{"award-number":["1402-33-32-33"]}],"id":[{"id":"10.13039\/501100004484","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004484","name":"Tehran University of Medical Sciences and Health Services","doi-asserted-by":"publisher","award":["1402-33-32-33"],"award-info":[{"award-number":["1402-33-32-33"]}],"id":[{"id":"10.13039\/501100004484","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Int J Equity Health"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>To appreciate dental care utilization in \u200cthe context of socio-economic inequalities, it is imperative to identify sources of inequalities and evaluate the extent to which dental care utilization is still related to socio-economic status. This study aimed to quantify the influence of contributed determinants on dental care utilization in the context of socio-economic inequalities amongst adults residing in Tehran metropolis<jats:bold>.<\/jats:bold><\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>In this cross-sectional community-based study, a stratified random sample of 1,510 subjects aged over 18\u00a0years was investigated by the zero-inflated Poisson analysis to measure the effect of determinants on utilization of dental care, and concentration index as well as the decomposition approach to identify the contributions of deterministic variables to the socio-economic inequality. Data was obtained by employing a phone interview survey. Individuals who were not willing or able to answer the questions in the telephone interview due to hearing or neurological problems did not participate in the interview. Dental care utilization was measured using the number of dental appointments.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Gender (male), oral health-related behaviors (such as brushing and dental flossing), experience of toothache, and concern about dental appearance were associated with an increased likelihood of utilizing dental care. Individuals who belonged to advanced age groups and lived alone significantly underutilized dental care. The concentration index equaling 0.05 (SE\u2009=\u20090.05) corroborates a pro-rich inequality. Decomposition analysis demonstrated the impact of oral health-related behaviors (i.e. dental brushing and use of dental flossing), concern about dental appearance, toothache, gender (male), insurance coverage of dental care, and smoking habit on the poor-rich gap in the dental care utilization.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>The influence of socio-economic inequalities on dental care utilization is discernable along the entire spectrum of socio-economic status. Individuals with lower socio-economic status experience more underutilization of dental care. Community subgroups, particularly the more deprived bracket, require consideration from key stakeholders, including policymakers and health professionals for the enhancement of dental care utilization as revealed by underlying determinants.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12939-024-02220-5","type":"journal-article","created":{"date-parts":[[2024,7,17]],"date-time":"2024-07-17T08:02:04Z","timestamp":1721203324000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["To appreciate the influence of contributed determinants on dental care utilization in the context of\u00a0socio-economic inequalities"],"prefix":"10.1186","volume":"23","author":[{"given":"Aydin","family":"Joudi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katayoun","family":"Sargeran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hossein","family":"Hessari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,7,17]]},"reference":[{"issue":"3","key":"2220_CR1","doi-asserted-by":"publisher","first-page":"240","DOI":"10.1111\/cdoe.12148","volume":"43","author":"E Raittio","year":"2015","unstructured":"Raittio E, Kiiskinen U, Helminen S, Aromaa A, Suominen AL. Income-related inequality and inequity in the use of dental services in Finland after a major subsidization reform. Community Dent Oral Epidemiol. 2015;43(3):240\u201354.","journal-title":"Community Dent Oral Epidemiol"},{"issue":"1","key":"2220_CR2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12939-019-1072-5","volume":"18","author":"S Rezaei","year":"2019","unstructured":"Rezaei S, Hajizadeh M, Irandoost SF, Salimi Y. Socioeconomic inequality in dental care utilization in Iran: a decomposition approach. Int J Equity Health. 2019;18(1):1\u201311.","journal-title":"Int J Equity Health"},{"issue":"6","key":"2220_CR3","doi-asserted-by":"publisher","first-page":"576","DOI":"10.1111\/cdoe.12394","volume":"46","author":"C Li","year":"2018","unstructured":"Li C, Yao N, Yin A. Disparities in dental healthcare utilization in China. Community Dent Oral Epidemiol. 2018;46(6):576\u201385.","journal-title":"Community Dent Oral Epidemiol"},{"issue":"3","key":"2220_CR4","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1177\/0022034515622198","volume":"95","author":"RG Watt","year":"2016","unstructured":"Watt RG, Heilmann A, Listl S, Peres MA. London charter on oral health inequalities. J Dent Res. 2016;95(3):245\u20137.","journal-title":"J Dent Res"},{"issue":"1","key":"2220_CR5","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1186\/s12903-022-02162-w","volume":"22","author":"DA Sahab","year":"2022","unstructured":"Sahab DA, Bamashmous MS, Ranauta A, Muirhead V. Socioeconomic inequalities in the utilization of dental services among adults in Saudi Arabia. BMC Oral Health. 2022;22(1):135.","journal-title":"BMC Oral Health"},{"issue":"1","key":"2220_CR6","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1038\/s41368-017-0006-6","volume":"10","author":"X Zhou","year":"2018","unstructured":"Zhou X, Xu X, Li J, Hu D, Hu T, Yin W, et al. Oral health in China: from vision to action. Int J Oral Sci. 2018;10(1):1.","journal-title":"Int J Oral Sci"},{"key":"2220_CR7","doi-asserted-by":"crossref","unstructured":"Pakshir HR. Oral health in Iran. Int Dent J. 2004;54:367\u201372. Available from: https:\/\/www.sciencedirect.com\/science\/article\/pii\/S0020653920352114.","DOI":"10.1111\/j.1875-595X.2004.tb00013.x"},{"key":"2220_CR8","unstructured":"Abbasi M, Zamani M, Ganjbakhsh M. Justice in medical ethics. Medical Ethics. 2010;3(10):11-33. Available from: https:\/\/sid.ir\/paper\/195789\/en."},{"issue":"2","key":"2220_CR9","first-page":"36","volume":"35","author":"F Bayat","year":"2017","unstructured":"Bayat F, Akbarzadeh A, Monajemi F. Assessment of demand for and utilization of dental services by insurance coverage in a developing Oral health care system. J Dent Sch. 2017;35(2):36\u201342.","journal-title":"J Dent Sch"},{"issue":"1","key":"2220_CR10","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12903-021-01912-6","volume":"21","author":"E Najafi","year":"2021","unstructured":"Najafi E, Amini-Rarani M, Moeeni M. Inequality in dental care expenditure in Iranian households: analysis of income quintiles and educational levels. BMC Oral Health. 2021;21(1):1\u20138.","journal-title":"BMC Oral Health"},{"issue":"1","key":"2220_CR11","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1186\/1475-9276-11-18","volume":"11","author":"EK Morasae","year":"2012","unstructured":"Morasae EK, Forouzan AS, Majdzadeh R, Asadi-Lari M, Noorbala AA, Hosseinpoor AR. Understanding determinants of socioeconomic inequality in mental health in Iran\u2019s capital, Tehran: a concentration index decomposition approach. Int J Equity Health. 2012;11(1):18.","journal-title":"Int J Equity Health"},{"key":"2220_CR12","unstructured":"Gholami M, Pakdaman A, Montazeri A, Virtanen JI. Evaluation of the impact of a mass media campaign on periodontal knowledge among Iranian adults: a three-month follow-up. PloS One 13. World Health Organization. Oral health surveys: basic methods. World Health Organization; 2013."},{"issue":"4","key":"2220_CR13","doi-asserted-by":"publisher","first-page":"346","DOI":"10.1111\/cdoe.12607","volume":"49","author":"H Taylor","year":"2021","unstructured":"Taylor H, Holmes AM, Blackburn J. Prevalence of and factors associated with unmet dental need among the US adult population in 2016. Community Dent Oral Epidemiol. 2021;49(4):346\u201353.","journal-title":"Community Dent Oral Epidemiol"},{"issue":"04","key":"2220_CR14","doi-asserted-by":"publisher","first-page":"542","DOI":"10.4103\/1305-7456.172622","volume":"09","author":"H Bahramian","year":"2015","unstructured":"Bahramian H, Mohebbi SZ, Khami MR, Asadi-Lari M, Shamshiri AR, Hessari H. Psychosocial determinants of dental service utilization among adults: Results from a population-based survey (Urban HEART-2) in Tehran. Iran Eur J Dent. 2015;09(04):542\u201350.","journal-title":"Iran Eur J Dent"},{"key":"2220_CR15","unstructured":"World Health Organization. Oral health surveys: basic methods. World Health Organization; 2013."},{"key":"2220_CR16","doi-asserted-by":"crossref","unstructured":"Yaghoubi Z, Khajedaluee M, Mohammadi T. Introducing a valid questionnaire for assessment of perceived oral health care needs, barriers to accessing oral health care services and its utility. Int J Dent Oral Health. 2017;3(4):1-4.","DOI":"10.16966\/2378-7090.239"},{"issue":"1","key":"2220_CR17","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1037\/cap0000255","volume":"62","author":"CA Hamza","year":"2021","unstructured":"Hamza CA, Ewing L, Heath NL, Goldstein AL. When social isolation is nothing new: A longitudinal study on psychological distress during COVID-19 among university students with and without preexisting mental health concerns. Can Psychol Can. 2021;62(1):20.","journal-title":"Can Psychol Can"},{"issue":"2","key":"2220_CR18","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1111\/idj.12016","volume":"63","author":"M Mantonanaki","year":"2013","unstructured":"Mantonanaki M, Koletsi-Kounari H, Mamai-Homata E, Papaioannou W. Prevalence of dental caries in 5-year-old Greek children and the use of dental services: evaluation of socioeconomic, behavioural factors and living conditions. Int Dent J. 2013;63(2):72\u20139.","journal-title":"Int Dent J"},{"issue":"2","key":"2220_CR19","doi-asserted-by":"publisher","first-page":"e0211776","DOI":"10.1371\/journal.pone.0211776","volume":"14","author":"D Weaving","year":"2019","unstructured":"Weaving D, Jones B, Ireton M, Whitehead S, Till K, Beggs CB. Overcoming the problem of multicollinearity in sports performance data: A novel application of partial least squares correlation analysis. PLoS ONE. 2019;14(2):e0211776.","journal-title":"PLoS ONE"},{"issue":"1","key":"2220_CR20","doi-asserted-by":"publisher","first-page":"21234","DOI":"10.1038\/srep21234","volume":"6","author":"SK Sarker","year":"2016","unstructured":"Sarker SK, Reeve R, Thompson J, Paul NK, Matthiopoulos J. Are we failing to protect threatened mangroves in the Sundarbans world heritage ecosystem? Sci Rep. 2016;6(1):21234.","journal-title":"Sci Rep"},{"issue":"1","key":"2220_CR21","doi-asserted-by":"publisher","first-page":"1","DOI":"10.2307\/1269547","volume":"34","author":"D Lambert","year":"1992","unstructured":"Lambert D. Zero-inflated Poisson regression, with an application to defects in manufacturing. Technometrics. 1992;34(1):1\u201314.","journal-title":"Technometrics"},{"issue":"7","key":"2220_CR22","doi-asserted-by":"publisher","first-page":"661","DOI":"10.1016\/j.puhe.2013.01.001","volume":"127","author":"A Mohammadbeigi","year":"2013","unstructured":"Mohammadbeigi A, Hassanzadeh J, Eshrati B, Rezaianzadeh A. Decomposition of inequity determinants of healthcare utilization. Iran Public Health. 2013;127(7):661\u20137.","journal-title":"Iran Public Health"},{"issue":"5","key":"2220_CR23","doi-asserted-by":"publisher","first-page":"545","DOI":"10.1016\/0277-9536(91)90212-U","volume":"33","author":"A Wagstaff","year":"1991","unstructured":"Wagstaff A, Paci P, Van Doorslaer E. On the measurement of inequalities in health. Soc Sci Med. 1991;33(5):545\u201357.","journal-title":"Soc Sci Med"},{"issue":"6","key":"2220_CR24","doi-asserted-by":"publisher","first-page":"717","DOI":"10.1177\/0022034511399907","volume":"90","author":"S Listl","year":"2011","unstructured":"Listl S. Income-related inequalities in dental service utilization by Europeans aged 50+. J Dent Res. 2011;90(6):717\u201323.","journal-title":"J Dent Res"},{"issue":"2","key":"2220_CR25","doi-asserted-by":"publisher","first-page":"298","DOI":"10.1111\/j.1447-0594.2012.00895.x","volume":"13","author":"T Somkotra","year":"2013","unstructured":"Somkotra T. Experience of socioeconomic-related inequality in dental care utilization among Thai elderly under universal coverage. Geriatr Gerontol Int. 2013;13(2):298\u2013306.","journal-title":"Geriatr Gerontol Int"},{"issue":"2\u20133","key":"2220_CR26","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1016\/j.healthpol.2011.09.011","volume":"103","author":"L Lupi-Pegurier","year":"2011","unstructured":"Lupi-Pegurier L, Clerc-Urmes I, Abu-Zaineh M, Paraponaris A, Ventelou B. Density of dental practitioners and access to dental care for the elderly: a multilevel analysis with a view on socio-economic inequality. Health Policy. 2011;103(2\u20133):160\u20137.","journal-title":"Health Policy"},{"issue":"9","key":"2220_CR27","doi-asserted-by":"publisher","first-page":"1047","DOI":"10.1177\/0022034520916151","volume":"99","author":"JT Marchesan","year":"2020","unstructured":"Marchesan JT, Byrd KM, Moss K, Preisser JS, Morelli T, Zandona AF, Jiao Y, Beck J. Flossing is associated with improved oral health in older adults. J Dent Res. 2020;99(9):1047\u201353.","journal-title":"J Dent Res"},{"issue":"2","key":"2220_CR28","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.2105\/AJPH.2017.304180","volume":"108","author":"S Reda","year":"2018","unstructured":"Reda S, Reda S, Thomson W, Schwendicke F. Inequality in utilization of dental services: a systematic review and meta-analysis. Am J Public Health. 2018;108(2):e1\u20137.","journal-title":"Am J Public Health"},{"issue":"75","key":"2220_CR29","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.jdent.2018.04.010","volume":"1","author":"SM Reda","year":"2018","unstructured":"Reda SM, Krois J, Reda SF, Thomson WM, Schwendicke F. The impact of demographic, health-related and social factors on dental services utilization: systematic review and meta-analysis. J Dent. 2018;1(75):1\u20136.","journal-title":"J Dent"},{"key":"2220_CR30","doi-asserted-by":"crossref","unstructured":"Chan AKY, Tamrakar M, Jiang CM, Lo ECM, Leung KCM, Chu CH. A systematic review on caries status of older adults. Int J Environ Res Public Health. 2021;18(20):10662.","DOI":"10.3390\/ijerph182010662"},{"issue":"1","key":"2220_CR31","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1177\/0022034508327523","volume":"88","author":"R Ide","year":"2009","unstructured":"Ide R, Hoshuyama T, Wilson D, Takahashi K, Higashi T. The effects of smoking on dental care utilization and its costs in Japan. J Dent Res. 2009;88(1):66\u201370.","journal-title":"J Dent Res"},{"issue":"3","key":"2220_CR32","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1007\/s10198-016-0793-2","volume":"18","author":"J Keto","year":"2017","unstructured":"Keto J, Ventola H, Jokelainen J, Timonen M, Linden K, Ylisaukko-Oja T, Keinanen-Kiukaanniemi S, Auvinen J. Primary health care utilisation and its costs among middle-aged smokers. Eur J Health Econ. 2017;18(3):351\u201360.","journal-title":"Eur J Health Econ"},{"issue":"5","key":"2220_CR33","doi-asserted-by":"publisher","first-page":"256","DOI":"10.1111\/j.1875-595X.2012.00118.x","volume":"62","author":"YD Park","year":"2012","unstructured":"Park YD, Kang JO, Kim SJ, Kwon HJ, Hwang JH, Hwang KS. Estimation of the costs of smoking-related oral disease: a representative South Korean study. Int Dent J. 2012;62(5):256\u201361.","journal-title":"Int Dent J"},{"key":"2220_CR34","doi-asserted-by":"crossref","unstructured":"Bof de Andrade F, Drumond Andrade FC, Noronha K. Measuring socioeconomic inequalities in the use of dental care services among older adults in Brazil. Community Dentistry and Oral Epidemiology. 2017;45(6):559\u201366.","DOI":"10.1111\/cdoe.12323"}],"container-title":["International Journal for Equity in Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12939-024-02220-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12939-024-02220-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12939-024-02220-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,17]],"date-time":"2024-07-17T08:04:30Z","timestamp":1721203470000},"score":1,"resource":{"primary":{"URL":"https:\/\/equityhealthj.biomedcentral.com\/articles\/10.1186\/s12939-024-02220-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,17]]},"references-count":34,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["2220"],"URL":"https:\/\/doi.org\/10.1186\/s12939-024-02220-5","relation":{},"ISSN":["1475-9276"],"issn-type":[{"value":"1475-9276","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,17]]},"assertion":[{"value":"21 January 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 June 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 July 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was conducted in accordance with the Declaration of Helsinki. Ethical approval for this study was confirmed by the Ethics Committee of Health Sciences at Tehran University of Medical Sciences (IR.TUMS.DENTISTRY.REC.1400.182). Informed verbal consent was obtained from all participants by phone before proceeding to the survey.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"141"}}