| Background: Socioeconomic-related inequality in oral hygiene behaviors in Iran is poorly understood. This study
aims to measure and decompose socioeconomic-related inequalities in oral hygiene behaviors among middle-aged
and elderly adults in Iran.
Methods: A cross-sectional analysis was performed using data from the Prospective Epidemiological Research
Studies in IrAN (PERSIAN), a large national cohort study. A total of 130,016 individuals aged 35 years and above from
17 cohort centers in Iran were included in the study. The normalized concentration index (Cn) was used to measure
the magnitude of inequality in oral hygiene behaviors, i.e. brushing at least twice and flossing once daily, among
middle-aged and elderly Iranian adults included in the cohort centers. Decomposition analysis was performed to
quantify the contribution of each determinant to the observed inequality in oral hygiene behaviors.
Results: Totally, 65.5% of middle-aged and elderly adults brushed their teeth twice a day or more, 7.6% flossed at
least once a day and 3.48% had both habits. The estimated Cn of the two habits combined, i.e. tooth brushing and
dental flossing, for all provinces taken part in the PERSIAN cohort study was 0.399 (95% confidence interval [CI]:
0.383 to 0.417), indicating that the prevalence of the two habits combined is more concentrated among individuals
with higher socioeconomic status. Inequality in oral hygiene behaviors was pro-rich in all cohort centers. The
decomposition results suggested socioeconomic status as the main factor contributing to the overall inequality,
followed by the level of education, and the province of residence.
Conclusion: A low prevalence of oral hygiene behaviors among middle-aged and elderly Iranian adults was
observed. There was also a pro-rich inequality in oral hygiene behaviors among middle-aged and elderly adults in
all cohort centers. These results suggest an urgent need for targeted policy interventions to increase the prevalence
of preventive oral hygiene behaviors among the poor and less-educated middle-aged and elderly adults in Iran. |