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Background <p>Oral health is integral to overall well-being and Universal Health Coverage (UHC), yet disparities in dental service utilization (DSU) persist in low- and middle-income countries (LMICs). Socioeconomic status (SES) and educational inequalities exacerbate barriers to accessing essential dental services, limiting UHC progress. Therefore, this study assessed absolute and relative socioeconomic and education-based inequalities in DSU in Bangladesh, Bhutan, and Nepal and identified demographic and socioeconomic determinants.</p> Methods <p>Data from the most recent WHO STEPwise approach to surveillance (STEPS) surveys in Bangladesh (2017–18), Bhutan (2019), and Nepal (2019) were analyzed. Inequalities in DSU were assessed using the slope index of inequality (SII), relative index of inequality (RII), and relative concentration index (RCI). The determinants of DSU were assessed using mixed-effects binary logistic regression models.</p> Results <p>Ever DSU was highest in Bhutan (48.8%), followed by Bangladesh (29.1%) and Nepal (5.6%). Socioeconomic inequalities in DSU were significant in Bhutan, with higher utilization concentrated among the wealthiest groups (SII: 33.9, 95% confidence interval [CI]: 27.8–40.1 for ever DSU; RII: 2.11, 95% CI: 1.86–2.39), while education-based disparities favored individuals with higher education (RII: 1.85, 95% CI: 1.62–2.13). In Bangladesh, education-based inequalities in DSU were evident only in urban areas (SII: 17.3, 95% CI: 8.2–26.5; RII: 1.69, 95% CI: 1.38–2.06). In Nepal, DSU was uniformly low across all groups, with minimal or even reversed socioeconomic and educational disparities. Independent determinants of DSU, identified through adjusted mixed-effects logistic regression, included older age, higher education, and urban residence in Bangladesh; higher education and SES in Bhutan; and female sex in Nepal.</p> Conclusions <p>DSU was limited across Bangladesh, Bhutan, and Nepal, with the lowest rates observed in Nepal. Substantial socioeconomic and educational inequalities in DSU were evident in Bhutan and Bangladesh. These findings underscore the need for UHC-aligned, equity-focused reforms, including national oral health policies, targeted outreach to disadvantaged groups, and expanded access to preventive services.</p>

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Inequalities in dental service utilization among adults in Bangladesh, Bhutan, and Nepal: a population-based cross-sectional study

  • 期刊论文

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  • 发表日期：

    2025年9月22日

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  • Abir Nagata,
  • Md Mahfuzur Rahman,
  • Tshewang Gyeltshen,
  • Takatoshi Nakagawa,
  • Anam Ahmed,
  • Abu Saleh Muhammad Shahriar,
  • Kiran Acharya,
  • Yu Kubota,
  • Md Shafiur Rahman

摘要

Background

Oral health is integral to overall well-being and Universal Health Coverage (UHC), yet disparities in dental service utilization (DSU) persist in low- and middle-income countries (LMICs). Socioeconomic status (SES) and educational inequalities exacerbate barriers to accessing essential dental services, limiting UHC progress. Therefore, this study assessed absolute and relative socioeconomic and education-based inequalities in DSU in Bangladesh, Bhutan, and Nepal and identified demographic and socioeconomic determinants.

Methods

Data from the most recent WHO STEPwise approach to surveillance (STEPS) surveys in Bangladesh (2017–18), Bhutan (2019), and Nepal (2019) were analyzed. Inequalities in DSU were assessed using the slope index of inequality (SII), relative index of inequality (RII), and relative concentration index (RCI). The determinants of DSU were assessed using mixed-effects binary logistic regression models.

Results

Ever DSU was highest in Bhutan (48.8%), followed by Bangladesh (29.1%) and Nepal (5.6%). Socioeconomic inequalities in DSU were significant in Bhutan, with higher utilization concentrated among the wealthiest groups (SII: 33.9, 95% confidence interval [CI]: 27.8–40.1 for ever DSU; RII: 2.11, 95% CI: 1.86–2.39), while education-based disparities favored individuals with higher education (RII: 1.85, 95% CI: 1.62–2.13). In Bangladesh, education-based inequalities in DSU were evident only in urban areas (SII: 17.3, 95% CI: 8.2–26.5; RII: 1.69, 95% CI: 1.38–2.06). In Nepal, DSU was uniformly low across all groups, with minimal or even reversed socioeconomic and educational disparities. Independent determinants of DSU, identified through adjusted mixed-effects logistic regression, included older age, higher education, and urban residence in Bangladesh; higher education and SES in Bhutan; and female sex in Nepal.

Conclusions

DSU was limited across Bangladesh, Bhutan, and Nepal, with the lowest rates observed in Nepal. Substantial socioeconomic and educational inequalities in DSU were evident in Bhutan and Bangladesh. These findings underscore the need for UHC-aligned, equity-focused reforms, including national oral health policies, targeted outreach to disadvantaged groups, and expanded access to preventive services.