Welfare regimes and socioeconomic inequalities in edentulism: A multilevel analysis of 40 countries

Abstract Aim To evaluate the association between welfare regimes with edentulism and to investigate if it modifies the magnitude of socioeconomic inequalities in edentulism. Methods We analysed data from 40 high-, middle- and low-income countries collected between 2007 and 2018, encompassing 117397 individuals 20 years or older. The main outcome was edentulism and welfare regimes were the main exposure and effect modifier. Individual level variables were sex, age and quintiles of the wealth score. Multilevel logistic regression was used to estimate the odds of being edentulous and cross-level interaction terms between individual wealth and country factors were tested. Findings Individuals at the lowest wealth quintile had a consistently higher prevalence of edentulism. The highest age-sex standardised prevalence of edentulism was found in Eastern European countries (9.9%) followed by Informal Security (9.4%), while the lowest was among the Insecurity regime (1.4%) followed by the Social Democratic regime (4.7%). Liberal countries presented the highest magnitude of absolute and relative inequalities, where the lowest quintile had OR = 16.7 (95%CI: 10.5-26.5) times more chances of being edentulous and 14.4 percentage points higher prevalence. Low-income countries in the Insecurity Regime in social and labour market presented the lowest level of inequalities. Among HIC and upper-middle income countries, Social Democratic regime had the lowest absolute inequalities (4.0 percentage points difference between highest and lowest quintiles) and the Informal Security regime had the lowest relative differences between the highest and lowest quintiles (OR = 3.21, 95%CI: 2.83-3.63). Interpretation Our findings suggest that policies in some welfare regimes might improve oral health while reducing inequalities. High and upper-middle-income countries presented a high level of edentulism and inequalities. Key messages • Larger socioeconomic inequalities in edentulism were found in high-income countries with liberal policies. • A possible benefit of welfare policies on prevalence and inequalities in edentulism may be only evident among industrialised countries.