Multidimenzionalni pristup u proceni stanja oralnog zdravlja odraslog stanovništva Srbije

Abstract

Oralno zdravlje predstavlja stanje zdravlja svih anatomskih i funkcionalnih delova usne duplje, jedan je od osnovnih elemenata blagostanja i važan pokazatelj kvaliteta života stanovništva. Podaci Svetske zdravstvene organizacije (SZO) ukazuju da je 15-20% svetskog stanovništva srednje životne dobi (starosti od 35 do 44 godine) pod rizikom od gubitka zuba, a oko 30% stanovništva starosti od 65 do 74 godine nema svoje zube. Oboljenja usta i zuba su jedan od vodećih javno zdravstvenih problema 21. veka u svetu i nalaze se na 4. mestu po visini troškova. Osnovni cilj ovog istraživanja je bio da se utvrdi stanje oralnog zdravlja odraslog stanovništva Srbije starosne dobi 20 i više godina i evaluiraju činioci koji na njega utiču. Istraživanje predstavlja deo nacionalne studije “Istraživanje zdravlja stanovnika Srbije” za 2013. godinu Ministarstva zdravlja Republike Srbije, koja je sprovedena u vidu studije preseka na reprezentativnom uzorku od 13690 ispitanika (53,8% žene i 46,2% muškarci). U istraživanju su korišćene tri vrste upitnika koji su dizajnirani u skladu sa upitnikom Evropskog istraživanja zdravlja. Svaki ispitanik stariji za jednu godinu ima 8% veću šansu da svoje oralno zdravlje oceni kao loše (OR=1.08; 95% IP=(1.07-1.09); p=0,000). Ispitanici sa blagim depresivnim simptomima i depresivnim poremećajima imaju 2,04 odnosno 3,48 puta veću šansu da svoje oralno zdravlje ocene kao loše u odnosu na ispitanike koji nisu depresivni (OR=2.04; 95% IP=(1.28-3.26); p=0,003) (OR=3.48; 95% IP=(1.14-10.59); p=0,028). Žene imaju 30% veću šansu da pripadnu povoljnoj kategoriji poseta stomatologu u odnosu na muškarce (OR=0.70; 95% IP=(0.63-0.78); p=0,000). Ispitanici sa nižim i srednjim obrazovanjem imaju 5,70 odnosno 2,45 puta veću šansu da svoje zube operu povremeno u odnosu na visoko obrazovane (OR=5.70; 95% IP=(4.35-7.48); p=0,000) (OR=2.45; 95% IP=(1.91-3.13); p=0,000). Ispitanici najsiromašnijeg sloja imaju 4,88, siromašnog sloja 3,73, srednjeg sloja 2,52 i bogatog sloja 2,01 put veću šansu da izgube 10 i više zuba u odnosu na najbogatiji sloj (OR=4.88; 95% IP=(2.95-8.08); p=0,000) (OR=3.73; 95% IP=(2.42-5.75); p=0,000) (OR=2.52; 95% IP=(1.69-3.76); p=0.000) (OR=2.01; 95% IP=(1.38-2.91); p=0,000). Bivši pušači i pušači imaju 1,43 odnosno 2,80 puta veću šansu da izgube 10 i više zuba u odnosu na nepušače (OR=1.43; 95% IP=(1.00-2.03); p=0,046) (OR=2.80; 95% IP=(2.08-3.76); p=0,000). Najučestaliji prediktori oralnog zdravlja su žene, starije stanovništvo, niže obrazovanje, nezaposleno i neaktivno stanovništvo, najsiromašniji i pušači.

Oral health represents health status of all anatomic and functional parts of oral cavity, it is one of the basic elements of well-being and important quality of life indicator. According to the World Health Organization (WHO) 15-20% of world population aged 35-44 have risk of tooth loss, and about 30% population aged 65-74 does not have own teeth. Oral and dental diseases are one of the leading public health problems in 21st century and on the 4th place of the health care expenditure. The main aim of this research was to assess oral health of adult population in Serbia aged 20 years and older and to evaluate related factors. The research represents a part of “National Health Survey in Serbia 2013” implemented by The Ministry of Health of the Republic of Serbia, which was conducted as a cross-sectional study on the representative sample of adult population in Serbia. The study included 13690 examinees (53.8% females and 46.2% males). Three types of questionnaires which were designed according to the European Health Interview Survey were used. Every examinee older for one year had 8% greater odds to assess their oral health as bed (OR=1.08; 95% CI=(1.07-1.09); p=0.000). Respondents with mild depressive symptoms and depressive disorders had 2.04 and 3.48 times greater odds to assess their oral health as bed compared to one who were not depressed (OR=2.04; 95% CI=(1.28-3.26); p=0.003) (OR=3.48; 95% CI=(1.14-10.59); p=0.028). Females had 30% more odds to be in the category of affordable dental visit compared to men (OR=0.70; 95% CI=(0.63-0.78); p=0.000). Respondents with lower and middle level of education had 5.70 and 2.45 greater odds to brush their teeth occasionally compared to higher educated (OR=5.70; 95% CI=(4.35-7.48); p=0.000) (OR=2.45; 95% CI=(1.91-3.13); p=0.000). Respondents who belonged to the poorest class had 4.88, poorer 3.73, middle 2.52 and richer class 2.01 greater odds to lose 10 and more teeth compared to the richest (OR=4.88; 95% CI=(2.95-8.08); p=0.000) (OR=3.73; 95% CI=(2.42-5.75); p=0.000) (OR=2.52; 95% CI=(1.69-3.76); p=0.000) (OR=2.01; 95% CI=(1.38-2.91); p=0.000). Former smokers and smokers had 1.43 and 2.80 times greater odds to lose 10 and more teeth compared with non smokers (OR=1.43; 95% CI=(1.00-2.03); p=0.046) (OR=2.80; 95% CI=(2.08-3.76); p=0.000). The most frequent predictors of oral health are: women, elderly people, those with low educational attainment, unemployed, inactive and respondents who assessed their financial situation as poor and smokers.