Oral Health in Norway. The HUNT Study.

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Background The oral health studies in Trøndelag Oral health may obviously be associated with many other health factors. But data on oral health was for the first time collected in a general health survey in Norway in the HUNT Study 2006-08 ( HUNT3). Thus, this new joint initiative between the HUNT Research Centre, Faculty of Medicine NTNU and the Odontological Faculty Oslo University, opens up new opportunities. And due to that HUNT is population based and data is collected in 24 municipalities, oral health in the general population aged 20-100 years old may be mapped. However, both questionnaire and clinical data have been collected in Norway earlier, as part of the first WHO International Collaborative Study (WHO ICS-I) in 1973 (1). In 1983, 1994 and in 2006 oral health has been examined again in random samples of the same birthcohorts that were selected in 1973 (11) (Figure 1). An analysis within 1983 showed that social inequality in oral health was found in 13-14 year olds, and the inequality increased in the older adult age-groups assessed cross-sectionally (2). Schuller (1999) analysed whether the oral health improvement from 1983 to 1994 among 23-24 olds in Trøndelag was equally distributed among high and low social status groups (2). Schuller found that improved oral health was accompanied by more inequality among young adults. In the present study it has been possible to follow samples of two birth-cohorts (1959-1960 and 1929-1938) and samples of 35-44 year olds in time series for more than 30 years (Table 1). Figure 1. The basic design of the Oral Health Trøndelag studies Age 1973 1983 1994 2006 (HUNT3) 13-14 X X 23-24 X X 33-34 X 35-44 X X X X (+46,47) 45-54 X X 55-64 X 68-77 X
At the start of the 21 st century, all European countries are faced with substantial inequalities in health and disease within their populations (3). Health and disease inequalities are mainly caused by a higher exposure to material, psychosocial and behavioural risk factors in lower socio-economic groups. A number of studies suggest that the relationship between socio-economic status and disease forms of a social gradient from the top to the bottom of the social hierarchy (4-6). According to the gradient theory inequality of health is not only confined to the poorest members of society but runs right across the social spectrum (Marmot 5,6). The challenge in the gradient research is to provide further evidence of the obvious interplay between psycho-social, material, cultural and behavioural explanations. In Norway researchers and national health authorities have adopted the gradient explanation, and a national strategy to reduce inequalities in disease and health outcomes has been launched (7- 9). The social distribution of oral health among adults in Norway has been studied recently (3). The relationship between income quintiles and edentulousness and having a functional dentition was analysed from 1975 to 2002 by four datasets from Statistics Norway. The main finding was that in absolute terms oral health was more equally distributed in 2002 than in 1975, and the lowest income groups benefited the most. Among the elderly, however, having a functional dentition was less equally distributed in 2002 than in 1985. The relative differences increased for the oldest for each new birth cohort; thus the chances of being edentulous was 7.5 times higher in the lowest income group versus the highest group in 2002, whereas the chances were only 2 times higher in 1972. Based on epidemiological clinical data on oral health of young and older adults gathered by epidemiological field studies in 1973, 1983, 1994 and 2006, time series analyses of social status and oral health have shown a socially unequal distribution of oral health most pronounced during the period from 1973 to 1983. From 1983 to 2006 the inequalities in oral health caused by social position did not seem to increase further (11). The direction of the results seems to be dependent upon the choice of outcome measure. Ongoing research uses outcome measures of both pathogenic and salutogenic nature as effect measures of social inequality. It has been pointed out that social inequality research of oral health must make a careful distinction between inequality of disease occurrence and inequality of treatment.
Page 1: Protocol 11.9.2011 Oral Health in N
Page 5 and 6: The oral health Trøndelag studies
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Page 9: References 1. Holst D, Schuller AA,

Oral Health in Norway. The HUNT Study.

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