During past decades, the number of dentists has continuously increased in Iran. Beside the quantity, the distribution of dentists affects the oral health status of population. The current study aimed to assess the pure and social disparities in distribution of dentists across the provinces in Iran in 2009. Data on provinces’ characteristics, including population and social situation, were obtained from multiple sources. The disparity measures (including Gini coefficient, index of dissimilarity, Gaswirth index of disparity and relative index of inequality (RII)) and pairwise correlations were used to evaluate the pure and social disparities in the number of dentists in Iran. On average, there were 28 dentists per 100,000 population in the country. There were substantial pure disparities in the distribution of dentists across the provinces in Iran. The unadjusted and adjusted RII values were 3.82 and 2.13, respectively; indicating area social disparity in favor of people in better-off provinces. There were strong positive correlations between density of dentists and better social rank. It is suggested that the results of this study should be considered in conducting plans for redistribution of dentists in the country. In addition, further analyses are needed to explain these disparities.
References
[1]
Petersen, P.E. Global policy for improvement of oral health in the 21st century—Implications to oral health research of World Health Assembly 2007, World health organization. Community Dent. Oral Epidemiol. 2009, 37, 1–8, doi:10.1111/j.1600-0528.2008.00448.x.
[2]
Eaton, K.A. Global oral public health—The current situation and recent developments. J. Publ. Health Pol. 2012, 33, 382–386, doi:10.1057/jphp.2012.22.
[3]
Bagramian, R.A.; Garcia-Godoy, F.; Volpe, A.R. The global increase in dental caries. A pending public health crisis. Am. J. Dent. 2009, 22, 3–8.
[4]
Petersen, P.E. The world oral health report 2003: Continuous improvement of oral health in the 21st century—The approach of the WHO global oral health programme. Community Dent. Oral Epidemiol. 2003, 31 (Suppl. 1), 3–23.
[5]
Somkotra, T. Socioeconomic inequality in self-reported oral health status: The experience of Thailand after implementation of the universal coverage policy. Community Dent. Health 2011, 28, 136–142.
[6]
Guarnizo-Herreno, C.C.; Wehby, G.L. Explaining racial/ethnic disparities in children’s dental health: A decomposition analysis. Am. J. Publ. Health 2012, 102, 859–866.
[7]
Watt, R.; Sheiham, A. Inequalities in oral health: A review of the evidence and recommendations for action. Br. Dent. J. 1999, 187, 6–12.
[8]
Do, L.G. Distribution of caries in children: Variations between and within populations. J. Dent. Res. 2012, 91, 536–543, doi:10.1177/0022034511434355.
[9]
Olutola, B.G.; Ayo-Yusuf, O.A. Socio-environmental factors associated with self-rated oral health in south africa: A multilevel effects model. Int. J. Environ. Res. Public Health 2012, 9, 3465–3483, doi:10.3390/ijerph9103465.
[10]
Petersen, P.E.; Kjoller, M.; Christensen, L.B.; Krustrup, U. Changing dentate status of adults, use of dental health services, and achievement of national dental health goals in denmark by the year 2000. J. Publ. Health Dent. 2004, 64, 127–135, doi:10.1111/j.1752-7325.2004.tb02742.x.
[11]
Wall, T.P.; Vujicic, M.; Nasseh, K. Recent trends in the utilization of dental care in the United States. J. Dent. Educ. 2012, 76, 1020–1027.
[12]
Somkotra, T. Experience of socioeconomic-related inequality in dental care utilization among Thai elderly under universal coverage. Geriatr. Gerontol. Int. 2013, 13, 298–306, doi:10.1111/j.1447-0594.2012.00895.x.
[13]
Hosseinpoor, A.R.; Itani, L.; Petersen, P.E. Socio-economic inequality in oral healthcare coverage: Results from the World Health Survey. J. Dent. Res. 2012, 91, 275–281, doi:10.1177/0022034511432341.
[14]
Pakshir, H.R. Oral health in Iran. Int. Dent. J. 2004, 54, 367–372.
[15]
Iran Medical Council. Available online: www.Irimc.Org (accessed on 20 May 2011).
[16]
Sanjesh Organization. Available online: sanjesh.Org (accessed on 7 September 2012).
[17]
Ahmad Kiadaliri, A.; Najafi, B.; Haghparast-Bidgoli, H. Geographic distribution of need and access to health care in rural population: An ecological study in Iran. Int. J. Equity Health 2011, 10, 39, doi:10.1186/1475-9276-10-39.
[18]
Rasanathan, K.; Montesinos, E.V.; Matheson, D.; Etienne, C.; Evans, T. Primary health care and the social determinants of health: Essential and complementary approaches for reducing inequities in health. J. Epidemiol. Community Health 2011, 65, 656–660, doi:10.1136/jech.2009.093914.
[19]
CSDH. Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health. Final Report of the Commission on Social Determinants of Health; World Health Organization: Geneva, Switzerland, 2008.
[20]
Momeni, A.; Mardi, M.; Pieper, K. Caries prevalence and treatment needs of 12-year-old children in the islamic republic of Iran. Med. Princ. Pract. 2006, 15, 24–28, doi:10.1159/000089381.
[21]
Hessari, H.; Vehkalahti, M.M.; Eghbal, M.J.; Murtomaa, H.T. Oral health among 35- to 44-year-old Iranians. Med. Princ. Pract. 2007, 16, 280–285, doi:10.1159/000102150.
[22]
Hessari, H.; Vehkalahti, M.M.; Eghbal, M.J.; Samadzadeh, H.; Murtomaa, H.T. Oral health and treatment needs among 18-year-old Iranians. Med. Princ. Pract. 2008, 17, 302–307, doi:10.1159/000129610.
[23]
Bayat, F.; Vehkalahti, M.M.; Heikki, T.; Zafarmand, H.A. Dental attendance by insurance status among adults in tehran, Iran. Int. Dent. J. 2006, 56, 338–344, doi:10.1111/j.1875-595X.2006.tb00338.x.
[24]
Statistical Centre of Iran (SCI). Iran Statistical Yearbooks; Statistical Centre of Iran: Tehran, Iran, 2012.
[25]
National Organization for Civil Registration. Available online: www.Sabteahval.Ir/en (accessed on 13 March 2012).
[26]
President Deputy of Strategic Planning and Control. Available online: www.Spac.Ir/portal/home (accessed on 13 March 2012).
[27]
Gravelle, H.; Sutton, M. Inequality in the geographical distribution of general practitioners in England and Wales 1974–1995. J. Health Serv. Res. Pol. 2001, 6, 6–13, doi:10.1258/1355819011927143.
[28]
Mackenbach, J.P.; Kunst, A.E. Measuring the magnitude of socio-economic inequalities in health: An overview of available measures illustrated with two examples from Europe. Soc. Sci. Med. 1997, 44, 757–771, doi:10.1016/S0277-9536(96)00073-1.
[29]
Toyabe, S. Trend in geographic distribution of physicians in Japan. Int. J. Equity Health 2009, 8, 5, doi:10.1186/1475-9276-8-5.
[30]
Brown, M.C. Using Gini-style indices to evaluate the spatial patterns of health practitioners: Theoretical considerations and an application based on Alberta data. Soc. Sci. Med. 1994, 38, 1243–1256, doi:10.1016/0277-9536(94)90189-9.
[31]
Wagstaff, A.; Paci, P.; van Doorslaer, E. On the measurement of inequalities in health. Soc. Sci. Med. 1991, 33, 545–557, doi:10.1016/0277-9536(91)90212-U.
[32]
Gastwirth, J.L. A graphical summary of disparities in health care and related summary measures. J. Stat. Plan. Infer. 2007, 137, 1059–1065, doi:10.1016/j.jspi.2006.06.024.
[33]
Bayat, F.; Vehkalahti, M.M.; Zafarmand, A.H.; Tala, H. Impact of insurance scheme on adults’ dental check-ups in a developing oral health care system. Eur. J. Dent. 2008, 2, 3–10.
[34]
Leive, A.; Xu, K. Coping with the Out-of-Pocket Health Payments: Applications of Engel Curves and Two-Part Models in Six African Countries; World Health Organization: Geneva, Switzerland, 2007.
[35]
WHO Global Atlas of the Health Workforce. Available online: www.who.int/globalatlas/autologin/ hrh_login.asp (accessed on 17 April 2013).
[36]
Ravaghi, V.; Underwood, M.; Marinho, V.; Eldridge, S. Socioeconomic status and self-reported oral health in Iranian adolescents: The role of selected oral health behaviors and psychological factors. J. Publ. Health Dent. 2012, 72, 198–207, doi:10.1111/j.1752-7325.2012.00330.x.
[37]
Naghibi Sistani, M.M.; Yazdani, R.; Virtanen, J.; Pakdaman, A.; Murtomaa, H. Determinants of oral health: Does oral health literacy matter? ISRN Dent. 2013, 2013, 249591, doi:10.1155/2013/249591.
[38]
Manski, R.J.; Cooper, P.F. Dental care use: Does dental insurance truly make a difference in the US? Community Dent. Health 2007, 24, 205–212.
[39]
Widstrom, E.; Seppala, T. Willingness and ability to pay for unexpected dental expenses by Finnish adults. BMC Oral Health 2012, 12, 35, doi:10.1186/1472-6831-12-35.
[40]
Vahid Dastjerdi, M.; Mahdian, M.; Vahid Dastjerdi, E.; Namdari, M. Study motives and career choices of Iranian medical and dental students. Acta Med. Iran. 2012, 50, 417–424.
[41]
Steele, M.T.; Schwab, R.A.; McNamara, R.M.; Watson, W.A. Emergency medicine resident choice of practice location. Ann. Emerg. Med. 1998, 31, 351–357, doi:10.1016/S0196-0644(98)70346-4.
[42]
Seifer, S.D.; Vranizan, K.; Grumbach, K. Graduate medical education and physician practice location. Implications for physician workforce policy. JAMA 1995, 274, 685–691, doi:10.1001/jama.1995.03530090017015.
[43]
Kruger, E.; Tennant, M.; George, R. Application of geographic information systems to the analysis of private dental practices distribution in Western Australia. Rural Rem. Health 2011, 11, 1736.
[44]
Okawa, Y.; Hirata, S.; Okada, M.; Ishii, T. Geographic distribution of dentists in Japan: 1980–2000. J. Publ. Health Dent. 2011, 71, 236–240.
[45]
Haghparast Bidgoli, H.; Bogg, L.; Hasselberg, M. Pre-hospital trauma care resources for road traffic injuries in a middle-income country—A province based study on need and access in Iran. Injury 2011, 42, 879–884, doi:10.1016/j.injury.2010.04.024.
[46]
Shahabi M, T.S.; Maleki, M.R. The nurse and specialist physicians manpower distribution by population and its relationship with the number of beds at Iran’s public hospitals in 2001–2006. Health Manag. 2010, 13, 7–14.
[47]
Kamppi, A.; Tanner, T.; Pakkila, J.; Patinen, P.; Jarvelin, M.R.; Tjaderhane, L.; Anttonen, V. Geographical distribution of dental caries prevalence and associated factors in young adults in Finland. Caries Res. 2013, 47, 346–354, doi:10.1159/000346435.
[48]
Cypriano, S.; Hoffmann, R.H.; de Sousa Mda, L.; Wada, R.S. Dental caries experience in 12-year-old schoolchildren in Southeastern Brazil. J. Appl. Oral Sci. 2008, 16, 286–292, doi:10.1590/S1678-77572008000400011.