Measuring social inequality in dental health services research: individual, household and area-based measures.

The literature on inequalities in health is extensive and provides convincing evidence that lower socio-economic groups have poorer general and dental health than higher socio-economic groups. In this literature, socio-economic status has been measured in terms of occupation, income or education. These conventional measures have a number of methodological and theoretical weaknesses which limit their ability to fully describe and explain differences in health between population sub-groups. In this paper, these measures are reviewed and alternatives, in the form of area-based indicators, are considered. The evidence suggests that measures of the socio-economic characteristics of neighbourhoods are better predictors of the health status of population subgroups than measures of the socio-economic characteristics of individuals or households. Moreover, they add additional explanatory power to models of health inequalities. Area-based measures can be readily applied to survey data or information derived from health records or routinely collected sources. Since they identify where deprived groups with relatively poor health live, they may prove useful in terms of the planning and targeting of health services. These alternative indicators should be explored in the context of dentistry to determine their ability to predict differences in dental health and risk factors for dental disorders among different segments of the population.