Socioeconomic inequalities in use and non-use of dental services in Poland.

OBJECTIVES: To assess the impact of classical socioeconomic factors on the use and non-use of dental services on a representative sample of Polish population. METHODS: The study was based on face-to-face surveys conducted by GUS (Statistics Poland) on 13,376 respondents in 2010 and 12,532 individuals in 2013. RESULTS: The percentage of people using dental services in the highest income group was approximately twice as high as that in the lowest one (Q1: 7.0% vs. Q5: 16.4%), with the same being true for education (the lowest education group: 8.3% vs. the highest education group: 18.0%), and place of residence (inhabitants of rural areas: 9.2% vs. inhabitants of largest cities: 15.9%) in 2013. The analysis has shown the disparities in not using dental services when in need to be less clear-cut. CONCLUSIONS: The conducted research, based on two independent periods, a representative population sample, univariate analysis and the multivariate regression model has revealed pronounced social inequalities in dental care use. It is a challenge to determine the factors which contribute most to health inequalities and the interventions which are most effective in reducing them.

Inequalities in breast cancer incidence and stage distribution between urban and rural female population in Swietokrzyskie Province, Poland.

INTRODUCTION AND OBJECTIVE: One of the main factors determining the burden of breast cancer is the effectiveness of measures taken to combat this cancer including urban-rural differences. The aim of the study was to analyse the differences in breast cancer incidence and disease stage distribution among urban and rural women in the Swietokrzyskie Province as a part of a strategy for breast cancer control. MATERIAL AND METHODS: The study of disease stage distribution included 483 female residents of Swietokrzyskie Province who were diagnosed in 2013 with invasive breast cancer, and reported to Swietokrzyskie Office for Cancer Registration. Urban-rural differences in breast cancer incidence in 2002-2013 were presented using Range Ratio (RR). Changes in incidence trends in urban and rural areas were analysed using joinpoint models. Annual Percentage Change (APC) of the rates was calculated for each time trend. RESULTS: Breast cancer incidence rate in the urban female population was higher than in rural women with RR, amounting to 1.43. However, the analysis of trends showed that the pace and direction of change were developing negatively among inhabitants of rural areas. In 2002-2013, in rural women, the age-standardized rate (ASR) values increased by 2.8% per year (p<0.05). The course of ASR trends showed statistically significant urban-rural differences (p=0.004). Analysis of urban-rural differences in disease stage distribution revealed a non-significantly higher proportion of cases with localised stage in urban than in rural areas, amounting to 51.0% and 43.9%, respectively. CONCLUSIONS: Existing health inequalities indicate the need to intensify activities in rural areas and should be the starting point for making key decisions in combating breast cancer.

Socio-economic inequalities in the use of dental care in urban and rural areas in Poland.

INTRODUCTION: The issue of inequalities in the use of health services and health inequalities between urban and rural dwellers is a subject of numerous scientific reports, but similar publications on dental health are scarce. OBJECTIVE: The aim of this study is to assess the correlations between the use or non-use of dental services and the classical socio-economic factors (SES) in urban and rural groups in a representative population of Poland. MATERIAL AND METHODS: The analysis consisted in desk research based on a questionnaire survey conducted by the Central Statistical Office of Poland on 12,532 individuals (urban areas - 6411, rural areas - 6121) in 2013. The chi-squared test, multivariate and univariate logistic regression models were applied. RESULTS: There were major differences in the use of dental services depending on income level, education and source of income among rural and urban populations, as well as differences between these populations. Urban dwellers had 1.34 times greater odds of using dental services than rural ones (95% CI: 1.20-1.51). In the case of the highest income group, the odds were 3.26 (95% CI 2.21-4.83) times greater in cities and 2.07 (95% CI 1.51-2.85) times greater in villages than the odds in the lowest income group. In the highest education group, the odds were 1.58 (95% CI 1.17-2.13) times greater in urban areas and 2.08 (95% CI 1.48-2.91) times greater in rural areas than the odds in the lowest education group. CONCLUSIONS: There are considerable inequalities in the use of dental services, yet the differences in non-use, despite such a need, are less evident. This could imply that health disparities arise not only from economic constraints and unavailability of health care, but also from health attitudes and behaviours.