Evidence map›Paper›PMID 40983894›Full record

ArticleBMC public health2025

Inequalities in dental service utilization among adults in Bangladesh, Bhutan, and Nepal: a population-based cross-sectional study.

Abir Nagata, Md Mahfuzur Rahman, Tshewang Gyeltshen, Takatoshi Nakagawa, Anam Ahmed, Abu Saleh Muhammad Shahriar, Kiran Acharya, Yu Kubota, Md Shafiur Rahman

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Article in BMC public health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

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3citing papers in PubMed
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1 · What the graph read from it

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2 · The registry

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3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

9 authors.

Abir NagataResearch Center for Child Mental Development, Hamamatsu University School of Medicine, Hamamatsu, Japan. abir-n@hama-med.ac.jp.
Md Mahfuzur RahmanGraduate School of Public Health, St. Luke's International University, Tokyo, Japan.
Tshewang GyeltshenDepartment of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Bunkyo, Japan.
Takatoshi NakagawaDepartment of Dermatology, Graduate School of Medicine, The University of Osaka, Suita, Japan.
Anam AhmedDepartment of Dental Public Health, University Dental College, Dhaka, Bangladesh.
Abu Saleh Muhammad ShahriarDepartment of Periodontology and Oral Pathology, University Dental College, Dhaka, Bangladesh.
Kiran AcharyaNew ERA, Rudramati Marga, Kalopul, Kathmandu, Nepal.
Yu KubotaGraduate School of Health Innovation, Kanagawa University of Human Services, Kawasaki, Kanagawa, Japan.
Md Shafiur RahmanResearch Center for Child Mental Development, Hamamatsu University School of Medicine, Hamamatsu, Japan. rahman-2s5@kuhs.ac.jp.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundOral health is integral to overall well-being and Universal Health Coverage (UHC), yet disparities in dental service utilization (DSU) persist in low- and middle-income countries (LMICs). Socioeconomic status (SES) and educational inequalities exacerbate barriers to accessing essential dental services, limiting UHC progress. Therefore, this study assessed absolute and relative socioeconomic and education-based inequalities in DSU in Bangladesh, Bhutan, and Nepal and identified demographic and socioeconomic determinants.

methodsData from the most recent WHO STEPwise approach to surveillance (STEPS) surveys in Bangladesh (2017-18), Bhutan (2019), and Nepal (2019) were analyzed. Inequalities in DSU were assessed using the slope index of inequality (SII), relative index of inequality (RII), and relative concentration index (RCI). The determinants of DSU were assessed using mixed-effects binary logistic regression models.

resultsEver DSU was highest in Bhutan (48.8%), followed by Bangladesh (29.1%) and Nepal (5.6%). Socioeconomic inequalities in DSU were significant in Bhutan, with higher utilization concentrated among the wealthiest groups (SII: 33.9, 95% confidence interval [CI]: 27.8-40.1 for ever DSU; RII: 2.11, 95% CI: 1.86-2.39), while education-based disparities favored individuals with higher education (RII: 1.85, 95% CI: 1.62-2.13). In Bangladesh, education-based inequalities in DSU were evident only in urban areas (SII: 17.3, 95% CI: 8.2-26.5; RII: 1.69, 95% CI: 1.38-2.06). In Nepal, DSU was uniformly low across all groups, with minimal or even reversed socioeconomic and educational disparities. Independent determinants of DSU, identified through adjusted mixed-effects logistic regression, included older age, higher education, and urban residence in Bangladesh; higher education and SES in Bhutan; and female sex in Nepal.

conclusionsDSU was limited across Bangladesh, Bhutan, and Nepal, with the lowest rates observed in Nepal. Substantial socioeconomic and educational inequalities in DSU were evident in Bhutan and Bangladesh. These findings underscore the need for UHC-aligned, equity-focused reforms, including national oral health policies, targeted outreach to disadvantaged groups, and expanded access to preventive services.

Indexed as

Dental Health ServicesHealthcare DisparitiesPatient Acceptance of Health CareAdolescentAdultBangladeshBhutanCross-Sectional StudiesFemaleHumansMaleMiddle AgedNepalSocioeconomic FactorsYoung AdultDental service utilizationEducation-based inequalityLow- and Middle-Income countriesSocioeconomic inequalityUniversal health coverage

Identifiers

PMID40983894
PMCPMC12452004

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.