BACKGROUND Socioeconomic-related inequality in oral hygiene behaviors in Iran is poorly understood. This study aims to measure and decompose socioeconomic-related inequalities in oral hygiene behaviors among middle-aged and elderly adults in Iran. METHODS A cross-sectional analysis was performed using data from the Prospective Epidemiological Research Studies in IrAN (PERSIAN), a large national cohort study. A total of 130,016 individuals aged 35 years and above from 17 cohort centers in Iran were included in the study. The normalized concentration index (Cn) was used to measure the magnitude of inequality in oral hygiene behaviors, i.e. brushing at least twice and flossing once daily, among middle-aged and elderly Iranian adults included in the cohort centers. Decomposition analysis was performed to quantify the contribution of each determinant to the observed inequality in oral hygiene behaviors. RESULTS Totally, 65.5% of middle-aged and elderly adults brushed their teeth twice a day or more, 7.6% flossed at least once a day and 3.48% had both habits. The estimated Cn of the two habits combined, i.e. tooth brushing and dental flossing, for all provinces taken part in the PERSIAN cohort study was 0.399 (95% confidence interval [CI]: 0.383 to 0.417), indicating that the prevalence of the two habits combined is more concentrated among individuals with higher socioeconomic status. Inequality in oral hygiene behaviors was pro-rich in all cohort centers. The decomposition results suggested socioeconomic status as the main factor contributing to the overall inequality, followed by the level of education, and the province of residence. CONCLUSION A low prevalence of oral hygiene behaviors among middle-aged and elderly Iranian adults was observed. There was also a pro-rich inequality in oral hygiene behaviors among middle-aged and elderly adults in all cohort centers. These results suggest an urgent need for targeted policy interventions to increase the prevalence of preventive oral hygiene behaviors among the poor and less-educated middle-aged and elderly adults in Iran.

中文翻译：

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口腔卫生行为中与社会经济相关的不平等：对PERSIAN队列研究的横断面分析。

背景技术人们对伊朗口腔卫生行为中与社会经济相关的不平等了解很少。这项研究旨在衡量和分解伊朗中年和老年人在口腔卫生行为方面与社会经济有关的不平等现象。方法使用来自大型国家队列研究IrAN的前瞻性流行病学研究数据进行横断面分析。这项研究包括来自伊朗17个队列中心的总计130,016名年龄在35岁以上的人。归一化浓度指数（Cn）用于测量队列中心中伊朗中年成年人在口腔卫生行为中的不平等程度，即每天至少刷牙两次和用牙线剔牙一次。进行分解分析以量化每个决定因素对观察到的口腔卫生行为不平等的贡献。结果总共有65.5％的中老年人每天刷两次或两次以上牙齿，7.6％的牙线至少每天刷牙一次，3.48％的人有两种习惯。参与PERSIAN队列研究的所有省份，两种习惯（即刷牙和牙线）的估计Cn为0.399（95％置信区间[CI]：0.383至0.417），表明这两种习惯的患病率社会经济地位较高的人中，合并人数更多。在所有队列中心，口腔卫生行为的不平等现象都十分普遍。分解结果表明，社会经济地位是造成整体不平等的主要因素，其次是教育程度，和居住省份。结论观察到伊朗中年和老年人的口腔卫生行为普遍存在。在所有队列中心的中老年人中，口腔卫生行为也存在着丰富的不平等现象。这些结果表明，迫切需要针对性的政策干预措施，以增加伊朗贫困和教育程度较低的中年和老年人的预防性口腔卫生行为的患病率。