Oral Health and Oral Health Service Utilization in Native and Immigrant Population: A Cross-Sectional Analysis from the PELFI Cohort in Spain

  • Andrés A. Agudelo-SuárezEmail author
  • Natalia Muñoz-Pino
  • Annie M. Vivares-Builes
  • Elena Ronda-Pérez
Original Paper


This study analyzes associated factors to self-perceived oral health and use of oral health services in native and immigrant adults from the PELFI cohort in Spain. A cross-sectional analysis was conducted (401 adults ≥ 18 years, from Spain, Ecuador, Colombia and Morocco). Frequencies for sociodemographic, self-perceived general and oral health variables were calculated. The association between oral health/oral health services use and origin country was estimated by logistic regression (adjusted odds ratio-aOR-; 95% confidence intervals -95%CI-). Ecuadorian men were more likely to report dental caries (aPR 2.75; 95%CI 1.30–5.80) and Moroccan women were more likely to report gingival bleeding (aPR 3.61; 95%CI 1.83–7.15) and the use of oral health services ≥ 1 year/never (aPR 1.69; 95%CI 1.06–2.69). Colombian women were less likely to report missing teeth (aPR 0.73; 95%CI 0.56–0.95). Poor self-perceived oral health indicators were observed in immigrants and were modified for sociodemographic and general health variables.


Emigrants and immigrants Oral health Dental caries Periodontal diseases Dental health surveys 



The authors would like to thank all the individuals and families from the PELFI cohort of the cities of Barcelona and Alicante that agreed to take part in this study.

Author Contributions

AAAS coordinated the design of the manuscript confection and drafted the manuscript. The rest of the authors made substantial contributions to the interpretation of data. All the authors contributed to the revision of the different versions of the manuscript and the approval of the final version to be submitted to the journal.


Healthcare Research Fund of the Spanish Ministry of Health (Ref. PI14/01146-PI14/02005), Institute for Health Carlos III-FEDER. Immigration and Health Subprogram in the Center for Biomedical Network Research on Epidemiology and Public Health (CIBERESP-SIS), Spain.

Compliance with Ethical Standards

Conflict of interest

All the authors declare that they have no conflict of interests.


  1. 1.
    Glick M, Williams DM, Kleinman DV, Vujicic M, Watt RG, Weyant RJ. A new definition for oral health developed by the FDI World Dental Federation opens the door to a universal definition of oral health. Int Dent J. 2016;66(6):322–4.CrossRefGoogle Scholar
  2. 2.
    Bagde R, Rao RD, Jain AK, Verma MR. Impact of oral health on quality of life. Int J Oral Care Res. 2017;5(4):342–4.CrossRefGoogle Scholar
  3. 3.
    Costa SM, Martins CC, Pinto MQC, Vasconcelos M, Abreu M. Socioeconomic factors and caries in people between 19 and 60 years of age: an update of a systematic review and meta-analysis of observational studies. Int J Environ Res Public Health. 2018;15(8):1775.CrossRefGoogle Scholar
  4. 4.
    Yee R, Sheiham A. The burden of restorative dental treatment for children in Third World countries. Int Dent J. 2002;52(1):1–9.CrossRefGoogle Scholar
  5. 5.
    Hakeberg M, Wide BU. Self-reported oral and general health in relation to socioeconomic position. BMC Public Health. 2017;18(1):63.CrossRefGoogle Scholar
  6. 6.
    de los Ángeles Ramírez M, Suárez Paniagua S, de la Fuente Hernández J, Shimada Beltrán H, Reyes Durán JF, Acosta-Torres LS. Componentes culturales que influyen en la salud bucal [cultural components that influence oral health]. Salud(i)Ciencia. 2015;21(3):294–300.Google Scholar
  7. 7.
    Luchi CA, Peres KG, Bastos JL, Peres MA. Inequalities in self-rated oral health in adults. Rev Saude Publica. 2013;47(4):740–51.CrossRefGoogle Scholar
  8. 8.
    United Nations. Department of Economic and Social Affairs. Population Division. Trends in International Migrant Stock: The 2017 Revision. (United Nations database, POP/DB/MIG/Stock/Rev.2017). New York: United Nations; 2017.Google Scholar
  9. 9.
    Rechel B, Mladovsky P, Ingleby D, Mackenbach JP, McKee M. Migration and health in an increasingly diverse Europe. Lancet. 2013;381(9873):1235–45.CrossRefGoogle Scholar
  10. 10.
    Ronda-Perez E, Agudelo-Suarez AA, Lopez-Jacob MJ, Garcia AM, Benavides FG. Scoping review about working conditions and health of immigrant workers in Spain. Rev Esp Salud Publica. 2014;88(6):703–14.CrossRefGoogle Scholar
  11. 11.
    Gea-Sanchez M, Alconada-Romero A, Briones-Vozmediano E, Pastells R, Gastaldo D, Molina F. Undocumented immigrant women in Spain: a scoping review on access to and utilization of health and social services. J Immigr Minor Health. 2017;19(1):194–204.CrossRefGoogle Scholar
  12. 12.
    Bastia T. Should I stay or should I go? Return migration in times of crises. J Int Dev. 2011;23(4):583–95.CrossRefGoogle Scholar
  13. 13.
    Spolsky VW, Marcus M, Der-Martirosian C, Coulter ID, Maida CA. Oral health status and the epidemiologic paradox within Latino immigrant groups. BMC Oral Health. 2012;12:39.CrossRefGoogle Scholar
  14. 14.
    Calvasina P, Muntaner C, Quinonez C. The deterioration of Canadian immigrants' oral health: analysis of the Longitudinal Survey of Immigrants to Canada. Community Dent Oral Epidemiol. 2015;43(5):424–32.CrossRefGoogle Scholar
  15. 15.
    Wilson FA, Wang Y, Borrell LN, Bae S, Stimpson JP. Disparities in oral health by immigration status in the United States. J Am Dent Assoc. 2018;149(6):414–21e3.CrossRefGoogle Scholar
  16. 16.
    Liu Y. Differentiation of self-rated oral health between American non-citizens and citizens. Int Dent J. 2016;66(6):350–5.CrossRefGoogle Scholar
  17. 17.
    Wilson FA, Wang Y, Stimpson JP, McFarland KK, Singh KP. Use of dental services by immigration status in the United States. J Am Dent Assoc. 2016;147(3):162–9e4.CrossRefGoogle Scholar
  18. 18.
    Aarabi G, Reissmann DR, Seedorf U, Becher H, Heydecke G, Kofahl C. Oral health and access to dental care—a comparison of elderly migrants and non-migrants in Germany. Ethn Health. 2018;23(7):703–17.CrossRefGoogle Scholar
  19. 19.
    Calvasina P, Muntaner C, Quinonez C. Factors associated with unmet dental care needs in Canadian immigrants: an analysis of the longitudinal survey of immigrants to Canada. BMC Oral Health. 2014;14:145.CrossRefGoogle Scholar
  20. 20.
    Gao X, Chan CW, Mak SL, Ng Z, Kwong WH, Kot CC. Oral health of foreign domestic workers: exploring the social determinants. J Immigr Minor Health. 2014;16(5):926–33.CrossRefGoogle Scholar
  21. 21.
    Quandt SA, Hiott AE, Grzywacz JG, Davis SW, Arcury TA. Oral health and quality of life of migrant and seasonal farmworkers in North Carolina. J Agric Saf Health. 2007;13(1):45–55.CrossRefGoogle Scholar
  22. 22.
    Paredes Gallardo V, Paredes Cencillo C, Mir PB. Prevalencia de la caries dental en el niño inmigrante: estudio comparativo con el niño autóctono [prevalence of dental caries: comparison between immigrant and autochthonous children]. An Pediatr (Barc). 2006;65(4):337–41.CrossRefGoogle Scholar
  23. 23.
    Almerich Silla JM, Montiel Company JM. Oral health survey of the child population in the Valencia Region of Spain (2004). Med Oral Patol Oral Cir Bucal. 2006;11(4):E369–81.PubMedGoogle Scholar
  24. 24.
    Riatto SG, Montero J, Perez DR, Castano-Seiquer A, Dib A. Oral health status of Syrian children in the Refugee Center of Melilla, Spain. Int J Dent. 2018;2018:2637508.CrossRefGoogle Scholar
  25. 25.
    Munoz-Pino N, Vives-Cases C, Agudelo-Suarez AA, Ronda-Perez E. Comparing oral health services use in the Spanish and immigrant working population. J Immigr Minor Health. 2018;20(4):809–15.CrossRefGoogle Scholar
  26. 26.
    Cayuela-Mateo A, Martinez-Martinez JM, Ferrer Serret L, Felt E, Casabona IBJ, Collazos Sanchez F, et al. PELFI project: recruitment and sociodemographic characteristics of immigrant and autochthonous families from alicante and Barcelona City Subcohorts. Rev Esp Salud Publica. 2017;91:e1–e9.Google Scholar
  27. 27.
    World Health Organization. Obesity and overweight. Fact sheet. Updated June 2016. Accessed 3 Apr 2017.
  28. 28.
    Sanchez-Lopez Mdel P, Dresch V. The 12-Item General Health Questionnaire (GHQ-12): reliability, external validity and factor structure in the Spanish population. Psicothema. 2008;20(4):839–43.PubMedGoogle Scholar
  29. 29.
    Schiaffino A, Rodriguez M, Pasarin MI, Regidor E, Borrell C, Fernandez E. Odds ratio or prevalence ratio? Their use in cross-sectional studies. Gac Sanit. 2003;17(1):70–4.CrossRefGoogle Scholar
  30. 30.
    Castañeda H, Holmes SM, Madrigal DS, Young M-ED, Beyeler N, Quesada J. Immigration as a social determinant of health. Annu Rev Public Health. 2015;36:375–92.CrossRefGoogle Scholar
  31. 31.
    Mattila A, Ghaderi P, Tervonen L, Niskanen L, Pesonen P, Anttonen V, et al. Self-reported oral health and use of dental services among asylum seekers and immigrants in Finland—a pilot study. Eur J Public Health. 2016;26(6):1006–100.CrossRefGoogle Scholar
  32. 32.
    Bravo Pérez M, Almerich Silla J, Ausina Márquez V, Avilés Gutiérrez P, Blanco González J, Canorea Díaz E, et al. Encuesta de salud oral en España 2015 [Oral Health Spanish Survey 2015]. RCOE. 2016;21(Supl1):8–48.Google Scholar
  33. 33.
    Gao XL, McGrath C. A review on the oral health impacts of acculturation. J Immigr Minor Health. 2011;13(2):202–13.CrossRefGoogle Scholar
  34. 34.
    Cruz GD, Chen Y, Salazar CR, Karloopia R, LeGeros RZ. Determinants of oral health care utilization among diverse groups of immigrants in New York City. J Am Dent Assoc. 2010;141(7):871–8.CrossRefGoogle Scholar
  35. 35.
    Dehmoobadsharifabadi A, Singhal S, Quinonez C. Investigating the "inverse care law" in dental care: a comparative analysis of Canadian jurisdictions. Can J Public Health. 2017;107(6):e538–e544544.CrossRefGoogle Scholar
  36. 36.
    Mc Grath C, Bedi R. Gender variations in the social impact of oral health. J Ir Dent Assoc. 2000;46(3):87–91.PubMedGoogle Scholar
  37. 37.
    Azodo CC, Barnabas U. Gender difference in oral health perception and practices among Medical House Officers. Rus Open Med J. 2012;1(2):0208.CrossRefGoogle Scholar
  38. 38.
    Monge S, Ronda E, Pons-Vigues M, Vives Cases C, Malmusi D, Gil-Gonzalez D. Methodological limitations and recommendations in publications on migrant population health in Spain. Gac Sanit. 2015;29(6):461–3.CrossRefGoogle Scholar
  39. 39.
    Marino R, Schofield M, Wright C, Calache H, Minichiello V. Self-reported and clinically determined oral health status predictors for quality of life in dentate older migrant adults. Community Dent Oral Epidemiol. 2008;36(1):85–94.PubMedGoogle Scholar
  40. 40.
    Blizniuk A, Ueno M, Zaitsu T, Kawaguchi Y. Association between self-reported and clinical oral health status in Belarusian adults. J Investig Clin Dent. 2017;8(2):e12206.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2020

Authors and Affiliations

  1. 1.Faculty of DentistryUniversity of AntioquiaMedellínColombia
  2. 2.Public Health Research GroupUniversity of AlicanteAlicanteSpain
  3. 3.Centre for Biomedical Network Research on Epidemiology and Public Health (CIBERESP)MadridSpain

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