Spatiotemporal trends in oral health inequalities
Session
Health and social differnces
Abstract
The study evaluated the association between childhood socioeconomic position (SEP) and dental caries experience (DMFS index) in the Danish municipalities (n=276).
Nationwide repeated cross-sectional studies were conducted on 15-year-olds in Denmark from 1995, 2003, and 2013 (N=149808). Multilevel Bayesian conditional autoregressive zero-inflated negative binomial models were constructed to evaluate the association between childhood SEP and dental caries, adjusting for individual, neighborhood, temporal, and spatial clustering effects.
Considerable variation in dental caries experience was observed across the municipalities in all three study years, with higher caries experience noted in Western and Northern Jutland and Western and Southern parts of Zealand. The findings also highlighted the primacy of SEP as a cardinal determinant of dental caries experience in adolescents in Denmark.
Målgruppe
Epidemiologists and public health professionals
Yderligere uddybning af abstract
To examine the spatial variation and temporal trends in the distribution of dental caries among adolescents in Danish municipalities between 1995 and 2013. Moreover, to evaluate the association between childhood socioeconomic position (SEP) and dental caries experience adjusting for individual, neighborhood, and temporal effects, and spatial clustering.
Nationwide repeated cross-sectional studies were conducted on 15-year-olds in Denmark from 1995 (n=48900), 2003 (n=50195), and 2013 (n=50713). Data on dental caries experience (measured by the DMFS index) and individual-level social variables (childhood SEP, immigrant status, country of origin, no. of children and persons in family, and household type) were obtained, respectively, from the national dental register of the Danish Health Authority and administrative registers at Statistics Denmark. Indicators of childhood SEP included previous year’s parental education, occupation, and household equivalized disposable income.
Measures of municipality income and deprivation (GINI coefficient; proportion of poor, unemployed, low educated, and unmarried/non-cohabiting individuals; proportion of household overcrowding and single parent households) were estimated from Statistics Denmark’s Statbank. Geo-mapping of trends in dental caries experience and severity was undertaken for the erstwhile (pre-2007) Danish municipalities (n=276). Multilevel Bayesian conditional autoregressive (CAR) zero-inflated negative binomial models were constructed to evaluate the association between childhood SEP and dental caries, adjusting for individual, neighborhood, temporal, and spatial autocorrelation effects, with parametric inference accomplished using integrated nested Laplace approximations.
Caries prevalence among Danish adolescents declined from 71% in 1995 to 63% in 2003 and 45% in 2013; nevertheless, considerable variation in dental caries experience and severity was observed among the municipalities in all three years, with higher caries experience noted in Western and Northern Jutland and Western and Southern Zealand. In all three years, clear gradients were observed in terms of caries differentials in all three SEP categories, with statistically significant associations, even after adjustment for all other covariates. For instance, in 2013, being from a subordinate parental education group was associated with up to 1.79 (95% CI: 1.68–1.91)-fold increase in the amount of caries experience.
The corresponding values for parental occupation and income were 1.4 (95% CI: 1.3–1.5) and 1.51 (95% CI: 1.41–1.6), respectively. In the fully-adjusted spatiotemporal model, in addition to childhood SEP indicators, year, gender, country of origin, and proportion of low educated individuals in the municipality were significant predictors of childhood dental caries.
The findings highlight the primacy of SEP as a cardinal determinant of dental caries experience in adolescents in Denmark.
