Health disparities in deprived areas: ethnicity, social-economic circumstances or behaviour?

Objective: To assess correlates of caries experience in adolescents living in a deprived area. Methods: A survey was carried out in 2005 (Phase 3, RELACHS study). Ethical approval and consent were obtained. Adolescents aged 15-16 years were randomly selected from schools in East London following RELACHS criteria (www.relachs.org). Participants answered a questionnaire and were examined in classroom by two trained examiners (P.E., G.S.) following WHO criteria (DMFT). Data analysis followed a conceptual hierarchical modelling, and included multivariate logistic regression. Results: Response rate was 87%. Further 23 special need participants were excluded from this analysis (n=881). Kappa value for inter-examiners agreement was 0.81. The prevalence of caries (42%) was lower than the overall prevalence in the United Kingdom (49%). Asian British (27.9%), followed by Asian Indian (31.9%), and Black (31.5%) had the lowest prevalence of caries. White (45.3%), Bangladesh (52%), and Pakistani (53.7%) were 2.5 (95%CI 1.3, 5.1), 3.3 (95%CI 1.6, 6.6) and 3.3 (95%CI 1.5, 7.4) times more likely to experience caries than Asian British (P<0.01). Odds ratios were adjusted for socio-economic (financial difficulties, employment status, free school meals), demographic (sex, family structure) and behavioural (tooth brushing frequency and dental attendance) factors. Multivariate analysis also confirmed dental visiting within the last 12 months was related to caries (OR 0.44; 95%CI 0.3, 0.6). Tooth brushing was not related to caries (P>0.05), as only 3 participants reported brushing their teeth less than once a day. Univariate analysis showed parental unemployment was related to caries (P<0.05), but the association did not remain significant after adjusting for ethnicity. Financial difficulties, free school meals (deprivation), family structure and gender were not related to caries in this population (P>0.05). Conclusions: Self-reported race or ethnicity was the main determinant of caries. Materialistic and behavioural pathways explained a very small proportion in ethnicity disparity in a deprived area.