IADR Abstract Archives
Contextual and Individual Inequalities in Caries Experience: A Multilevel Analysis
Objectives: To assess the effect of individual and contextual socioeconomic position in dental caries experience among children beneficiary of a nationwide school dental program.
Methods: Data from Nationwide school dental programme by the National Board of School Aid and Scholarships (JUNAEB) dependent on the Ministry of Education were used in this cross-sectional study. The population corresponded to 185.643 children from pre-kinder to eighth grade of schooling. Explanatory variables included living in extreme poverty at individual-level and Human Development Index (HDI) at community-level. Outcomes studied were DMFT/dmft indexes for permanent and primary dentition. Covariates included sex, municipality rurality index and school grade as proxy of age. Three Poisson multilevel regression models were executed: first a null model with DMFT/dmft variable. Then, the crude association model between HDI and DMFT/dmft. Finally, a full model adjusted for all covariates. Afterwards, adjusted predictions of DMFT/dmft scores at representative values (mean age, mean rurality index and male sex) were calculated from the final model and expressed as probability graphs.
Results: For permanent teeth, individuals from low HDI municipalities had 42% lower risk of caries experience (95%CI=18-59%) while for those belonging to medium and high HDI the relative risk was 41% lower (95%CI=17-58%). For primary teeth, compared to individuals living in very low HDI municipalities, those from low and medium HDI were likely to have a 66% (95%IC=50-76%) lower caries experience.
The lowest dmft predicted were non-poor children living in high HDI municipalities (2.24, 95%CI=2.07-2.40), while the highest dmft observed were for those living in very low HDI municipalities and living in extreme poverty (7.33, 95%CI=4.50-10.16). Similar results were observed for predicted DMFT.
Conclusions: Contextual socioeconomic position was associated to caries experience in both dentitions. A social gradient in predicted dmft/DMFT by municipality HDI was observed regardless of individual socioeconomic position.
Methods: Data from Nationwide school dental programme by the National Board of School Aid and Scholarships (JUNAEB) dependent on the Ministry of Education were used in this cross-sectional study. The population corresponded to 185.643 children from pre-kinder to eighth grade of schooling. Explanatory variables included living in extreme poverty at individual-level and Human Development Index (HDI) at community-level. Outcomes studied were DMFT/dmft indexes for permanent and primary dentition. Covariates included sex, municipality rurality index and school grade as proxy of age. Three Poisson multilevel regression models were executed: first a null model with DMFT/dmft variable. Then, the crude association model between HDI and DMFT/dmft. Finally, a full model adjusted for all covariates. Afterwards, adjusted predictions of DMFT/dmft scores at representative values (mean age, mean rurality index and male sex) were calculated from the final model and expressed as probability graphs.
Results: For permanent teeth, individuals from low HDI municipalities had 42% lower risk of caries experience (95%CI=18-59%) while for those belonging to medium and high HDI the relative risk was 41% lower (95%CI=17-58%). For primary teeth, compared to individuals living in very low HDI municipalities, those from low and medium HDI were likely to have a 66% (95%IC=50-76%) lower caries experience.
The lowest dmft predicted were non-poor children living in high HDI municipalities (2.24, 95%CI=2.07-2.40), while the highest dmft observed were for those living in very low HDI municipalities and living in extreme poverty (7.33, 95%CI=4.50-10.16). Similar results were observed for predicted DMFT.
Conclusions: Contextual socioeconomic position was associated to caries experience in both dentitions. A social gradient in predicted dmft/DMFT by municipality HDI was observed regardless of individual socioeconomic position.