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Ganbavale S, Papachristou E, Mathers J, Papacosta A, Lennon L, Whincup P, Wannamethee S, Ramsay S. Neighborhood Deprivation and Changes in Oral Health in Older Age: A Longitudinal Population-Based Study. J Dent Res 2024; 103:434-441. [PMID: 38414259 PMCID: PMC10966931 DOI: 10.1177/00220345231224337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024] Open
Abstract
The aim of this study was to examine the extent to which neighborhood-level socioeconomic factors (objective and perceived) are associated with poor oral health in older adults over time, independent of individual socioeconomic position. Data for this cross-sectional and longitudinal observation study came from a socially and geographically representative cohort of men aged 71 to 92 y in 2010-12 (n = 1,622), drawn from British general practices, which was followed up in 2018-19 (aged 78-98 y; N = 667). Dental measures at both times included number of teeth, periodontal pocket depth, self-rated oral health, and dry mouth. Neighborhood deprivation was based on Index of Multiple Deprivation (IMD) and a cumulative index measuring perceptions about local environment. Individual-level socioeconomic position was based on longest-held occupation. Multilevel and multivariate logistic regressions, adjusted for relevant sociodemographic, behavioral, and health-related factors, were performed to examine the relationships of dental measures with IMD and perceived neighborhood quality index, respectively. Cross-sectionally, risks of tooth loss, periodontal pockets, and dry mouth increased from IMD quintiles 1 to 5 (least to most deprived); odds ratios (ORs) for quintile 5 were 2.22 (95% confidence interval [CI], 1.41-3.51), 2.82 (95% CI, 1.72-4.64), and 1.51 (95% CI, 1.08-2.09), respectively, after adjusting for sociodemographic, behavioral, and health-related factors. Risks of increased pocket depth and dry mouth were significantly greater in quintile 5 (highest problems) of perceived neighborhood quality index compared to quintile 1. Over the 8-y follow-up, deterioration of dentition (tooth loss) was significantly higher in the most deprived IMD quintiles after full adjustment (OR for quintile 5 = 2.32; 95% CI, 1.09-4.89). Deterioration of dentition and dry mouth were significantly greater in quintile 5 of perceived neighborhood quality index. Neighborhood-level factors were associated with poor oral health in older age, both cross-sectionally and longitudinally, particularly with tooth loss, and dry mouth, independent of individual-level socioeconomic position.
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Affiliation(s)
- S.G. Ganbavale
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, North East England, UK
| | - E. Papachristou
- Department of Primary Care and Population Health, UCL, London, UK
| | - J.C. Mathers
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, North East England, UK
| | - A.O. Papacosta
- Department of Primary Care and Population Health, UCL, London, UK
| | - L.T. Lennon
- Department of Primary Care and Population Health, UCL, London, UK
| | - P.H. Whincup
- Population Health Research Institute, St George’s, University of London, London, UK
| | - S.G. Wannamethee
- Department of Primary Care and Population Health, UCL, London, UK
| | - S.E. Ramsay
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, North East England, UK
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Filgueiras LV, Konflanz W, Haas AN, Celeste RK. Assessment of the contextual effects on the prevalence of periodontitis: a systematic review. Braz Oral Res 2023; 36:e0125. [PMID: 36651384 DOI: 10.1590/1807-3107bor-2022.vol36.0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 06/02/2021] [Indexed: 01/17/2023] Open
Abstract
This study reviews the influence of contextual factors on periodontitis based on a systematic search of studies recorded in the PubMed, Scopus, Web of Science, and EMBASE databases. Periodontitis was assessed by clinical attachment loss and probing depth for studies with data on the socioeconomic status (SES) of a specific area (area-level SES) or dental care service (service-level) in a catchment area among individuals aged 18 and over. Two independent reviewers performed study selection, data extraction, and assessment of methodological quality. Of the 646 articles identified, 13 were included in the systematic review, representing 101,362 individuals from five countries (USA, UK, Brazil, China, and Uruguay). A higher prevalence of periodontitis was described in lower SES neighborhoods, more deprived postcodes, and poorer provinces. Gini Index results were mixed and inconclusive. Three studies showed that higher coverage of primary dental care at the municipal level was associated with a lower prevalence of periodontitis. Contextual factors at the area-level SES and dental care service might influence periodontitis, but the existing evidence is unclear. The contextual effect is important for periodontal health and may contribute to the prevalence of periodontitis, independent of well-known risk factors and individual levels.
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Affiliation(s)
- Leonardo Vilar Filgueiras
- Universidade Federal do Rio Grande do Sul - UFRGS, Department of Preventive and Social Dentistry, Porto Alegre, RS, Brazil
| | - Willian Konflanz
- Universidade Federal do Rio Grande do Sul - UFRGS, Department of Periodontology, Porto Alegre, RS, Brazil
| | - Alex Nogueira Haas
- Universidade Federal do Rio Grande do Sul - UFRGS, Department of Periodontology, Porto Alegre, RS, Brazil
| | - Roger Keller Celeste
- Universidade Federal do Rio Grande do Sul - UFRGS, Department of Preventive and Social Dentistry, Porto Alegre, RS, Brazil
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van Meijeren-van Lunteren AW, Oude Groeniger J, Wolvius EB, Kragt L. Neighbourhood characteristics and children's oral health: a multilevel population-based cohort study. Eur J Public Health 2021; 31:742-748. [PMID: 33624096 PMCID: PMC8514066 DOI: 10.1093/eurpub/ckab013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background To understand determinants of oral health inequalities, multilevel modelling is a useful manner to study contextual factors in relation to individual oral health. Several studies outside Europe have been performed so far, however, contextual variables used are diverse and results conflicting. Therefore, this study investigated whether neighbourhood level differences in oral health exist, and whether any of the neighbourhood characteristics used were associated with oral health. Methods This study is embedded in The Generation R Study, a prospective cohort study conducted in The Netherlands. In total, 5 960 6-year-old children, representing 158 neighbourhoods in the area of Rotterdam, were included. Data on individual and neighbourhood characteristics were derived from questionnaires, and via open data resources. Caries was assessed via intraoral photographs, and defined as decayed, missing and filled teeth (dmft). Results Differences between neighbourhoods explained 13.3% of the risk of getting severe caries, and 2% of the chance of visiting the dentist yearly. After adjustments for neighbourhood and individual characteristics, neighbourhood deprivation was significantly associated with severe dental caries (OR: 1.48, 95% CI: 1.02–2.15), and suggestive of a low odds of visiting the dentist yearly (OR: 0.81, 95% CI: 0.56–1.18). Conclusions Childhood caries and use of dental services differs between neighbourhoods and living in a deprived neighbourhood is associated with increased dental caries and decreased yearly use of dental services. This highlights the importance of neighbourhoods for understanding differences in children’s oral health, and for targeted policies and interventions to improve the oral health of children living in deprived neighbourhoods.
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Affiliation(s)
- Agatha W van Meijeren-van Lunteren
- The Generation R Study Group, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Department of Oral & Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Joost Oude Groeniger
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Department of Public Administration and Sociology, Erasmus University, Rotterdam, The Netherlands
| | - Eppo B Wolvius
- The Generation R Study Group, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Department of Oral & Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Lea Kragt
- The Generation R Study Group, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Department of Oral & Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Centre, Rotterdam, The Netherlands
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Smith JS. Archaeological oral health: a comparison of post-medieval and modern-day dental caries exposure of adults in East London. Br Dent J 2019; 227:721-725. [PMID: 31654010 DOI: 10.1038/s41415-019-0737-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Modern levels of dental decay worldwide are on the rise. This study aimed to calculate historical rates of decay and compare them with recent figures. To compare the rate of dental decay in East Londoners from a post-medieval burial ground and a published modern sample, a database of human remains held at the Museum of London Archaeology (MOLA) was interrogated. The resulting numbers of decayed and missing teeth were analysed and compared to the East London Oral Health Inequality study initially undertaken in 2010. A lower decayed/missing/filled teeth (DMFT) score was seen in the post-medieval burials.
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Affiliation(s)
- Joseph S Smith
- Queen Mary University of London, Oral and Maxillofacial Department, Turner Street, Whitechapel, London, UK.
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Mohd Radzi N. Effects of area-based deprivation on dental caries, perceived dental treatment need and oral health related quality of life of UK adults. J Int Oral Health 2019. [DOI: 10.4103/jioh.jioh_47_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Lorenzo-Erro SM, Massa F, Álvarez-Vaz R, Schuch HS, Correa MB, Peres MA. The role of contextual and individual factors on periodontal disease in Uruguayan adults. Braz Oral Res 2018; 32:e62. [PMID: 29995066 DOI: 10.1590/1807-3107bor-2018.vol32.0062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 05/23/2018] [Indexed: 11/22/2022] Open
Abstract
The present study aimed at understanding the relationship between periodontitis and socio-contextual and individual determinants of health. Data from "The First Uruguayan Oral Health Survey, 2011", which included 223 and 455 individuals with 35-44 and 65-74 years old respectively, were used. A stratified, multistage cluster sampling design was adopted (cities with ≥ 20.000 residents). Periodontitis was assessed using the modified Community Periodontal Index (CPI) and clinical attachment loss (CAL) (periodontal pocket and CAL ≥ 4 mm). Independent variables included contextual socioeconomic status (SES) measured by proportion of houses with Unsatisfied Basic Needs (UBN) and individual demographic and behavioral factors. Logistic regression multilevel models were generated. Living in contexts with a higher UBN was associated with higher odds for periodontitis in both age groups, even when adjusting for individual level variables (odds ratio [OR] = 1.51, 95%CI = 1.42-1.60 and 1.31, 95%CI = 1.21-1.42, respectively). Being male or heavy smoker increased the odds of periodontitis in this population for both age groups. Social structure impacts periodontal disease by modifying individual socioeconomic situations: in better socioeconomic context, UBN acts increasing the protector role of socioeconomic situation but in a poverty context the role is attenuated. Conclusions for this study are that periodontitis varies across contextual socio-demographic groups being higher in the population with a lower SES, challenging health authorities to integrate oral health into national non-communicable diseases programs.
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Affiliation(s)
| | - Fernando Massa
- University of the Republic of Uruguay, School of Dentistry, Epidemiology and Statistic Unit, Montevideo, Uruguay
| | - Ramón Álvarez-Vaz
- University of the Republic of Uruguay, Statistic Institute School of Economy, Montevideo, Uruguay
| | - Helena Silveira Schuch
- The University of Adelaide, Australian Research Centre for Population Oral Health, Adelaide Dental School, Australia
| | - Marcos Britto Correa
- Universidade Federal de Pelotas - UFPel, School of Dentistry, Graduate Program in Dentistry, Pelotas, RS, Brazil
| | - Marco Aurélio Peres
- The University of Adelaide, Australian Research Centre for Population Oral Health, Adelaide Dental School, Australia
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7
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Sun X, Bernabé E, Liu X, Gallagher JE, Zheng S. Do contextual factors have a role in periodontal disease? J Clin Periodontol 2016; 44:13-21. [DOI: 10.1111/jcpe.12630] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Xiangyu Sun
- Department of Preventive Dentistry; Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology; Beijing Key Laboratory of Digital Stomatology; Beijing China
- King's College London Dental Institute at Guy's; King's College and St Thomas' Hospitals, Population and Patient Health Division; London UK
| | - Eduardo Bernabé
- King's College London Dental Institute at Guy's; King's College and St Thomas' Hospitals, Population and Patient Health Division; London UK
| | - Xuenan Liu
- Department of Preventive Dentistry; Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology; Beijing Key Laboratory of Digital Stomatology; Beijing China
| | - Jennifer E. Gallagher
- King's College London Dental Institute at Guy's; King's College and St Thomas' Hospitals, Population and Patient Health Division; London UK
| | - Shuguo Zheng
- Department of Preventive Dentistry; Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology; Beijing Key Laboratory of Digital Stomatology; Beijing China
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Kim CS, Han SY, Lee SE, Kang JH, Kim CW. Dental Care Utilization for Examination and Regional Deprivation. J Prev Med Public Health 2015; 48:195-202. [PMID: 26265665 PMCID: PMC4542294 DOI: 10.3961/jpmph.15.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 07/17/2015] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES Receiving proper dental care plays a significant role in maintaining good oral health. We investigated the relationship between regional deprivation and dental care utilization. METHODS Multilevel logistic regression was used to identify the relationship between the regional deprivation level and dental care utilization purpose, adjusting for individual-level variables, in adults aged 19+ in the 2008 Korean Community Health Survey (n=220 258). RESULTS Among Korean adults, 12.8% used dental care to undergo examination and 21.0% visited a dentist for other reasons. In the final model, regional deprivation level was associated with significant variations in dental care utilization for examination (p<0.001). However, this relationship was not shown with dental care utilization for other reasons in the final model. CONCLUSIONS This study's findings suggest that policy interventions should be considered to reduce regional variations in rates of dental care utilization for examination.
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Affiliation(s)
- Cheol-Sin Kim
- Research Institute for Dental Care Policy, Korean Dental Association, Seoul, Korea
| | - Sun-Young Han
- Research Institute for Dental Care Policy, Korean Dental Association, Seoul, Korea
| | - Seung Eun Lee
- Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - Jeong-Hee Kang
- Department of Nursing Science, Youngdong University, Youngdong, Korea
| | - Chul-Woung Kim
- Department of Preventive Medicine, Chungnam National University School of Medicine, Daejeon, Korea ; Research Institute for Medical Sciences, Chungnam National University School of Medicine, Daejeon, Korea
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Saito M, Kondo K, Kondo N, Abe A, Ojima T, Suzuki K. Relative deprivation, poverty, and subjective health: JAGES cross-sectional study. PLoS One 2014; 9:e111169. [PMID: 25350284 PMCID: PMC4211701 DOI: 10.1371/journal.pone.0111169] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 09/23/2014] [Indexed: 11/30/2022] Open
Abstract
To evaluate the association between relative deprivation (lacking daily necessities) and subjective health in older Japanese adults, we performed a cross-sectional analysis using data from the Japan Gerontological Evaluation Study (JAGES). The data were obtained from functionally independent residents aged ≥65 years from 24 municipalities in Japan (n = 24,742). Thirteen items in three dimensions were used to evaluate relative deprivation of material conditions. Approximately 28% of older Japanese people indicated that they lacked some daily necessities (non-monetary poverty). A two-level Poisson regression analysis revealed that relative deprivation was associated with poor self-rated health (PR = 1.3-1.5) and depressive symptoms (PR = 1.5-1.8) in both men and women, and these relationships were stronger than those observed in people living in relative poverty (monetary poverty). The interaction effect between relative deprivation and relative poverty was not associated with poor health. As a dimension of the social determinants of health, poverty should be evaluated from a multidimensional approach, capturing not only monetary conditions but also material-based, non-monetary conditions.
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Affiliation(s)
- Masashige Saito
- Department of Social Welfare, Nihon Fukushi University, Aichi, Japan
| | - Katsunori Kondo
- Center for Preventive Medical Science, Chiba University, Chiba, Japan
| | - Naoki Kondo
- Department of Health Economics and Epidemiology Research, The University of Tokyo, Tokyo, Japan
| | - Aya Abe
- Department of Empirical Social Security Research, National Institute of Population and Social Security Research, Tokyo, Japan
| | - Toshiyuki Ojima
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Kayo Suzuki
- Department of Social Studies, Aichi Gakuin University, Aichi, Japan
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Vettore MV, Marques RADA, Peres MA. Desigualdades sociais e doença periodontal no estudo SBBrasil 2010: abordagem multinível. Rev Saude Publica 2013; 47 Suppl 3:29-39. [DOI: 10.1590/s0034-8910.2013047004422] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Accepted: 03/20/2013] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Estimar a prevalência e a distribuição geográfica da doença periodontal na população adulta brasileira e sua associação com desigualdades sociais contextuais e individuais. MÉTODOS: Foram utilizados dados dos adultos de 35 a 44 anos de idade da Pesquisa Nacional de Saúde Bucal – SBBrasil 2010 (n = 9.564). O Índice Periodontal Comunitário (CPI) e o Índice de Perda Periodontal (PIP) foram usados para definir a doença periodontal em “moderada a grave” (CPI > 2 e PIP > 0) e “grave” (CPI > 2 e PIP > 1). As desigualdades sociais contextuais incluíram o índice de desenvolvimento humano e a desigualdade de renda (Índice de Gini). Outras variáveis contextuais foram a cobertura de equipes de saúde bucal da Estratégia de Saúde da Família e o percentual de adultos fumantes. Modelos de regressão logística multinível para os participantes com dados completos (n = 4.594) foram usados para estimar odds ratios (OR) e intervalos de 95% de confiança (IC95%) entre desigualdades sociais e doença periodontal. RESULTADOS: A prevalência da doença periodontal “moderada a grave” em brasileiros adultos foi de 15,3% e 5,8% para a condição “grave”, com variações consideráveis entre os municípios. Dentre as variáveis contextuais, a desigualdade de renda foi independentemente associada com a doença periodontal “grave” (OR = 3,0; IC95% 1,5;5,9). A menor cobertura de equipes de saúde bucal foi associada com as duas formas de doença periodontal, enquanto o percentual de fumantes manteve-se associado com a doença periodontal “moderada a grave”. Adultos com idade mais avançada, de cor de pele parda, sexo masculino, menor renda familiar e menor escolaridade apresentaram maiores chances para ambas as condições periodontais investigadas. CONCLUSÕES: No Brasil, a prevalência da doença periodontal variou conforme o município e a definição de doença empregada. A desigualdade de renda teve um papel importante na ocorrência da doença periodontal “grave”. Características individuais de posição social foram associadas com as duas formas de doença periodontal.
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Affiliation(s)
| | | | - Marco A Peres
- University of Adelaide, Australia; Departamento de Saúde Pública, Universidade Federal de Santa Catarina, Brasil
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Borenstein H, Renahy E, Quiñonez C, O'Campo P. Oral health, oral pain, and visits to the dentist: neighborhood influences among a large diverse urban sample of adults. J Urban Health 2013; 90:1064-78. [PMID: 23615780 PMCID: PMC3853181 DOI: 10.1007/s11524-013-9802-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The objective of this study was to assess the association between oral health and individual-level characteristics as well as both socioeconomic position (SEP) and service provision characteristics at the neighborhood level. Multilevel logistic analysis was undertaken of data from the Neighbourhood Effects on Health and Well-being Study in Toronto comprising 2,412 participants living in 47 neighborhoods and 87 census tracts. Three oral health outcomes were investigated: last dental visit, self-rated oral health, and self-rated oral pain. Results indicated that SEP was significantly associated with no dental visits in the last year, poor self-rated oral health, and experiencing oral pain after adjusting for age, gender, and immigrant status. Lack of dental insurance was associated with no visits to the dentist in the last year and poor self-rated oral health; however, no association was observed with oral pain. In adjusted regression models, few neighborhood level variables were significantly associated with dental visits and self-rated oral health and no neighborhood variables were associated with oral pain. Based on these results, SEP appears to be important in evaluating oral health outcomes. While insignificant in this study, neighborhood factors are important when considering the impact of service provision on oral health.
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Affiliation(s)
- Heidi Borenstein
- Centre for Research on Inner City Health, St. Michael's Hospital, 209 Victoria Street, Third Floor, Toronto, Ontario, Canada, M5C 1N8,
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Lamarca GA, Leal MDC, Leao ATT, Sheiham A, Vettore MV. The different roles of neighbourhood and individual social capital on oral health-related quality of life during pregnancy and postpartum: a multilevel analysis. Community Dent Oral Epidemiol 2013; 42:139-50. [DOI: 10.1111/cdoe.12062] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 06/20/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Gabriela A. Lamarca
- Escola Nacional de Saúde Pública FIOCRUZ; Rio de Janeiro RJ Brazil
- Department of Epidemiology and Public Health; University College London; London UK
| | - Maria do C. Leal
- Escola Nacional de Saúde Pública FIOCRUZ; Rio de Janeiro RJ Brazil
| | - Anna T. T. Leao
- Faculdade de Odontologia; Universidade Federal do Rio de Janeiro; Rio de Janeiro RJ Brazil
| | - Aubrey Sheiham
- Department of Epidemiology and Public Health; University College London; London UK
| | - Mario V. Vettore
- Unit of Dental Public Health; School of Clinical Dentistry; University of Sheffield; Sheffield UK
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High dental caries among adults aged 35 to 44 years: case-control study of distal and proximal factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:2401-11. [PMID: 23749056 PMCID: PMC3717743 DOI: 10.3390/ijerph10062401] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 05/24/2013] [Accepted: 05/27/2013] [Indexed: 11/16/2022]
Abstract
The aim of this study was to determine whether a high degree of dental caries severity is associated with the distal and proximal determinants of caries in a group of Brazilian adults aged 35 to 44 years. A population-based case-control study was conducted using two groups—a case group with high caries severity (DMFT ≥ 14) and a control group without high caries severity (DMFT < 14). The sample comprised adults from metropolitan Belo Horizonte, Brazil (180 cases and 180 controls matched for gender and age). The exam was performed by calibrated dentists using the DMFT index. The statistical analysis used the Mann-Whitney test and bivariate and multivariate logistic regression (the conditional backward stepwise method). The mean DMFT was 8.4 ± 3.9 in the control group and 20.1 ± 4.5 in the case group. High caries severity was associated with regular visits to the dentist, low income, use of private/supplementary dental service and not petitioning the authorities for community benefits. The results of the study underscore the importance of considering distal and proximal factors in the assessment of the severity of dental caries. Greater caries severity persists among low-income families and among groups with a low degree of social cohesion.
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Jagger DC, Sherriff A, Macpherson LM. Measuring socio-economic inequalities in edentate Scottish adults--cross-sectional analyses using Scottish Health Surveys 1995-2008/09. Community Dent Oral Epidemiol 2013; 41:499-508. [PMID: 23398352 DOI: 10.1111/cdoe.12040] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 01/13/2013] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To investigate the appropriateness of different measures of socio-economic inequalities, in relation to adult oral health in Scotland, utilizing data from a series of large, representative population surveys. METHODS The Scottish Health Surveys (SHeS) (1995; 1998; 2003; 2008/09) are cross-sectional national population-based surveys used to monitor health status in those living in private households. The age groups included in this study are as follows: 45-54; 55-64 years: all survey years; 65-74: 1998 onwards; 75+: 2003 onwards. Primary outcome was no natural teeth (edentulism). Three measures of socio-economic position: Occupational social class, Education, Carstairs deprivation score (2001) were used. Simple (absolute/relative differences) and complex measures (Slope Index, Relative Index, Concentration Index and c-index) of inequality were produced for each age group across all four surveys. RESULTS Simple and complex (absolute) measures of inequality have both demonstrated narrowing disparities in edentulism over time in the 45- to 64-year-old group, a levelling off in those aged 65 and above, and a rise in those aged 75+. Complex relative measures (RII, Concentration Index and c-index), however, show an increasing trend in inequalities over time for all age groups, suggesting that rates of improvement in edentulism rates are not uniform across all social groups. CONCLUSIONS Simple absolute inequality provides a quick and easy indication of the extent of disparities between extreme groups, whereas complex measures (absolute and relative) consider the gradient in health across all social groups. We have demonstrated that both are useful measures of inequality and should be considered complementary to one another. The appropriate choice of complex measure of inequality will depend on the audience to whom the results are to be communicated. This methodological approach is not confined to oral health but is applicable to other health outcomes that are socially patterned.
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Affiliation(s)
- Daryll C Jagger
- Clinical Dentistry, Glasgow Dental Hospital & School, University of Glasgow, Glasgow, UK
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Santiago BM, Valença AMG, Vettore MV. Social capital and dental pain in Brazilian northeast: a multilevel cross-sectional study. BMC Oral Health 2013; 13:2. [PMID: 23289932 PMCID: PMC3543847 DOI: 10.1186/1472-6831-13-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Accepted: 01/02/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is limited evidence on possible associations between social determinants and dental pain. This study investigated the relationship of neighborhood and individual social capital with dental pain in adolescents, adults and the elderly. METHODS A population-based multilevel study was conducted involving 624 subjects from 3 age groups: 15-19, 35-44 and 65-74 years. They were randomly selected from 30 census tracts in three cities in the State of Paraíba, Brazil. A two-stage cluster sampling was used considering census tracts and households as sampling units. The outcome of study was the presence of dental pain in the last 6 months. Information on dental pain, demographic, socio-economic, health-related behaviors, use of dental services, self-perceived oral health and social capital measures was collected through interviews. Participants underwent a clinical examination for assessment of dental caries. Neighborhood social capital was evaluated using aggregated measures of social trust, social control, empowerment, political efficacy and neighborhood safety. Individual social capital assessment included bonding and bridging social capital. Multilevel logistic regression was used to test the relationship of neighborhood and individual social capital with dental pain after sequential adjustment for covariates. RESULTS Individuals living in neighborhoods with high social capital were 52% less likely to report dental pain than those living in neighborhoods with low social capital (OR = 0.48, 95% CI = 0.27-0.85). Bonding social capital (positive interaction) was independently associated with dental pain (OR = 0.88, 95% CI = 0.80-0.91). Last dental visit, self-perceived oral health and number of decayed teeth were also significantly associated with dental pain. CONCLUSIONS Our findings suggest that contextual and individual social capital are independently associated with dental pain.
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Affiliation(s)
- Bianca Marques Santiago
- Department of Clinic and Social Dentistry, Federal University of Paraíba, Manaíra, João Pessoa, PB, Brazil.
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Costa SM, Vasconcelos M, Haddad JPA, Abreu MHNG. The severity of dental caries in adults aged 35 to 44 years residing in the metropolitan area of a large city in Brazil: a cross-sectional study. BMC Oral Health 2012; 12:25. [PMID: 22849537 PMCID: PMC3532240 DOI: 10.1186/1472-6831-12-25] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 07/20/2012] [Indexed: 11/30/2022] Open
Abstract
Background In recent decades, studies in the field of public health have increasingly focused on social determinants that affect the health-illness process. The epidemiological perspective considers oral health to be a reflection of socioeconomic and environmental aspects, and it is particularly influenced by the social context. The aim of the present study was to assess the association between the severity of dental caries among adults aged 35 to 44 years and characteristics on the different levels at which the determinants of caries operate (individual, social structure and social context). Methods A home-based, cross-sectional field study was carried out involving a sample of 1,150 adults (35 to 44 years of age) residing in metropolitan Belo Horizonte, Brazil. The DMFT (decayed, missing, filled tooth) index (≥14) was used to determine the severity of dental caries. Bivariate and multivariate analyses were carried out using the Poisson regression model with the level of significance set at 5% (p < 0.05) and 95% confidence intervals. Results The majority of the participants (68.5%) had high caries severity. The rate of high-severity caries in the group between 40 and 44 years of age was 1.15-fold (CI: 1.04-1.26) greater than that among those aged 35 to 39 years. A greater prevalence of high caries severity was found among those who frequently visited the dentist (PR = 1.18; CI: 1.07-1.30), those with a lower income (PR = 1.11; CI: 1.01-1.23), those who reported that their neighborhood did not come together in the previous year to petition political leaders for benefits (PR = 1.16; CI: 1.05-1.28) and those who are unable to make decisions (without empowerment) (PR = 1.12; CI: 1.01-1.24). Conclusions The present study revealed high dental caries severity in adults, which was associated with individual characteristics, health-related behavior and social structure and contextual variables. These findings underscore the importance of considering social determinants involved in the health-illness process when carrying out epidemiological studies on dental caries.
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Affiliation(s)
- Simone M Costa
- Department of Dentistry, Universidade Estadual de Montes Claros, Montes Claros, Brazil
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Lee HY, Choi YH, Park HW, Lee SG. Changing patterns in the association between regional socio-economic context and dental caries experience according to gender and age: a multilevel study in Korean adults. Int J Health Geogr 2012; 11:30. [PMID: 22839762 PMCID: PMC3464692 DOI: 10.1186/1476-072x-11-30] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 07/16/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little is known about the effects of socio-environmental factors on dental caries in different demographic situations in Asian populations. We investigated whether the nature of the association between regional socio-economic context and dental caries experience differed according to gender and age groups in Korean adults. METHODS We obtained a linked data set containing individual information from the 2000 Korean National Oral Health Survey and regional information from the "Major statistical indices of Si-Gun-Gu" (city-county-ward), published by the Korean Statistical Office. We stratified participants into women and men and into four 10-year-interval age groups (19-34, 35-44, 45-54, and 55-64 years) and analysed the linked data using a multilevel analysis. In total, 5,259 individuals were included in the final study population. RESULTS Regional socio-economic context was significantly associated with dental caries experience in men, but not in women. The patterns of the association between regional contextual variables and dental caries experience differed among age groups. People 35-44 years of age living in areas less dependent on the manufacturing industry and those 45-54 years of age living in areas where local government was relatively poor were more prone to have caries experience. CONCLUSIONS The results of this study indicated that socio-economic factors affecting residents' dental health status may operate through different mechanisms or degrees according to geographic location, suggesting that some gender- and age-defined subgroups may be likely to benefit from different types of intervention, including the development of specific health policies.
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Affiliation(s)
- Hoo-Yeon Lee
- Department of Social Medicine, College of Medicine, Dankook University, Cheonan, South Korea
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Stephenson J. A model for the analysis of caries occurrence in primary molar tooth surfaces. Caries Res 2012; 46:452-9. [PMID: 22739707 DOI: 10.1159/000339390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 04/17/2012] [Indexed: 11/19/2022] Open
Abstract
Recently methods of caries quantification in the primary dentition have moved away from summary 'whole mouth' measures at the individual level to methods based on generalised linear modelling (GLM) approaches or survival analysis approaches. However, GLM approaches based on logistic transformation fail to take into account the time-dependent process of tooth/surface survival to caries. There may also be practical difficulties associated with casting parametric survival-based approaches in a complex multilevel hierarchy and the selection of an optimal survival distribution, while non-parametric survival methods are not generally suitable for the assessment of supplementary information recorded on study participants. In the current investigation, a hybrid semi-parametric approach comprising elements of survival-based and GLM methodologies suitable for modelling of caries occurrence within fixed time periods is assessed, using an illustrative multilevel data set of caries occurrence in primary molars from a cohort study, with clustering of data assumed to occur at surface and tooth levels. Inferences of parameter significance were found to be consistent with previous parametric survival-based analyses of the same data set, with gender, socio-economic status, fluoridation status, tooth location, surface type and fluoridation status-surface type interaction significantly associated with caries occurrence. The appropriateness of the hierarchical structure facilitated by the hybrid approach was also confirmed. Hence the hybrid approach is proposed as a more appropriate alternative to primary caries modelling than non-parametric survival methods or other GLM-based models, and as a practical alternative to more rigorous survival-based methods unlikely to be fully accessible to most researchers.
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Affiliation(s)
- J Stephenson
- School of Human & Health Sciences, University of Huddersfield, Huddersfield, UK.
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Lupi-Pegurier L, Clerc-Urmes I, Abu-Zaineh M, Paraponaris A, Ventelou B. Density of dental practitioners and access to dental care for the elderly: A multilevel analysis with a view on socio-economic inequality. Health Policy 2011; 103:160-7. [DOI: 10.1016/j.healthpol.2011.09.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Revised: 08/30/2011] [Accepted: 09/30/2011] [Indexed: 11/30/2022]
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Tsakos G, Demakakos P, Breeze E, Watt RG. Social gradients in oral health in older adults: findings from the English longitudinal survey of aging. Am J Public Health 2011; 101:1892-9. [PMID: 21852627 PMCID: PMC3222342 DOI: 10.2105/ajph.2011.300215] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2011] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined prospective associations between socioeconomic position (SEP) markers and oral health outcomes in a national sample of older adults in England. METHODS Data were from the English Longitudinal Survey of Aging, a national cohort study of community-dwelling people aged 50 years and older. SEP markers (education, occupation, household income, household wealth, subjective social status, and childhood SEP) and sociodemographic confounders (age, gender, and marital status) were from wave 1. We collected 3 self-reported oral health outcomes at wave 3: having natural teeth (dentate vs edentate), self-rated oral health, and oral impacts on daily life. Using multivariate logistic regression models, we estimated associations between each SEP indicator and each oral health outcome, adjusted for confounders. RESULTS Irrespective of SEP marker, there were inverse graded associations between SEP and edentulousness, with proportionately more edentate participants at each lower SEP level. Lower SEP was also associated with worse self-rated oral health and oral impacts among dentate, but not among edentate, participants. CONCLUSIONS There are consistent and clear social gradients in the oral health of older adults in England, with disparities evident throughout the SEP hierarchy.
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Affiliation(s)
- Georgios Tsakos
- Department of Epidemiology and Public Health, University College London, United Kingdom.
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Newton P, Cabot L, Wilson NHF, Gallagher JE. The graduate entry generation: a qualitative study exploring the factors influencing the career expectations and aspirations of a graduating cohort of graduate entry dental students in one London institution. BMC Oral Health 2011; 11:25. [PMID: 21942994 PMCID: PMC3201891 DOI: 10.1186/1472-6831-11-25] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Accepted: 09/24/2011] [Indexed: 11/22/2022] Open
Abstract
Background Dentistry in the UK has a number of new graduate-entry programmes. The aim of the study was to explore the motivation, career expectations and experiences of final year students who chose to pursue a dental career through the graduate entry programme route in one institution; and to explore if, and how, their intended career expectations and aspirations were informed by this choice. Method In-depth interviews of 14 graduate entry students in their final year of study. Data were transcribed verbatim and analysed using framework analysis. Results There were three categories of factors influencing students' choice to study dentistry through graduate entry: 'push', 'pull' and 'mediating'. Mediating factors related to students' personal concerns and circumstances, whereas push and pull factors related to features of their previous and future careers and wider social factors. Routes to Graduate Entry study comprised: 'early career changers', 'established career changers' and those pursuing 'routes to specialisation'. These routes also influenced the students' practice of dentistry, as students integrated skills in their dental studies, and encountered new challenges. Factors which students believed would influence their future careers included: vocational training; opportunities for specialisation or developing special interests and policy-related issues, together with wider professional and social concerns. The graduate entry programme was considered 'hard work' but a quick route to a professional career which had much to offer. Students' felt more could have been made of their pre-dental studies and/or experience during the programme. Factors perceived as influencing students' future contribution to dentistry included personal and social influences. Overall there was strong support for the values of the NHS and 'giving back' to the system in their future career. Conclusion Graduate entry students appear to be motivated to enter dentistry by a range of factors which suit their preferences and circumstances. They generally embrace the programme enthusiastically and seek to serve within healthcare, largely in the public sector. These students, who carry wider responsibilities, bring knowledge, skills and experience to dentistry which could be harnessed further during the programme. The findings suggest that graduate entry students, facilitated by varied career options, will contribute to an engaged workforce.
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Affiliation(s)
- Paul Newton
- King's College London Dental Institute at Guy's, King's College and St Thomas's Hospitals Oral Health Services Research & Dental Public Health, Caldecot Road Denmark Hill London SE5 9RW UK
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Factores de riesgo hereditarios y socioeconómicos para labio o paladar hendido no asociados a un síndrome en México: estudio de casos y controles pareado. BIOMEDICA 2011. [DOI: 10.7705/biomedica.v31i3.378] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Giordani JMDA, de Slavutzky SMB, Koltermann AP, Pattussi MP. Inequalities in prosthetic rehabilitation among elderly people: the importance of context. Community Dent Oral Epidemiol 2010; 39:230-8. [PMID: 21070321 DOI: 10.1111/j.1600-0528.2010.00587.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE It has been demonstrated that social, economic, and environmental factors may influence individuals' oral health conditions, particularly among vulnerable groups such as elderly people. The aim of this study was to investigate the association between contextual factors and the need for full dental prosthesis among elderly people. METHODS This was a cross-sectional population-based epidemiological study of multilevel nature, with two levels of analysis: individual and contextual (municipal). Data at the individual level were obtained from oral clinical examinations (WHO criteria) in 5349 individuals aged 65-74. Data at the contextual level were obtained from the United Nations Development Program for the 250 Brazilian municipalities participating in the survey. The outcome was the need for a full dental prosthesis for at least one arch. Exposures at the contextual level included socioeconomic, demographic, and dental service data. Data analysis used multilevel logistic regression. RESULTS After controlling for individual socioeconomic, demographic, and dental service variables, the chance of needing full prosthesis was higher in municipalities with lower educational levels than in better-off ones (OR 1.57; 95% CI: 1.09-2.27) and lower in municipalities with fewer dentists (per capita) (OR 0.71; 95% CI: 0.52-0.97), compared to those with more dentists. CONCLUSION This study can contribute to the identification of priority municipalities, helping healthcare authorities and communities to formulate equitable public oral healthcare policies that improve the quality of life for this population.
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Peres MA, Peres KG, Frias AC, Antunes JLF. Contextual and individual assessment of dental pain period prevalence in adolescents: a multilevel approach. BMC Oral Health 2010; 10:20. [PMID: 20707920 PMCID: PMC2928166 DOI: 10.1186/1472-6831-10-20] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2010] [Accepted: 08/13/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite evidence that health and disease occur in social contexts, the vast majority of studies addressing dental pain exclusively assessed information gathered at individual level. OBJECTIVES To assess the association between dental pain and contextual and individual characteristics in Brazilian adolescents. In addition, we aimed to test whether contextual Human Development Index is independently associated with dental pain after adjusting for individual level variables of socio-demographics and dental characteristics. METHODS The study used data from an oral health survey carried out in São Paulo, Brazil, which included dental pain, dental exams, individual socioeconomic and demographic conditions, and Human Development Index at area level of 4,249 12-year-old and 1,566 15-year-old schoolchildren. The Poisson multilevel analysis was performed. RESULTS Dental pain was found among 25.6% (95%CI = 24.5-26.7) of the adolescents and was 33% less prevalent among those living in more developed areas of the city than among those living in less developed areas. Girls, blacks, those whose parents earn low income and have low schooling, those studying at public schools, and those with dental treatment needs presented higher dental-pain prevalence than their counterparts. Area HDI remained associated with dental pain after adjusting for individual level variables of socio demographic and dental characteristics. CONCLUSIONS Girls, students whose parents have low schooling, those with low per capita income, those classified as having black skin color and those with dental treatment needs had higher dental pain prevalence than their counterparts. Students from areas with low Human Development Index had higher prevalence of dental pain than those from the more developed areas regardless of individual characteristics.
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Affiliation(s)
- Marco A Peres
- Oral Epidemiology and Public Health Dentistry, Post-graduate Program in Public Health, Department of Public Health, Universidade Federal de University of Santa Catarina, Florianópolis, Brazil
| | - Karen G Peres
- Oral Epidemiology and Public Health Dentistry, Post-graduate Program in Public Health, Department of Public Health, Universidade Federal de University of Santa Catarina, Florianópolis, Brazil
| | - Antônio C Frias
- Department of Social Dentistry, Faculty of Dentistry, Universidade de São Paulo, São Paulo, Brazil
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Pereira SM, Ambrosano GM, Cortellazzi KL, Tagliaferro EP, Vettorazzi CA, Ferraz SF, Meneghim MC, Pereira AC. Geographic information systems (GIS) in assessing dental health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2010; 7:2423-36. [PMID: 20623033 PMCID: PMC2898058 DOI: 10.3390/ijerph7052423] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Revised: 04/26/2010] [Accepted: 05/12/2010] [Indexed: 11/24/2022]
Abstract
The present study investigated the distribution profile of dental caries and its association with areas of social deprivation at the individual and contextual level. The cluster sample consisted of 1,002 12-year-old schoolchildren from Piracicaba, SP, Brazil. The DMFT Index was used for dental caries and the Care Index was used to determine access to dental services. On the individual level, variables were associated with a better oral status. On the contextual level, areas were not associated with oral status. However, maps enabled determining that the central districts have better social and oral conditions than the deprived outlying districts.
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Affiliation(s)
- Stela M. Pereira
- Department of Community Dentistry, Piracicaba Dental School, P.O. BOX 52. University of Campinas—UNICAMP, Piracicaba, SP 13414-903, Brazil; E-Mails:
(G.M.B.A.);
(K.L.C.);
(E.P.S.T.);
(M.C.M.);
(A.C.P.)
- Department of Public Health, Lavras University Center—Unilavras, Lavras, MG 37200-000, Brazil
- Author to whom correspondence should be addressed; E-Mail:
; Tel: +55-192-106-5209; Fax: +55-192-106-5218
| | - Gláucia M.B. Ambrosano
- Department of Community Dentistry, Piracicaba Dental School, P.O. BOX 52. University of Campinas—UNICAMP, Piracicaba, SP 13414-903, Brazil; E-Mails:
(G.M.B.A.);
(K.L.C.);
(E.P.S.T.);
(M.C.M.);
(A.C.P.)
| | - Karine L. Cortellazzi
- Department of Community Dentistry, Piracicaba Dental School, P.O. BOX 52. University of Campinas—UNICAMP, Piracicaba, SP 13414-903, Brazil; E-Mails:
(G.M.B.A.);
(K.L.C.);
(E.P.S.T.);
(M.C.M.);
(A.C.P.)
| | - Elaine P.S. Tagliaferro
- Department of Community Dentistry, Piracicaba Dental School, P.O. BOX 52. University of Campinas—UNICAMP, Piracicaba, SP 13414-903, Brazil; E-Mails:
(G.M.B.A.);
(K.L.C.);
(E.P.S.T.);
(M.C.M.);
(A.C.P.)
| | - Carlos A. Vettorazzi
- Department of Rural Engineering - ESALQ, University of Sao Paulo, Piracicaba, São Paulo, SP 13418-900, Brazil; E-Mails:
(C.A.V.);
(S.F.B.F.)
| | - Sílvio F.B. Ferraz
- Department of Rural Engineering - ESALQ, University of Sao Paulo, Piracicaba, São Paulo, SP 13418-900, Brazil; E-Mails:
(C.A.V.);
(S.F.B.F.)
| | - Marcelo C. Meneghim
- Department of Community Dentistry, Piracicaba Dental School, P.O. BOX 52. University of Campinas—UNICAMP, Piracicaba, SP 13414-903, Brazil; E-Mails:
(G.M.B.A.);
(K.L.C.);
(E.P.S.T.);
(M.C.M.);
(A.C.P.)
| | - Antonio C. Pereira
- Department of Community Dentistry, Piracicaba Dental School, P.O. BOX 52. University of Campinas—UNICAMP, Piracicaba, SP 13414-903, Brazil; E-Mails:
(G.M.B.A.);
(K.L.C.);
(E.P.S.T.);
(M.C.M.);
(A.C.P.)
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Dental caries risk studies revisited: causal approaches needed for future inquiries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2009; 6:2992-3009. [PMID: 20049240 PMCID: PMC2800328 DOI: 10.3390/ijerph6122992] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Accepted: 11/25/2009] [Indexed: 11/17/2022]
Abstract
Prediction of high-risk individuals and the multi-risk approach are common inquiries in caries risk epidemiology. These studies prepared the ground for future studies; specific hypotheses about causal patterns can now be formulated and tested applying advanced statistical methods designed for causal studies, such as structural equation modeling, path analysis and multilevel modeling. Causal studies should employ measurements, analyses and interpretation of findings, which are in accordance to causal aims. Examples of causal empirical studies from medical and oral research are presented.
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Lopez R, Frydenberg M, Baelum V. Contextual effects in the occurrence of periodontal attachment loss and necrotizing gingival lesions among adolescents. Eur J Oral Sci 2009; 117:547-54. [DOI: 10.1111/j.1600-0722.2009.00658.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Levin KA, Davies CA, Topping GVA, Assaf AV, Pitts NB. Inequalities in dental caries of 5-year-old children in Scotland, 1993-2003. Eur J Public Health 2009; 19:337-42. [PMID: 19307245 DOI: 10.1093/eurpub/ckp035] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Previous research suggests there are significant differences between socio-economic groups in prevalence and amount of decayed missing and filled primary teeth (d3mft). The aim of this study was to describe the variation in obvious tooth decay experience amongst 5-year olds in Scotland and to look at the association between d3mft and deprivation in Scotland. METHODS Data derived from 1993 to 2003 National Dental Inspection Programme were modelled using Bayesian multilevel zero-inflated Negative Binomial models, adjusting for age, sex and the deprivation. RESULTS Deprivation is positively and significantly associated with having d3mft; the odds of a child in DepCat 7 (most deprived) having d3mft in 1993 were 7.49 (5.03-11.15) that of a child in DepCat 1 (most affluent). Inequalities in the prevalence of d3mft have reduced and in 2003 the odds of a child in DepCat 7 having d3mft were 4.60 (3.47-6.14) that of a child in DepCat 1. However, socio-economic inequalities in the amount of d3mft for those with d3mft have seen no reduction and have in fact increased between 1993 and 2003, with this increase approaching significance. CONCLUSION While socio-economic inequalities in prevalence of children with d3mft have decreased in recent years, socio-economic inequalities in the amount of d3mft for those with d3mft persist. This suggests that improvements are only seen for those children with the potential for low d3mft. High d3mft persists among children from more deprived areas. The national target conceals this apparent inconsistency.
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Affiliation(s)
- Kate A Levin
- Child and Adolescent Health Research Unit, The Moray House School of Education, The University of Edinburgh, St Leonard's Land, Holyrood Road, Edinburgh EH8 8AQ, UK.
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Sanders AE, Turrell G, Slade GD. Affluent neighborhoods reduce excess risk of tooth loss among the poor. J Dent Res 2008; 87:969-73. [PMID: 18809753 DOI: 10.1177/154405910808701006] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The effect of neighborhood on health may vary according to the characteristics of the residents. We tested the hypothesis that, in affluent neighborhoods, low-income adults retain more teeth than their income-equivalent peers in poor neighborhoods. In 2003, the Adelaide Small Area Dental Study collected sociodemographic and tooth retention information from 2860 adults in 60 neighborhoods. Neighborhood socio-economic position was a census-based composite measure. Using multilevel modelling, we fitted a series of two-level random intercept variance component models. Findings revealed significant main effects for individual and neighborhood predictors and a significant interaction between neighborhood disadvantage and low income. In affluent areas, disparities in tooth retention were negligible, but in poor neighborhoods, substantial variation in tooth retention between individuals was found based on their level of income. Low-income adults appeared to benefit from living in affluent areas, while wealthier adults living in poor neighborhoods did not lose their oral health advantage.
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Affiliation(s)
- A E Sanders
- School of Dentistry, University of Michigan, Ann Arbor, MI, USA.
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Lang IA, Gibbs SJ, Steel N, Melzer D. Neighbourhood deprivation and dental service use: a cross-sectional analysis of older people in England. J Public Health (Oxf) 2008; 30:472-8. [PMID: 18587145 DOI: 10.1093/pubmed/fdn047] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Appropriate dental care is an important part of maintaining good oral health. We examined the relationship between socioeconomic status, neighbourhood deprivation levels and older people's dental service use. METHODS We used logistic regression analysis to assess the relationship between self-reported dental service use and neighbourhood deprivation, adjusting for individual socioeconomic and health factors, in individuals aged 65+ in the 2005 Health Survey for England (n = 4240). RESULTS Among dentulous respondents, 69.9% reported attending for regular check-ups, 6.2% occasional check-ups, 18.4% only saw a dentist when in trouble and 5.6% never went to a dentist. In our adjusted model age, sex, region, education level, occupational social class, self-reported health and smoking status, but not degree of urbanization, were associated with use of dental services. Following adjustment for these other factors those living in the most deprived 20% of neighbourhoods, compared with those in the least deprived, had a relative risk ratio of 2.25 (95% confidence interval 1.59-3.17) of using dental services only when symptomatic, rather than going for regular or occasional check-ups. When alternative outcomes of reporting having recently seen a doctor or been a hospital inpatient were assessed these deprivation-related patterns in service use were not evident. CONCLUSION Levels of neighbourhood deprivation are associated with the use of dental services by older people. Action is needed to ensure older people in deprived communities access appropriate and comprehensive dental services.
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Affiliation(s)
- I A Lang
- Epidemiology and Public Health Group, Peninsula Medical School, Exeter, UK.
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