The 80:20 phenomenon: help or hindrance to planning caries prevention programmes?

Abstract

Objective: to compare the outcomes of population segmentation analyses according to caries experience using the distribution of dmft and the Super Profiles geodemographic classification.

Basic research design: The study population consisted of all 15,747 children in seven districts in the North West Region, England who were examined in whole population surveys during the 1995/6 NHS epidemiological survey of 5-year-old children. Market penetration analyses were used to segment this population according to caries experience by their dmft score and by the Super Profiles geodemographic classification. Lorenz curves were plotted and Gini coefficients were calculated from the outputs.

Main outcome measures: When dmft was used to segment the population approximately 80% of carious teeth were found in some 42% of the total population, producing a Lorenz Curve with a Gini coefficient of 66%. The population was then segmented using Super Profiles Target Markets. The target markets were ranked according to caries experience and the denominator population living in each of these area types. Some 81% of the total population dmft was found in the topmost ranked 73.8% of the total population. The resultant Lorenz curve produced a Gini coefficient of 16.2%.

Conclusions: About half of the population disease was confined to a minority of the population but not to the extent of 80% of the disease in 20% of the population. Although these high risk children were more commonly found in underprivileged area types, they did not live exclusively in a small number of deprived areas. These findings shed doubt on the wisdom of a targeted approach to oral health promotion and disease prevention programmes.