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. 2022 Aug 31;17(8):e0268899.
doi: 10.1371/journal.pone.0268899. eCollection 2022.

Comparative inequalities in child dental caries across four countries: Examination of international birth cohorts and implications for oral health policy

Sharon Goldfeld  1   2   3 , Kate L Francis  2 , Elodie O'Connor  1 , Johnny Ludvigsson  4 , Tomas Faresjö  5 , Beatrice Nikiema  6   7 , Lise Gauvin  6   8 , Junwen Yang-Huang  9   10 , Yara Abu Awad  11 , Jennifer J McGrath  11 , Jeremy D Goldhaber-Fiebert  12 , Åshild Faresjo  5 , Hein Raat  10 , Lea Kragt  9   13 , Fiona K Mensah  2   3 ; EPOCH Collaborative Group
Affiliations

Comparative inequalities in child dental caries across four countries: Examination of international birth cohorts and implications for oral health policy

Sharon Goldfeld et al. PLoS One. .

Abstract

Child dental caries (i.e., cavities) are a major preventable health problem in most high-income countries. The aim of this study was to compare the extent of inequalities in child dental caries across four high-income countries alongside their child oral health policies. Coordinated analyses of data were conducted across four prospective population-based birth cohorts (Australia, n = 4085, born 2004; Québec, Canada, n = 1253, born 1997; Rotterdam, the Netherlands, n = 6690, born 2002; Southeast Sweden, n = 7445, born 1997), which enabled a high degree of harmonization. Risk ratios (adjusted) and slope indexes of inequality were estimated to quantify social gradients in child dental caries according to maternal education and household income. Children in the least advantaged quintile for income were at greater risk of caries, compared to the most advantaged quintile: Australia: AdjRR = 1.18, 95%CI = 1.04-1.34; Québec: AdjRR = 1.69, 95%CI = 1.36-2.10; Rotterdam: AdjRR = 1.67, 95%CI = 1.36-2.04; Southeast Sweden: AdjRR = 1.37, 95%CI = 1.10-1.71). There was a higher risk of caries for children of mothers with the lowest level of education, compared to the highest: Australia: AdjRR = 1.18, 95%CI = 1.01-1.38; Southeast Sweden: AdjRR = 2.31, 95%CI = 1.81-2.96; Rotterdam: AdjRR = 1.98, 95%CI = 1.71-2.30; Québec: AdjRR = 1.16, 95%CI = 0.98-1.37. The extent of inequalities varied in line with jurisdictional policies for provision of child oral health services and preventive public health measures. Clear gradients of social inequalities in child dental caries are evident in high-income countries. Policy related mechanisms may contribute to the differences in the extent of these inequalities. Lesser gradients in settings with combinations of universal dental coverage and/or fluoridation suggest these provisions may ameliorate inequalities through additional benefits for socio-economically disadvantaged groups of children.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Forest plots illustrating inequalities in child dental caries by income and maternal education.
Forest plots showing the association between (1) household income and child dental caries comparing the highest income to the each of the four lower categories; (2) mother’s education and child dental caries with the highest education category compared to the middle level and lowest level.
Fig 2
Fig 2. Slope Index of Inequality (SII) in child dental caries by income and education.
See this image and copyright information in PMC

References

    1. Goldfeld S, Cameron A, Doyle K, Drummond B, Kilpatrick N, Morris P, et al. The Royal Australasian College of Physicians oral health in children and young people position statement. Sydney, Australia: Royal Australasian College of Physicians; 2012.
    1. GBD 2017 Oral Disorders Collaborators. Global, regional, and national levels and trends in burden of oral conditions from 1990 to 2017: A systematic analysis for the global burden of disease 2017 study. Journal of Dental Research. 2020;99(4):362–73. doi: 10.1177/0022034520908533 - DOI - PMC - PubMed
    1. Campus G, Cocco F, Strohmenger L, Cagetti M. Caries severity and socioeconomic inequalities in a nationwide setting: data from the Italian National pathfinder in 12-years children. Sci Rep. 2020;10(1):15622. doi: 10.1038/s41598-020-72403-x - DOI - PMC - PubMed
    1. Fraihat N, Madae’en S, Bencze Z, Herczeg A, Varga O. Clinical effectiveness and cost-effectiveness of oral-health promotion in dental caries prevention among children: Systematic review and meta-analysis. International Journal of Environmental Research and Public Health. 2019;16(15):2668. doi: 10.3390/ijerph16152668 . - DOI - PMC - PubMed
    1. Benzian H, Guarnizo-Herreño CC, Kearns C, Muriithi MW, Watt RG. The WHO global strategy for oral health: an opportunity for bold action. The Lancet. 2021. doi: 10.1016/S0140-6736(21)01404-5 - DOI - PubMed

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