Structural determinants explain caries differences among preschool children in Chile’s Metropolitan Region

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Abstract

Objective

To estimate the association between Social Determinants of Health (structural and intermediate) and caries indicators in Chile's Metropolitan Region preschool children.

Methods

A multilevel cross-sectional study of Social Determinants of Health (SDH) and caries in children aged 1 to 6 years in Chile's Metropolitan Region was conducted in 2014–2015, with three levels: district, school and child. Caries were assessed by the dmft-index and the prevalence of untreated caries. The structural determinants analyzed were Community Human Development Index (CHDI), urban/rural location, school type, caregiver's education and family income. Poisson multilevel regression models were fit.

Results

The sample size was 2,275 children from 40 schools in 13 districts. While the highest CHDI district had an untreated caries prevalence of 17.1% (12.3–22.7%), in the most disadvantaged district it was 53.9% (95% CI 46.0–61.6%). As family income increased, the probability of untreated caries prevalence decreased (PR = 0.9 95% CI 0.8–1.0). Rural districts had an average dmft-index of 7.3 (95% CI 7.2–7.4), while in urban districts, it was 4.4 (95% CI 4.3–4.5). Higher probabilities of untreated caries prevalence (PR = 3.0 95% CI 2.3–3.9) were observed in rural children. Greater probabilities of untreated caries prevalence (PR = 1.3 95% CI 1.1–1.6) and prevalence of caries experience (PR = 1.3 95% CI 1.1–1.5) were observed in children whose caregivers had a secondary educational level.

Conclusions

A strong association was observed between the social determinants of health, specifically the structural ones, and the caries indicators studied in children of the Metropolitan Region of Chile. There were notable differences in caries between districts according to social advantage. Rurality and caregiver's education were the most consistent predictors.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-023-02778-6.

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Most cited references 46

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Relative risk is usually the parameter of interest in epidemiologic and medical studies. In this paper, the author proposes a modified Poisson regression approach (i.e., Poisson regression with a robust error variance) to estimate this effect measure directly. A simple 2-by-2 table is used to justify the validity of this approach. Results from a limited simulation study indicate that this approach is very reliable even with total sample sizes as small as 100. The method is illustrated with two data sets.

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Oral diseases: a global public health challenge

Marco A. Peres, Lorna M D Macpherson, Robert J. Weyant … (2019)

Oral diseases are among the most prevalent diseases globally and have serious health and economic burdens, greatly reducing quality of life for those affected. The most prevalent and consequential oral diseases globally are dental caries (tooth decay), periodontal disease, tooth loss, and cancers of the lips and oral cavity. In this first of two papers in a Series on oral health, we describe the scope of the global oral disease epidemic, its origins in terms of social and commercial determinants, and its costs in terms of population wellbeing and societal impact. Although oral diseases are largely preventable, they persist with high prevalence, reflecting widespread social and economic inequalities and inadequate funding for prevention and treatment, particularly in low-income and middle-income countries (LMICs). As with most non-communicable diseases (NCDs), oral conditions are chronic and strongly socially patterned. Children living in poverty, socially marginalised groups, and older people are the most affected by oral diseases, and have poor access to dental care. In many LMICs, oral diseases remain largely untreated because the treatment costs exceed available resources. The personal consequences of chronic untreated oral diseases are often severe and can include unremitting pain, sepsis, reduced quality of life, lost school days, disruption to family life, and decreased work productivity. The costs of treating oral diseases impose large economic burdens to families and health-care systems. Oral diseases are undoubtedly a global public health problem, with particular concern over their rising prevalence in many LMICs linked to wider social, economic, and commercial changes. By describing the extent and consequences of oral diseases, their social and commercial determinants, and their ongoing neglect in global health policy, we aim to highlight the urgent need to address oral diseases among other NCDs as a global health priority.

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Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration.

Jan P. Vandenbroucke, Erik von Elm, Douglas G. Altman … (2015)

Much medical research is observational. The reporting of observational studies is often of insufficient quality. Poor reporting hampers the assessment of the strengths and weaknesses of a study and the generalisability of its results. Taking into account empirical evidence and theoretical considerations, a group of methodologists, researchers, and editors developed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) recommendations to improve the quality of reporting of observational studies. The STROBE Statement consists of a checklist of 22 items, which relate to the title, abstract, introduction, methods, results and discussion sections of articles. Eighteen items are common to cohort studies, case-control studies and cross-sectional studies and four are specific to each of the three study designs. The STROBE Statement provides guidance to authors about how to improve the reporting of observational studies and facilitates critical appraisal and interpretation of studies by reviewers, journal editors and readers. This explanatory and elaboration document is intended to enhance the use, understanding, and dissemination of the STROBE Statement. The meaning and rationale for each checklist item are presented. For each item, one or several published examples and, where possible, references to relevant empirical studies and methodological literature are provided. Examples of useful flow diagrams are also included. The STROBE Statement, this document, and the associated Web site (http://www.strobe-statement.org/) should be helpful resources to improve reporting of observational research. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

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Author and article information

Contributors

María José Monsalves: maria.monsalves@uss.cl

Journal

Journal ID (nlm-ta): BMC Oral Health

Journal ID (iso-abbrev): BMC Oral Health

Title: BMC Oral Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1472-6831

Publication date (Electronic): 9 March 2023

Publication date PMC-release: 9 March 2023

Publication date Collection: 2023

Volume: 23

Electronic Location Identifier: 136

Affiliations

[1 ]GRID grid.442215.4, ISNI 0000 0001 2227 4297, Facultad de Medicina y Ciencia, , Universidad San Sebastián, ; Lota 2465, 7510157 Santiago, Chile

[2 ]GRID grid.443909.3, ISNI 0000 0004 0385 4466, Departamento de Patología y Medicina Oral y Centro de Epidemiología y Vigilancia de Enfermedades Orales (CEVEO), Facultad de Odontología, , Universidad de Chile, ; 380544 Santiago, Chile

[3 ]GRID grid.440629.d, ISNI 0000 0004 5934 6911, Facultad de Odontología, , Universidad Finis Terrae, ; 7501015 Santiago, Chile

[4 ]GRID grid.443909.3, ISNI 0000 0004 0385 4466, Instituto de Investigación en Ciencias Odontológicas (ICOD), Facultad de Odontología, , Universidad de Chile, ; 380544 Santiago, Chile

[5 ]GRID grid.14709.3b, ISNI 0000 0004 1936 8649, Department of Epidemiology, Biostatistics and Occupational Health, , McGill University, ; Montreal, QC H3A1G1 Canada

[6 ]GRID grid.443909.3, ISNI 0000 0004 0385 4466, Escuela de Salud Pública, Facultad de Medicina, , Universidad de Chile, ; 8380453 Santiago, Chile

[7 ]GRID grid.25073.33, ISNI 0000 0004 1936 8227, Population Health Research Institute, McMaster University, ; Hamilton, ON L8L2X2 Canada

[8 ]GRID grid.25073.33, ISNI 0000 0004 1936 8227, Department of Health Research Methods, Evidence, and Impact, , McMaster University, ; Hamilton, ON L8N 3Z5 Canada

Article

Publisher ID: 2778

DOI: 10.1186/s12903-023-02778-6

PMC ID: 9996898

PubMed ID: 36894931

SO-VID: de66ec2e-9602-45e5-88c2-7e1e976e4854

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 8 November 2022

Date accepted : 30 January 2023

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100020884, Agencia Nacional de Investigación y Desarrollo;

Award ID: FONIS SA13I20130

Award Recipient : María José Monsalves Iris Espinoza Patricia Moya Josefina Aubert Doris Durán Shrikant I. Bangdiwala

Custom metadata

ScienceOpen disciplines: Dentistry

Keywords: social determinants,inequalities,caries,risk factors,children

Data availability:

ScienceOpen disciplines: Dentistry

Keywords: social determinants, inequalities, caries, risk factors, children

Structural determinants explain caries differences among preschool children in Chile’s Metropolitan Region

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Abstract

Objective

Methods

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Supplementary Information

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Arab Journal of Forensic Sciences & Forensic Medicine (AJFSFM)

Most cited references 46

A modified poisson regression approach to prospective studies with binary data.

Oral diseases: a global public health challenge

Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration.

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