Ecological Influences, Observational Caries Epidemiological Trends and Associated Socioeconomic and Geographic Dental Health Inequalities at Five-years of Age in Scotland, 1993/94-2007/08 PDF
By:Yvonne Isobel Blair
Published on 2011 by
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Abstract: Ecological influences, observational caries epidemiological trends and associated socioeconomic and geographic dental health inequalities at five years of age in Scotland, 1993/94-2007/08 Introduction: In recent years many national Governments have called for health improvements at the population level and at the same time reductions in health inequalities. To date, dental epidemiology has concentrated mainly on tracking trends in dental health. Methodologies relating to dental health inequalities are, however, not well established. Within Scotland, over the past decade, children's oral health improvement programmes have been established at national level. Preceding and concurrent with these developments, similar initiatives have been implemented within Greater Glasgow NHS Board. This is Scotland's largest NHS Board with the highest proportion of Scotland's socio-economic status (SES) deprived population. Recent reports from the National Dental Inspection Programme (NDIP) for five-year-olds show improvements in dental health. The above conditions provide the opportunity to explore dental trends in more detail at geographic level within Scotland and to investigate dental health inequality methodologies within the context of health improvement programmes and overall improvements in dental health. Aim: To examine caries epidemiology data and apply and appraise a range of tests of health inequality to data from Primary 1 (P1) five-year-old children in Scotland during the period 1993/94-2007/08, against a background of health improvement programmes. Furthermore, to apply the selected inequalities tests to the caries data for a) Scotland as a whole and b) the geographic subgroups: 1] Glasgow (GGHB) and 2] the remainder of Scotland, outwith Glasgow (Not-Glasgow). Methods: Secondary analyses were performed on eight successive cross-sectional NDIP five-year-olds' caries datasets, 1993/94 to 2007/08. These permitted both SES and geographic trends in mean d3mft and % dmft=0 to be plotted for the areas: Scotland, GGHB and Not-Glasgow. The metrics selected to model dental health inequalities were: the Significant Caries Index (SIC) and modified SIC10, the Receiver Operator Curve (ROC), the Gini coefficient, the Concentration Curve (CC), Koolman and Doorslaer's transformed Concentration Index (CI), the Slope Index of Inequality (SII), the Relative Index of Inequality (RII) and the Population Attributable Risk (PAR). Odds Ratios and Meta-analyses using Generalised Linear Modelling assessed statistical-inference for dental health and inequality trends. Results: Overall, usable data was retrieved for 68,398 five-year-old subjects (n=18,174 from GGHB; n=50,224 from Not-Glasgow). In Scotland as a whole, marked SES gradients in caries prevalence and caries burden were related to the DepCat score of children's home postcode. Between the start and endpoints of the study, the simple absolute SES inequality in mean d3mft between the most affluent and most deprived groups decreased (p0.02), whilst mean d3mft reduced across the entire SES spectrum. Relative to the baseline year (1993), by 2007, the Odds Ratios for d3mft0 in Scotland decreased (p0.0001) to 0.43 (95%CI, 0.40-0.46). Although Scotland's simple absolute SES related dental health inequality (DHI) decreased for mean d3mft (p0.02), there were no improvements in simple relative SES DHIs over this time period. Simple absolute and simple relative geographic inequalities in weighted %d3mft=0 and mean d3mft were seen when GGHB was compared with Not-Glasgow data. These geographic inequalities metrics tended to increase from 1993/94 until 1999/00. However, by 2007/08 reductions in simple absolute geographic inequality were observed, with marginal improvements in simple relative geographic inequality compared to baseline. Additionally, simple absolute and relative geographic inequality in SIC scores decreased overall against a background of SIC improvements in both GGHB & Not-Glasgow (Meta-analysis, p0.01, respectively). By 2007/08, relative to 1993/94, Odds Ratios for d3mft0 in the geographic subgroups GGHB and Not-Glasgow decreased, respectively (p
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