University of Edinburgh, Child and Adolescent Health Research Unit, St Leonard's Land, Holyrood Road, Edinburgh, United Kingdom.
Soc Sci Med. 2010 Dec;71(11):2020-7. doi: 10.1016/j.socscimed.2010.09.006. Epub 2010 Sep 29.
Previous research suggests there are significant differences between urban and rural areas in Scotland for health outcomes including heart disease, cancer and self reported health. The aim of this study was to describe the contemporary urban/rural variation in obvious decay experience amongst 5-year-olds in Scotland. Scotland was split into 6 geographies, ranging from 'The 4 Cities' (Glasgow, Edinburgh, Dundee and Aberdeen) to 'Remote Rural' areas. Data derived from the 2007/08 National Dental Inspection Programme, representative of the whole of Scotland, were modelled using Bayesian multilevel zero-inflated Negative Binomial and multilevel Poisson modelling, adjusting for age, sex and deprivation. The outcome variables modelled were d(3)mft (carious, extracted or filled deciduous teeth), d(3)t (carious teeth), mt (missing teeth, extracted due to caries) and ft (filled teeth). The proportion of 5-year old children in Scotland with d(3)mft = 0 was 58% in 2008. Adjusting for age and sex, the odds of a child in a Remote Rural area having d(3)mft>0 was 0.52 that of a city dweller. However, when deprivation was included in the model, the odds of having d(3)mft >0 rose to 0.74. The odds of d(3)mft>0 in 'Accessible Rural' areas also remained significantly lower than in the 4 Cities after adjustment for deprivation. For those with d(3)mft>0, the relative risk of additional d(3)mft was also significantly lower in Remote Rural areas, however this was explained by deprivation, while in Accessible Rural areas this remained significant even after adjustment for deprivation. The odds of having any extractions was lower in Rural areas, even after adjustment for deprivation, while the Care Index (ft/d(3)mft) was higher in Remote Towns. Deprivation, therefore, accounted for much but not all of the geographical difference in d(3)mft which exist in Scotland. Children in Remote and Rural areas appear to have better dental health and a higher proportion of filled teeth when compared with those living in Cities. Possible reasons for these differences and recommendations for future research are discussed.
先前的研究表明，苏格兰在健康结果方面，包括心脏病、癌症和自我报告的健康，城乡之间存在显著差异。本研究的目的是描述苏格兰 5 岁儿童明显龋齿经历的当代城乡差异。苏格兰分为 6 个地理区域，从“四城市”（格拉斯哥、爱丁堡、邓迪和阿伯丁）到“偏远农村”地区。数据来自于代表苏格兰全境的 2007/08 年全国牙科检查计划，使用贝叶斯多层零膨胀负二项式和多层泊松模型进行建模，调整了年龄、性别和贫困因素。建模的结果变量包括 d(3)mft（龋齿、拔除或填充的乳牙）、d(3)t（龋齿）、mt（因龋齿拔除的缺失牙）和 ft（填充牙）。2008 年，苏格兰 5 岁儿童中 d(3)mft=0 的比例为 58%。在调整年龄和性别因素后，农村地区儿童 d(3)mft>0 的几率是城市居民的 0.52 倍。然而，当模型中包含贫困因素时，d(3)mft>0 的几率上升到 0.74。在调整贫困因素后，“可接近的农村”地区 d(3)mft>0 的几率仍明显低于四个城市。对于那些 d(3)mft>0 的人，在 Remote Rural 地区，额外的 d(3)mft 的相对风险也显著降低，但这是由贫困造成的，而在可接近的农村地区，即使在调整贫困因素后，这仍然是显著的。即使在调整贫困因素后，农村地区的拔牙几率也较低，而 Remote Towns 的保健指数（ft/d(3)mft）较高。因此，贫困因素解释了苏格兰存在的城乡差异的大部分，但不是全部。与城市地区的儿童相比，农村地区的儿童口腔健康状况更好，填充牙齿的比例更高。讨论了这些差异的可能原因以及对未来研究的建议。
