Blair Yvonne I, McMahon Alex D, Gnich Wendy, Conway David I, Macpherson Lorna M D
Oral Health Directorate, NHS Greater Glasgow & Clyde, Glasgow Dental Hospital, 378 Sauchiehall St, Glasgow, G2 3JZ, Scotland, UK.
Community Oral Health Section, University of Glasgow Dental School, 378 Sauchiehall St, Glasgow, G2 3JZ, Scotland, UK.
BMC Public Health. 2015 Mar 4;15:212. doi: 10.1186/s12889-015-1492-0.
Socioeconomic inequalities in health within Glasgow, Scotland, are among the widest in the world. This is largely attributed to socio-economic conditions. The 'Glasgow Effect' labels the finding that the high prevalence of some diseases cannot be fully explained by a conventional area-based socio-economic metric. This study aimed to investigate whether differences in dental caries between Glasgow's resident children and those in the Rest of Scotland could be explained by this metric and whether differences were of fixed magnitude, over time.
Scotland's National Dental Inspection Programme (NDIP) cross-sectional data for five-year-old children in years: 1994, 1996, 1998, 2000, 2003, 2004, 2006, 2008, 2010, and 2012 (n = 92,564) were utilised. Endpoints were calculated from the mean decayed, missing and filled teeth score (d3mft) and percentage with obvious decay experience. Socioeconomic status was measured by DepCat, a Scottish area-based index. The Glasgow Effect was estimated by the odds-ratio (OR) of decay for Glasgow versus the Rest of Scotland adjusted by age, gender and DepCat. Inequalities were also assessed by the Significant Caries Index (SIC), SIC 10, and Scottish Caries Inequality Metric (SCIM 10).
Decay levels for deprived Glasgow children have reduced to be similar to those in the Rest of Scotland. In 1993, OR for d3mft > 0 for those living in the Glasgow area was 1.34(1.10, 1.64), p = 0.005. This reduced below unity in 2012, OR = 0.85(0.77, 0.93), p < 0.001. There were downward trends (p < 0.001) in absolute inequality measured by SIC and SIC 10 in each of the geographic areas. The SCIM 10 demonstrated further reductions in inequality across the population. The downward trends for all the inequality measures were larger for Glasgow than the Rest of Scotland.
Over the interval, Glasgow has eliminated the earlier extra health inequalities. When comparing 'like for like' by socioeconomic status there is now no higher level of dental caries in the Greater Glasgow area.
苏格兰格拉斯哥市健康方面的社会经济不平等现象在全球范围内极为严重。这在很大程度上归因于社会经济状况。“格拉斯哥效应”指的是这样一个发现：某些疾病的高患病率无法完全用传统的基于地区的社会经济指标来解释。本研究旨在调查格拉斯哥市常住儿童与苏格兰其他地区儿童在龋齿方面的差异是否能用该指标来解释，以及这些差异在一段时间内是否具有固定的幅度。
利用了苏格兰国家牙科检查计划（NDIP）在1994年、1996年、1998年、2000年、2003年、2004年、2006年、2008年、2010年和2012年收集的五岁儿童横断面数据（n = 92,564）。通过平均龋失补牙得分（d3mft）和有明显龋齿经历的百分比来计算终点指标。社会经济地位通过DepCat来衡量，DepCat是一个基于苏格兰地区的指数。通过格拉斯哥与苏格兰其他地区龋齿的优势比（OR）来估计格拉斯哥效应，该优势比按年龄、性别和DepCat进行了调整。不平等情况还通过显著龋指数（SIC）、SIC 10和苏格兰龋不平等指标（SCIM 1）进行了评估。
格拉斯哥贫困儿童的龋齿水平已降至与苏格兰其他地区相似。1993年，居住在格拉斯哥地区d3mft > 0的儿童的OR为1.34（1.10，1.64），p = 0.005。到2012年该值降至1以下，OR = 0.85（0.77，0.93）），p < 0.用于衡量绝对不平等的SIC和SIC 10在每个地理区域均呈现下降趋势（p < 0.001）。SCIM 10表明整个人口中的不平等现象进一步减少。格拉斯哥所有不平等指标的下降趋势都比苏格兰其他地区更为明显。
在这段时间内，格拉斯哥消除了早期额外的健康不平等现象。按社会经济地位进行“同类相比”时，大格拉斯哥地区目前的龋齿水平并不更高。
