University of Canterbury-Te Whare Wānanga o Waitaha, School of Health Sciences, Christchurch, New Zealand.
Primary Care Clinical Unit, The University of Queensland School of Clinical Medicine, Brisbane, Queensland, Australia.
JAMA Pediatr. 2020 Oct 1;174(10):969-976. doi: 10.1001/jamapediatrics.2020.2201.
Robust contemporary epidemiologic evidence for the population-wide efficacy of reticulated community water fluoridation is required.
To evaluate whether community water fluoridation is associated with the national rates of severe caries among 4-year-old children in New Zealand after accounting for key sociodemographic characteristics.
DESIGN, SETTING, AND PARTICIPANTS: This was a near whole population-level, natural, geospatial cross-sectional study of 4-year-old children who had a health and development assessment as part of the nationwide B4 School Check screening program conducted in New Zealand between July 1, 2010, and June 30, 2016. The extracted database included 391 677 children. However, geospatial information was missing for 18 558 children, another 32 939 children were unable to be geospatially matched, 5551 children resided in areas with changing fluoridation status, and 58 786 children had no oral health screen recorded, leaving 275 843 (70.4%) eligible children. Data were released in August 2019; statistical analysis was performed from September 2019 to December 2019.
Community water fluoridation status from 2011 through 2016.
Severe caries experience derived from the "lift the lip" oral health screening. Analyses were adjusted for age, sex, ethnicity, area-level deprivation, and residential location differences. Multilevel mixed-effects logistic regression models were used. Sensitivity analyses based on multiple imputed data were undertaken to measure any differential influence of missing data.
In the eligible sample of 275 843 children, the median age was 4.3 years (interquartile range, 4.1-4.6 years), 141 451 children (51.3%) were boys, and 153 670 children (55.7%) resided within fluoridated areas. Severe caries were identified for 24 226 children (15.8%) in fluoridated and 17 135 children (14.0%) in unfluoridated areas, yielding an unadjusted odds ratio of 0.93 (95% CI, 0.90-0.95). However, in the adjusted analyses, children residing in areas without fluoridation had higher odds of severe caries compared with those within fluoridated areas (odds ratio, 1.21; 95% CI, 1.17-1.24). The population attributional fraction associated with unfluoridated community water was 5.6% (95% CI, 4.7%-6.6%) in a complete case analysis.
This study finds that community water fluoridation continues to be associated with reduced prevalence of severe caries in the primary dentition of New Zealand's 4-year-old children.
需要有强有力的当代流行病学证据来证明社区普遍使用加氟饮水对人群的有效性。
在考虑到关键社会人口特征后，评估社区饮水氟化是否与新西兰 4 岁儿童严重龋齿的全国发病率有关。
设计、地点和参与者：这是一项近乎全人群水平的、自然的、地理空间的横断面研究，纳入了在新西兰全国 B4 学校检查筛查项目中接受健康和发育评估的 4 岁儿童（2010 年 7 月 1 日至 2016 年 6 月 30 日）。提取的数据库包括 391677 名儿童。然而，有 18558 名儿童的地理空间信息缺失，另外 32939 名儿童无法进行地理空间匹配，5551 名儿童居住在氟化物状态不断变化的地区，58786 名儿童没有口腔健康筛查记录，只有 275843 名（70.4%）符合条件的儿童。数据于 2019 年 8 月发布；统计分析于 2019 年 9 月至 12 月进行。
2011 年至 2016 年期间的社区水氟化状况。
“掀起嘴唇”口腔健康筛查得出的严重龋齿情况。分析调整了年龄、性别、种族、地区贫困程度和居住地点差异。使用多水平混合效应逻辑回归模型。进行了基于多重插补数据的敏感性分析，以衡量缺失数据的任何差异影响。
在 275843 名符合条件的儿童中，中位年龄为 4.3 岁（四分位距，4.1-4.6 岁），141451 名儿童（51.3%）为男孩，153670 名儿童（55.7%）居住在氟化区。在氟化区有 24226 名儿童（15.8%）和 17135 名儿童（14.0%）有严重龋齿，未经调整的比值比为 0.93（95%置信区间，0.90-0.95）。然而，在调整后的分析中，未氟化地区的儿童比氟化地区的儿童发生严重龋齿的几率更高（比值比，1.21；95%置信区间，1.17-1.24）。在完全案例分析中，与未氟化社区水相关的人群归因分数为 5.6%（95%置信区间，4.7%-6.6%）。
本研究发现，社区饮水氟化继续与新西兰 4 岁儿童原发性牙齿严重龋齿的患病率降低有关。
