Alberta Health Services, Calgary, Alberta, Canada.
Department of Community Health Sciences, University of Calgary, TRW3, 3280 Hospital Dr. NW, Calgary, Alberta, T2N 4Z6, Canada.
Can J Public Health. 2021 Aug;112(4):773-781. doi: 10.17269/s41997-021-00485-9. Epub 2021 Apr 12.
The objective of this study was to examine the presence of small-area-level effects on children's dental caries in Alberta, Canada, where dental public health programming is targeted in nature, based on an area-level measure of socio-economic circumstances.
This cross-sectional study included data on tooth decay (from an intra-oral examination conducted by dental hygienists at school) and socio-demographic and behavioural information (from a parent questionnaire) from 5677 grade 1 and 2 schoolchildren attending schools in public or Catholic school systems in Calgary and Edmonton in 2013/2014. Area-level socio-economic circumstances were quantified using the Pampalon Material Deprivation Index derived from census data, applied to the dissemination area (DA) of the child's school. The outcome variable was presence (vs. absence) of tooth decay (cavitation). Data were analyzed using multilevel modeling with two levels: individual level (level 1) and school dissemination area (DA) (level 2).
We observed a small but statistically significant area-level effect on children's caries experience, above and beyond individual-level characteristics.
Study findings are relevant to dental public health programming in Alberta and other jurisdictions that use targeted strategies. Multilevel interventions, including universal approaches, are necessary to reduce inequities in children's dental caries.
本研究旨在检验加拿大艾伯塔省儿童龋齿的小面积效应是否存在，该省的口腔公共卫生计划具有针对性，其依据是基于社会经济状况的区域水平衡量标准。
本横断面研究纳入了 2013/2014 年在卡尔加里和埃德蒙顿公立和天主教学校系统上学的 5677 名 1 年级和 2 年级学生的数据，包括由学校牙医卫生员进行的口腔内检查得出的龋齿（蛀蚀）情况和社会人口统计学及行为信息（来自家长问卷）。利用源自人口普查数据的潘帕隆物质剥夺指数量化区域水平的社会经济状况，并将其应用于儿童学校所在的传播区域（DA）。因变量为是否存在（vs. 不存在）龋齿（蛀蚀）。采用个体水平（一级）和学校传播区域（DA）（二级）的多水平模型对数据进行分析。
我们观察到，除了个体水平特征外，儿童龋齿经历方面还存在着微小但具有统计学意义的区域水平效应。
本研究结果与艾伯塔省及其他采用针对性策略的司法管辖区的口腔公共卫生计划相关。需要采取多层次干预措施，包括普遍方法，以减少儿童龋齿方面的不平等现象。
