Centre for Health Equity, Melbourne School of Population & Global Health, The University of Melbourne, Melbourne, Vic., Australia.
Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic., Australia.
Community Dent Oral Epidemiol. 2022 Jun;50(3):156-163. doi: 10.1111/cdoe.12646. Epub 2021 Apr 18.
Income inequalities in children's oral health have been well described. It is plausible that the security of tenure reflected by the ownership status of children's housing dynamically interacts with household income to shape these inequalities. We examined whether housing tenure modifies the known association between household income and oral health.
Data were analysed on 3344 10- to 11-year-old children from the Longitudinal Study of Australian Children. Multivariable regression models tested associations between household income and dental caries and tooth loss due to caries. Effect modification by home ownership (yes/no) was tested on the additive and multiplicative scales. Models were adjusted for sex, Indigenous status, main language spoken at home, area of residence, main carer education and family arrangement.
Children in households in the low income group had worse oral health than children in the high group for caries and tooth loss. Models only weakly supported an additive interaction for tooth loss; that is, the relative excess risk due to interaction (RERI) for low household income was -0.903 (-2.38; 0.571) for tooth loss and -0.076 (-0.42; 0.271) for dental decay, although we note that the low proportion of children from low-income homeowning households (6%) reduces the power to detect interactions. Notably, our models suggest renters in both high- and low-income categories had the highest risk of tooth loss compared to owners (PR for high-income renters: 2.19 (95% CI: 1.25, 3.85); PR for low-income renters: 2.11 (95% CI: 1.42, 3.16)).
Our study confirms that children in low-income households have poorer oral health outcomes than their high-income counterparts. Our findings additionally suggest that children in rental households may fare the worst of all housing and income combinations considered. Improving the security of housing for families privately renting may have wider health benefits that currently acknowledged.
儿童口腔健康方面的收入不平等现象已有详细描述。儿童住房的所有权状况所反映的居住保障情况与家庭收入之间可能存在动态相互作用，从而影响这些不平等现象。我们研究了住房保障是否会改变家庭收入与口腔健康之间的已知关联。
对来自澳大利亚儿童纵向研究的 3344 名 10 至 11 岁儿童的数据进行了分析。多变量回归模型检验了家庭收入与龋齿和因龋齿导致的牙齿缺失之间的关联。通过拥有住房（是/否）在加性和乘法尺度上检验了对作用的修饰。模型调整了性别、土著身份、家庭主要语言、居住地、主要照顾者教育程度和家庭安排。
低收家庭的儿童在龋齿和牙齿缺失方面的口腔健康状况均比高收入家庭的儿童差。模型仅微弱支持了牙齿缺失的加性交互作用；即低家庭收入的相对超额风险（RERI）因交互作用而导致的牙齿缺失为-0.903（-2.38；0.571），因交互作用而导致的龋齿为-0.076（-0.42；0.271），但请注意，低收家庭拥有住房的儿童比例较低（6%）降低了检测交互作用的能力。值得注意的是，与房主相比，高收入和低收入租户的牙齿缺失风险均最高（高收入租户的 PR：2.19（95%CI：1.25，3.85）；低收入租户的 PR：2.11（95%CI：1.42，3.16））。
我们的研究证实，低收入家庭的儿童口腔健康状况比高收入家庭的儿童差。我们的研究结果还表明，与所有考虑的住房和收入组合相比，租房家庭的儿童可能处境最差。改善私人租房家庭的住房保障可能会带来更广泛的健康益处，这是目前尚未认识到的。
