Centre for Community Child Health, Royal Children's Hospital, Melbourne, Victoria, Australia.
Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia.
PLoS One. 2022 Aug 31;17(8):e0268899. doi: 10.1371/journal.pone.0268899. eCollection 2022.
Child dental caries (i.e., cavities) are a major preventable health problem in most high-income countries. The aim of this study was to compare the extent of inequalities in child dental caries across four high-income countries alongside their child oral health policies. Coordinated analyses of data were conducted across four prospective population-based birth cohorts (Australia, n = 4085, born 2004; Québec, Canada, n = 1253, born 1997; Rotterdam, the Netherlands, n = 6690, born 2002; Southeast Sweden, n = 7445, born 1997), which enabled a high degree of harmonization. Risk ratios (adjusted) and slope indexes of inequality were estimated to quantify social gradients in child dental caries according to maternal education and household income. Children in the least advantaged quintile for income were at greater risk of caries, compared to the most advantaged quintile: Australia: AdjRR = 1.18, 95%CI = 1.04-1.34; Québec: AdjRR = 1.69, 95%CI = 1.36-2.10; Rotterdam: AdjRR = 1.67, 95%CI = 1.36-2.04; Southeast Sweden: AdjRR = 1.37, 95%CI = 1.10-1.71). There was a higher risk of caries for children of mothers with the lowest level of education, compared to the highest: Australia: AdjRR = 1.18, 95%CI = 1.01-1.38; Southeast Sweden: AdjRR = 2.31, 95%CI = 1.81-2.96; Rotterdam: AdjRR = 1.98, 95%CI = 1.71-2.30; Québec: AdjRR = 1.16, 95%CI = 0.98-1.37. The extent of inequalities varied in line with jurisdictional policies for provision of child oral health services and preventive public health measures. Clear gradients of social inequalities in child dental caries are evident in high-income countries. Policy related mechanisms may contribute to the differences in the extent of these inequalities. Lesser gradients in settings with combinations of universal dental coverage and/or fluoridation suggest these provisions may ameliorate inequalities through additional benefits for socio-economically disadvantaged groups of children.
儿童龋齿（即蛀牙）是大多数高收入国家的一个主要可预防的健康问题。本研究的目的是比较四个高收入国家儿童龋齿的不平等程度及其儿童口腔健康政策。对四个前瞻性的基于人群的出生队列（澳大利亚，n = 4085，出生于 2004 年；加拿大魁北克，n = 1253，出生于 1997 年；荷兰鹿特丹，n = 6690，出生于 2002 年；瑞典东南部，n = 7445，出生于 1997 年）的数据进行了协调分析，这些队列使高度协调成为可能。根据母亲的教育水平和家庭收入，估计了风险比（调整后）和不平等斜率指数，以量化儿童龋齿的社会梯度。与收入最有利的五分位数相比，收入最低五分位数的儿童患龋齿的风险更高：澳大利亚：调整后的 RR = 1.18，95%CI = 1.04-1.34；魁北克：调整后的 RR = 1.69，95%CI = 1.36-2.10；鹿特丹：调整后的 RR = 1.67，95%CI = 1.36-2.04；瑞典东南部：调整后的 RR = 1.37，95%CI = 1.10-1.71）。与教育水平最高的母亲相比，教育水平最低的母亲的孩子患龋齿的风险更高：澳大利亚：调整后的 RR = 1.18，95%CI = 1.01-1.38；瑞典东南部：调整后的 RR = 2.31，95%CI = 1.81-2.96；鹿特丹：调整后的 RR = 1.98，95%CI = 1.71-2.30；魁北克：调整后的 RR = 1.16，95%CI = 0.98-1.37。根据提供儿童口腔健康服务和预防公共卫生措施的司法管辖区政策，不平等的程度有所不同。在高收入国家，儿童龋齿的社会不平等程度明显存在梯度。与社会经济地位较低的儿童群体相关的政策机制可能会导致这些不平等程度的差异。在普遍覆盖牙科和/或氟化物的环境中，不平等程度较低，这表明这些规定可能通过为社会经济劣势群体的儿童提供额外福利来减轻不平等现象。
