Carbajal Rodriguez Gisselle, van Meijeren-van Lunteren Agatha W, Wolvius Eppo B, Kragt Lea
The Generation R Study Group, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Department of Oral and Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Community Dent Oral Epidemiol. 2025 Feb;53(1):90-97. doi: 10.1111/cdoe.13012. Epub 2024 Oct 10.
To investigate whether timing, accumulation and trajectories of poverty are associated with dental caries in young adolescents.
The study was conducted within the Generation R Study, which is an ongoing population-based prospective cohort study conducted in Rotterdam, the Netherlands. This study included 2653 children. Information about household income and number of children and adults living in a household at six time points from pregnancy to 13 years old was retrieved from parental questionnaires to construct the poverty variable. Dental caries was assessed with the decayed, missing and filled teeth index through intraoral photographs at the age of 13 years. Sociodemographic and oral health-related characteristics were included as possible confounders. The association between poverty and dental caries was analysed on the basis of the three lifecourse theories, that is, critical period, cumulative risk and social mobility model. For the latter, we used latent class growth analysis (LCGA) to identify poverty trajectories over time. Next, the associations were studied with Hurdle Negative Binomial Models.
Poverty at birth and intermittent poverty up to the age of 13 were significantly associated with dental caries at 13 years of age (OR 1.41, 95% CI 1.01-1.99; OR 1.36, 95% CI 1.01-1.83 respectively) and with an increased mean number of decayed teeth by 34% (95% CI 1.02-1.76; 95% CI 1.05-1.71, respectively). LCGA showed four trajectories for the probabilities of poverty. All trajectories were significantly associated with dental caries at 13 years of age, with the 'downward mobility' trajectory showing the strongest association with dental caries (OR 1.55, 95% CI 1.05-2.29) and an increasing mean number of decayed teeth by 58% (95% CI 1.18-2.12) than the 'stable absent' trajectory.
Poverty at birth, intermittent poverty and downward poverty trajectory were associated with higher odds and higher mean number of decayed teeth at 13 years of age. The three lifecourse models influenced dental caries status during adolescence, hence strategies and policies targeted to improve socioeconomic conditions on deprived children should be implemented.
研究贫困的时间、累积情况和轨迹是否与青少年龋齿有关。
本研究在“R世代研究”中进行，该研究是在荷兰鹿特丹开展的一项基于人群的前瞻性队列研究。本研究纳入了2653名儿童。从父母问卷中获取了从孕期到13岁六个时间点的家庭收入、家庭中儿童和成人数量的信息，以构建贫困变量。在13岁时通过口腔内照片，用龋失补牙指数评估龋齿情况。纳入社会人口统计学和口腔健康相关特征作为可能的混杂因素。基于三个生命历程理论，即关键期、累积风险和社会流动模型，分析贫困与龋齿之间的关联。对于后者，我们使用潜在类别增长分析（LCGA）来确定随时间变化的贫困轨迹。接下来，用障碍负二项模型研究这些关联。
出生时贫困以及13岁前的间歇性贫困与13岁时的龋齿显著相关（优势比分别为1.41，95%置信区间1.01 - 1.99；1.36，95%置信区间1.01 - 1.83），且平均龋齿数分别增加34%（95%置信区间1.02 - 1.76；95%置信区间1.05 - 1.71）。LCGA显示了贫困概率的四种轨迹。所有轨迹均与13岁时的龋齿显著相关，“向下流动”轨迹与龋齿的关联最强（优势比1.55，95%置信区间1.05 - 2.29），且平均龋齿数比“稳定无贫困”轨迹增加58%（95%置信区间1.18 - 2.12）。
出生时贫困、间歇性贫困和贫困向下轨迹与13岁时更高的龋齿几率和更高的平均龋齿数相关。这三个生命历程模型影响了青少年时期的龋齿状况，因此应实施旨在改善贫困儿童社会经济状况的策略和政策。
