Kranz A M, Evans L A, Gadwah-Meaden C, Geissler Kimberley H
RAND Corporation, Arlington, VA, USA.
University of Massachusetts Amherst School of Public Health and Health Sciences, USA.
JDR Clin Trans Res. 2024 Dec 20:23800844241308149. doi: 10.1177/23800844241308149.
Black children in the United States have lower rates of dental visits and higher rates of poor oral health. However, few studies have examined the role of structural racism as a contributor to racial gaps in children's oral health. This study assessed associations between state-level structural racism and oral health outcomes of children and the related Black-White disparities.
This repeated cross-sectional observational study examined children aged 1 to 17 y in the 2016 to 2021 National Survey of Children's Health (NSCH). Three outcomes were examined: utilization (dentist visit in past 12 mo), any oral health problem (difficulty in past 12 mo with bleeding gums, cavities, or toothaches), and oral health (teeth in excellent or very good condition). A state-level index was constructed to measure Black-White structural racism composed of 5 dimensions (judicial, educational, economic, political, and neighborhood segregation) and linked to the NSCH. Estimated population-weighted logit regression models were used to assess associations between the outcomes and race and structural racism, adjusting for demographics and socioeconomic status.
The dataset consisted of 98,423 Black (11%) or White (88%) children. Black children had relatively worse outcomes than White children did, with the largest difference observed for the children having teeth in excellent or very good condition (73% vs. 83%). State-level structural racism was not statistically significantly associated with a child receiving dental care, having any oral health problem, or having teeth in excellent or very good condition. US Black-White disparities in these outcomes were unchanged after adjustment for state-level structural racism.
Expanded efforts are needed to address US Black-White disparities in child oral health outcomes. State-level structural racism was not associated with these outcomes. Future research should explore whether findings change when examining these associations at a different geographic level and whether indices of structural racism should explicitly include items specific to health care access and child-specific institutional domains.
Black children in this US study had relatively worse oral health and were less likely to have a dental visit than White children were. Structural racism did not explain these disparities, which suggests the need for further research to study mechanisms driving these disparities and how to address them. Policy makers should consider policies that expand where care is delivered, who delivers care, and increase dentists' Medicaid participation, strategies identified previously for reducing disparities.
美国黑人儿童看牙医的比例较低，口腔健康状况较差的比例较高。然而，很少有研究探讨结构性种族主义在导致儿童口腔健康种族差距方面所起的作用。本研究评估了州一级的结构性种族主义与儿童口腔健康结果之间的关联以及相关的黑白差距。
这项重复横断面观察性研究在2016年至2021年全国儿童健康调查（NSCH）中调查了1至17岁的儿童。研究了三个结果：利用率（过去12个月内看过牙医）、任何口腔健康问题（过去12个月内牙龈出血、蛀牙或牙痛方面有困难）以及口腔健康（牙齿状况极佳或非常好）。构建了一个州一级的指数来衡量由五个维度（司法、教育、经济、政治和邻里隔离）组成的黑白结构性种族主义，并将其与NSCH相关联。使用估计的人口加权逻辑回归模型来评估结果与种族和结构性种族主义之间的关联，并对人口统计学和社会经济地位进行了调整。
数据集包括98423名黑人（11%）或白人（88%）儿童。黑人儿童的结果相对比白人儿童更差，在牙齿状况极佳或非常好的儿童中观察到的差异最大（73%对83%）。州一级的结构性种族主义与儿童接受牙科护理、有任何口腔健康问题或牙齿状况极佳或非常好之间在统计学上没有显著关联。在对州一级的结构性种族主义进行调整后，美国在这些结果方面的黑白差距没有变化。
需要加大力度解决美国儿童口腔健康结果方面的黑白差距。州一级的结构性种族主义与这些结果无关。未来的研究应该探讨在不同地理层面研究这些关联时结果是否会改变，以及结构性种族主义指数是否应明确纳入特定于医疗保健可及性和儿童特定机构领域的项目。
在这项美国研究中，黑人儿童的口腔健康相对较差，看牙医的可能性也比白人儿童小。结构性种族主义无法解释这些差距，这表明需要进一步研究驱动这些差距的机制以及如何解决这些差距。政策制定者应考虑扩大医疗服务提供地点、提供医疗服务人员的政策，并增加牙医参与医疗补助计划，这是之前确定的减少差距的策略。
