Jiang Linxin, Huang Shaohong, Wu Linmei, Qin Yuandong, Li Simin, Kreher Deborah, Reissmann Daniel R, Schmalz Gerhard, Huang Xiangyu
Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, Guangdong, China.
Department of Prosthodontics, University of Leipzig, Liebigstr. 12, 04103, Leipzig, Germany.
BMC Oral Health. 2025 Jun 21;25(1):952. doi: 10.1186/s12903-025-06302-w.
Early childhood untreated caries (ECC) has numerous adverse effects on children and remains more prevalent in Asia than the global average. Despite recent improvements in ECC prediction and treatment, inequalities related to parental education and economic status may persist and have potentially worsened in the context of the COVID-19 pandemic. This study analyzed the trends and associated factors of education- and economy- related inequalities in ECC among 5-year-old children in Guangdong, China, from 2005 to 2021.
Data from three cross-sectional surveys from Guangdong, China, were utilized, including dental examinations of 2,584 five-year-old children and parental questionnaires. Logistic regression models and education-economy-related interactions were used to identify factors associated with ECC. The Slope Index of Inequality (SII) and Relative Index of Inequality (RII), derived from linear regression models, were applied to access trends in inequalities over the survey years.
Children living in rural areas (OR = 1.97, 95%CI = 1.47 to 2.64) and those who have dental visits because of treatment (OR = 5.73, 95%CI = 2.73 to 12.05) were associated with a higher chance of having ECC, compared to their urban and non-visiting counterparts. Children whose parents had high (OR = 0.53, 95%CI = 0.31 to 0.88) or medium (OR = 0.64, 95%CI = 0.41 to 0.99) educational levels and those had high (OR = 0.60, 95%CI = 0.43 to 0.85) and medium (OR = 0.59, 95%CI = 0.42 to 0.84) economic levels were associated with a lower chance of having ECC compared those with levels. The highest education- and economy- related SII were observed in 2005. These declined by 14.0 and 4.3% points, respectively, in 2015, but increased again by 9.8 and 0.4% points in 2021. Besides, inequality as measured by SII increased continuously in rural areas. The RII values reflected similar trends in inequality distribution.
Children from rural areas, lower parental education and family economic level exhibited significantly higher ECC prevalence. The education- and economy- related inequalities persisted across different groups and demonstrated a downward trend overall, but inequalities have continued to rise in rural regions from 2005 to 2021.
幼儿期未经治疗的龋齿（ECC）对儿童有诸多不良影响，且在亚洲的患病率仍高于全球平均水平。尽管近期在ECC预测和治疗方面有所改善，但与父母教育程度和经济状况相关的不平等现象可能依然存在，并且在新冠疫情背景下可能有所加剧。本研究分析了2005年至2021年中国广东省5岁儿童中与教育和经济相关的ECC不平等趋势及相关因素。
利用来自中国广东省的三项横断面调查数据，包括对2584名5岁儿童的口腔检查和家长问卷。采用逻辑回归模型以及与教育经济相关的交互作用来确定与ECC相关的因素。应用从线性回归模型得出的不平等斜率指数（SII）和不平等相对指数（RII）来评估调查年份间不平等的趋势。
与城市儿童和未因治疗就诊的儿童相比，农村儿童（OR = 1.97，95%CI = 1.47至2.64）以及因治疗而就诊的儿童（OR = 5.73，95%CI = 2.73至12.05）患ECC的几率更高。父母教育水平高（OR = 0.53，95%CI = 0.31至0.88）或中等（OR = 0.64，95%CI = 0.41至0.99）以及经济水平高（OR = 0.60，95%CI = 0.43至0.85）和中等（OR = 0.59，95%CI = 0.42至0.84）的儿童患ECC的几率低于教育和经济水平低的儿童。2005年观察到与教育和经济相关的最高SII。2015年，这些指数分别下降了14.0和4.3个百分点，但在2021年又分别上升了9.8和0.4个百分点。此外，农村地区以SII衡量的不平等现象持续增加。RII值反映了不平等分布的类似趋势。
农村地区儿童、父母教育程度较低和家庭经济水平较低的儿童ECC患病率显著更高。与教育和经济相关的不平等在不同群体中持续存在，总体呈下降趋势，但2005年至2021年农村地区的不平等现象持续上升。
