Assessment of the magnitude of geographic variation and socioeconomic contextual effects on children’s dental caries: a multilevel cross-sectional analysis of a population-based sample

Background: Revealing geographic variation and assessing area contextual influences are important for reducing social inequalities in dental caries. The objective of this study was to investigate area contextual effects on children’s dental caries. Methods: This cross-sectional study included data from Grade 1 and 2 school children attending schools in the Public or Catholic school systems in the urban areas of Calgary and Edmonton in 2013/2014, in Canada. Three sources of data were used: (a) open mouth examinations, (b) parents’ questionnaires, and (c) Pampalon Material Deprivation Index derived from census data. Two dental caries outcomes were considered: (1) presence of dental caries, and (2) caries experience. Data were analyzed using multilevel modelling with two levels: school children (level 1) and dissemination area in which the child’s school was located (level 2). Results: The analytic sample included 5,677 school children attending school in 220 DAs. The study confirmed the existence of geographic variation; levels of dental caries were significantly higher among children attending schools in the most materially-deprived DAs than among those in the least materially-deprived DAs. After controlling for different population compositions in those areas, the DA-level variance represented a small but significant part (5-9%) of total variance in dental caries. Although the highest risk of having dental caries was found in the most materially-deprived DAs, the largest number of children at risk were more thinly spread across all deprivation quintiles. Conclusions: The school DA’s context may have an impact on children’s dental caries, beyond individual- and family-level factors. The study findings are relevant to Alberta Health Services’ practice of basing their selection of targeted areas for dental public health programming on school-DA’s material deprivation level and delivering preventive services to children attending schools in those selected DAs. Specifically, although risk of dental caries is highest in the most deprived quintiles, strategies focusing exclusively on the highest deprivation areas would miss many of the vulnerable children. Multilevel interventions are thus necessary to reduce social inequalities in children’s dental caries.

Name thesis:degree_name

Master of Science (MSc)

Discipline thesis:degree_discipline

Medicine – Community Health Sciences

Grantor dc:publisher.institution

Cumming School of Medicine

Year dc:date.issued

2019

Author dc:creator

• Shi, Congshi

Advisor dc:contributor.advisor

• McLaren, Lindsay

Committee members dc:contributor.committeemember

• Faris, Peter D.
• Aparicio-Ting, Fabiola E.
• Patterson, Steven M.

• dental caries, dental health, children, multilevel, contextual effects

Statement dc:rights

• University of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission.

Language dc:language.iso

en

DOI

http://dx.doi.org/10.11575/PRISM/36152

OAI identifier oai:identifier

oai:ucalgary.scholaris.ca:1880/109919