Small‐area socioeconomic status and children's oral health in a safety‐net care delivery setting

Abstract

Objectives: To better understand the impact of small-area socioeconomic status (SES) on caries experience and sealant presence among children receiving services through a comprehensive community-based safety-net oral health program. Methods: Census-tract level household data from the American Community Survey was utilized to construct an index that reflects the small-area socioeconomic environments in which children receive oral health services. This area SES index was entered into a logistic model with sociodemographic participant data collected by the community-based oral health program to consider its association with outcomes (caries and sealant experience) at first program visit, among children older and younger than 5 years. Results: Among poor children older than 5 years of age, higher census-tract level SES was associated with lesser caries experience and greater sealant experience at presentation for care to a community-based oral health program. Each standard deviation increase in census-tract level SES index was associated with reduced odds of any caries experience (aOR = 0.92; 95 percent CI 0.85, 0.99; P = 0.021) and increased odds of sealants (aOR = 1.20; 95 percent CI 1.05, 1.37; P = 0.009). Among children 5 years and under, only grade was associated with both outcomes. Conclusions: Within an inner city area of poverty, the greater a census tract's socioeconomic risks to health, the greater the odds that children over age five experience caries and the lesser their odds of having dental sealants. While associations between SES and oral health outcomes across the full spectrum of SES have been recognized, this study suggests that within lower SES areas, SESassociated gradients exist in children's oral health.

Self-Reported Dental Caries by Mexican Elementary and Middle-School Schoolchildren in the Context of Socioeconomic Indicators: A National Ecological Study

“…Socioeconomic inequalities in health may arise from diverse access to key resources-knowledge, money, and power-leveraged to attain health and avoid disease. Many causes of inequalities are difficult to identify, in part because they change in relation to their social context [22]. Several studies found significant associations between lower socioeconomic status and higher risk of dental caries [23][24][25][26][27][28][29].…”

“…Socioeconomic inequalities in dental health have been observed between countries, with more developed countries having a lower burden of untreated dental caries [1]. In Mexico, dental health is affected by a complex array of factors, including poor access to preventive and rehabilitative care-on account of costs but also of limited information about the importance of oral health [22,30,31]. Stratification of data dimensions is generally accepted in health research, acknowledging the need to go beyond analyses limited to the purely individual level [32].…”

A scoping review of the economic impact of family oral health: Implications for public health, research, and policy

“…As public and commercial payers, as well as policymakers, seek to quantify and financially reward health outcomes in the context of value-based care, there is an ever greater need to assess the impact of oral health and dental care on economic consequences at both individual and family levels. Social gradients in oral health are well documented [4] and, for children, extend to gradients within levels of poverty [5]. Greater understanding of the relationship between oral health and economic well-being supports efforts to integrate oral health and social care to reduce inequities related to social determinants of health.…”