Abstract
BackgroundSocioeconomic inequalities in health within Glasgow, Scotland, are among the widest in the world. This is largely attributed to socio-economic conditions. The ‘Glasgow Effect’ labels the finding that the high prevalence of some diseases cannot be fully explained by a conventional area-based socio-economic metric. This study aimed to investigate whether differences in dental caries between Glasgow’s resident children and those in the Rest of Scotland could be explained by this metric and whether differences were of fixed magnitude, over time.MethodsScotland’s National Dental Inspection Programme (NDIP) cross-sectional data for five-year-old children in years: 1994, 1996, 1998, 2000, 2003, 2004, 2006, 2008, 2010, and 2012 (n = 92,564) were utilised. Endpoints were calculated from the mean decayed, missing and filled teeth score (d3mft) and percentage with obvious decay experience. Socioeconomic status was measured by DepCat, a Scottish area-based index. The Glasgow Effect was estimated by the odds-ratio (OR) of decay for Glasgow versus the Rest of Scotland adjusted by age, gender and DepCat. Inequalities were also assessed by the Significant Caries Index (SIC), SIC 10, and Scottish Caries Inequality Metric (SCIM 10).ResultsDecay levels for deprived Glasgow children have reduced to be similar to those in the Rest of Scotland. In 1993, OR for d3mft > 0 for those living in the Glasgow area was 1.34(1.10, 1.64), p = 0.005. This reduced below unity in 2012, OR = 0.85(0.77, 0.93), p < 0.001. There were downward trends (p < 0.001) in absolute inequality measured by SIC and SIC 10 in each of the geographic areas. The SCIM 10 demonstrated further reductions in inequality across the population. The downward trends for all the inequality measures were larger for Glasgow than the Rest of Scotland.ConclusionsOver the interval, Glasgow has eliminated the earlier extra health inequalities. When comparing ‘like for like’ by socioeconomic status there is now no higher level of dental caries in the Greater Glasgow area.
Highlights
Socioeconomic inequalities in health within Glasgow, Scotland, are among the widest in the world
The ‘Glasgow Effect’ labels the finding that the high prevalence of some diseases observed in the city’s population cannot be fully explained by controlling for conventional socio-economic status (SES), using area and/or individual level measures, and that there may be ‘unknown drivers’ of poor health associated with living in the city [2,5,6,7]
Several explanations have been put forward for the ‘Glasgow Effect’ including: the sensitivity of measures of socio-economic status used; behavioural or biological variables; political and historical factors influencing residents’ sense of hopelessness and community coherence; Blair et al BMC Public Health (2015) 15:212 and additional unknown factors associated with living in the Glasgow area [5,6,7,8,9,10,11]
Summary
Socioeconomic inequalities in health within Glasgow, Scotland, are among the widest in the world. The incidence and prevalence rates for many chronic diseases in Glasgow are among the highest in developed countries [1,2,3] This poor health profile has been largely attributed to socio-economic conditions, since Glasgow has higher levels of deprivation than the Rest of Scotland and the UK [4]. The ‘Glasgow Effect’ labels the finding that the high prevalence of some diseases (and behaviours associated with ill health) observed in the city’s population cannot be fully explained by controlling for conventional socio-economic status (SES), using area and/or individual level measures, and that there may be ‘unknown drivers’ of poor health associated with living in the city [2,5,6,7]. A recent paper by the Glasgow Centre for Population Health [13] has identified SES, psychological and biological associations with adverse physiological outcomes e.g. biological-aging, epigenetic effects and high levels of biomarkers of ill health
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