Neighborhood Contexts and Oral Health Outcomes in a Pediatric Population: An Exploratory Study.

Vladyslav A Podskalniy,Liliani Aires Candido Vieira,Jinhyung Lee,Hiran Perinpanayagam,Sharat Chandra Pani

doi:10.3390/children8080653

Abstract

Aims: This study aimed to explore the impacts of neighborhood-level socioeconomic contexts on the therapeutic and preventative dental quality outcome of children under 16 years. Materials and Methods: Anonymized billing data of 842 patients reporting to a university children’s dental over three years (March 2017–2020) met the inclusion criteria. Their access to care (OEV-CH-A), topical fluoride application (TFL-CH-A) and dental treatment burden (TRT-CH-A) were determined by dental quality alliance (DQA) criteria. The three oral health variables were aggregated at the neighborhood level and analyzed with Canadian census data. Their partial postal code (FSA) was chosen as a neighborhood spatial unit and maps were created to visualize neighborhood-level differences. Results: The individual-level regression models showed significant negative associations between OEV-CH-A (p = 0.027) and TFL-CH-A (p = 0.001) and the cost of dental care. While there was no significant association between neighborhood-level sociodemographic variables and OEV-CH-A, TRT-CH-A showed a significant negative association at the neighborhood level with median household income and significant positive association with percentage of non-official first language (English or French) speakers. Conclusion: Initial analysis suggests differences exist in dental outcomes according to neighborhood-level sociodemographic variables, even when access to dental care is similar.

Highlights

Dental caries is one of the most common childhood diseases and the most common oral disease in children
Records of patients aged below 16 years at the time of the last dental visit were screened for the following inclusion criteria: (a) Presence of key patient attendance metrics including, treatments, age, date of treatment, Ontario Dental Association (ODA) treatment code, Forward Sortation Area (FSA) code; (b) Presence of at least one additional treatment code within a 180-day period, intended to avoid skew or bias, in keeping with the protocol set by the dental quality alliance (DQA) [14]; (c) At least 20 patients in each FSA code to ensure adequate weight for the neighborhoodlevel data
The DQA outcomes and cost of treatment was described for each FSA code (Table 1)

Summary

Introduction

Dental caries is one of the most common childhood diseases and the most common oral disease in children. There is growing evidence that sociodemographic variables such as family income and education strongly correlate to dental caries in children [6,7,8]. This has led to the development of several theoretical models for caries risk prediction based on social and demographic variables [9,10,11]. The postal code, as a descriptive unit of a neighborhood, has been effectively used to measure the spatial impacts of health data [12]. Statistics Canada collects neighborhood-level data on several demographic factors, including but not limited to education, household income and immigration status FSA code as a spatial unit of measurement. While some efforts have been made to estimate the distribution of dental caries, there have been few attempts to explore the association between neighborhood factors and children’s oral health outcomes in Canada [13,14,15]

Methods

Results

Discussion

Conclusion