Abstract
ObjectivesAlthough adolescence is a sensitive developmental period in oral health, the social equalization hypothesis that suggests health inequalities attenuate in adolescence has not been examined. This study analyses whether the socioeconomic gap and ethnic disadvantage in oral health among children aged 5 reduces among adolescents aged 15.MethodsData from the cross‐sectional Children's Dental Health Survey 2013 were analysed, comprising of 8541 children aged 5, 8, 12 and 15 attending schools in England, Wales and Northern Ireland. Oral health indicators included decayed and filled teeth, plaque, gingivitis and periodontal health. Ethnicity was measured using the 2011 UK census ethnic categories. Socioeconomic position was measured by family, school and residential deprivation. Negative binomial and probit regression models estimated the levels of oral health by ethnicity and socioeconomic position, adjusted for demographic and tooth characteristics.ResultsThe predicted rate of decayed teeth for White British/Irish children aged 5 was 1.54 (95%CI 1.30‐1.77). In contrast, the predicted rate for Indian and Pakistani children was about 2‐2.5 times higher. At age 15, ethnic differences had reduced considerably. Family deprivation was associated with higher levels of tooth decay among younger children but not among adolescents aged 15. The influence of residential deprivation on the rate of tooth decay and filled teeth was similar among younger and older children. Moreover, inequalities in poor periodontal health by residential deprivation was significantly greater among 15‐year‐old children compared to younger children.ConclusionsThis study found some evidence of smaller ethnic and family socioeconomic differences in oral health among British adolescents compared to younger children. However, substantial differences in oral health by residential deprivation remain among adolescents. Community levels of deprivation may be particularly important for the health of adolescents.
Highlights
There are substantial social inequalities in oral health, with children from disadvantaged and ethnic minority backgrounds experiencing poorer oral health.[1,2] there is considerable evidence that socioeconomic health inequalities appear to reduce from childhood to adolescence leading to the hypothesis of social equalization during adolescence.[3,4,5,6] This hypothesis involves a change in the pattern of socioeconomic differences in health from 1 in childhood characterized by health inequalities to 1 in youth characterized by relative equality.[3]
We examined whether the association between ethnicity and each of the oral health measures reduced in the regression models after controlling for the Socioeconomic position (SEP) measures
We found strong evidence of smaller ethnic differences in dental decay among British adolescents aged 15 compared to children aged 5, and this pattern was repeated for all the oral health measures
Summary
There are substantial social inequalities in oral health, with children from disadvantaged and ethnic minority backgrounds experiencing poorer oral health.[1,2] there is considerable evidence that socioeconomic health inequalities appear to reduce from childhood to adolescence leading to the hypothesis of social equalization during adolescence.[3,4,5,6] This hypothesis involves a change in the pattern of socioeconomic differences in health from 1 in childhood characterized by health inequalities to 1 in youth characterized by relative equality.[3]. There is some evidence that socioeconomic inequalities in oral health are attenuated among older children compared to younger children.[18,19] This socioeconomic equalization in health during adolescence is suggested to arise when the influences of the family and home environment diminish, with school, peers and youth culture playing a larger role in children’s lives.[3] Adolescence is a period when oral health-related behaviours are not as closely monitored by parents as during childhood, with a potentially larger role for the school and neighbourhood factors in influencing adolescent oral health and related behaviours. We hypothesize that family SEP and ethnicity will be less influential for the oral health of adolescents compared to younger children living in England, Wales and Northern Ireland
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