Trends in Socioeconomic Inequalities of Dental Caries Experience among 12-Year-Olds in Chile: An Ecological Cohort Study.

IF 2.5 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Caries Research Pub Date : 2026-02-23 DOI:10.1159/000551081

Mariél de Aquino Goulart, Jorge Celis-Dooner, Fanny Petermann-Rocha, David I Conway, Andrés Celis, Alex D McMahon

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引用次数: 0

Abstract

Introduction: Socioeconomic inequalities in adolescent dental caries remain a major public health concern, even in countries with declining overall prevalence. Chile provides a unique setting to examine these inequalities nationally and assess the potential mitigating role of systemic fluoride delivery programmes. This study aimed to address these gaps by providing a national analysis of dental caries trends among 12-year-olds in Chile from 2009 to 2023 and investigate socioeconomic inequalities in dental caries experience between municipalities.

Methods: This ecological cohort study analysed 1,261,690 dental examinations of 12-year-olds across 325 Chilean municipalities from 2009 to 2023, representing 99.8% of eligible national records. Caries prevalence was modelled against area socioeconomic deprivation (IDSE deciles), adjusting for rurality and systemic fluoride delivery programmes, and weighting for number of total examinations by municipality/year. Inequality metrics included absolute rate difference (ARD), Slope Index of Inequality (SII), and Relative Index of Inequality (RII).

Results: During the study period, a strong and persistent socioeconomic gradient was observed: adolescents in the most deprived municipalities had a 17-percentage-point higher caries prevalence than those in the least deprived (β = -0.17, 95% confidence interval [95% CI]: -0.20, -0.14). This gradient followed a dose-response pattern and was confirmed by summary measures (ARD = 0.151; RRR = 1.234). Temporal analysis revealed peak inequality pre-2018 (SII = 0.17, 95% CI: -0.20, -0.14), followed by a steady decline post-2018, reaching statistically nonsignificant levels by 2023 (SII = 0.04, 95% CI: -0.15, 0.06). Fluoridation programmes modestly attenuated the deprivation gradient by 24% (β = -0.13), though they explained limited variance (ΔR2 = 0.04).

Conclusion: Socioeconomic inequalities in dental caries among Chilean adolescents remain substantial, despite national declines in prevalence. While systemic fluoridation contributes to modest reductions in inequality, structural determinants are the primary drivers of persistent inequalities.

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智利12岁儿童龋齿经历的社会经济不平等趋势：一项生态队列研究

儿童龋齿的社会经济不平等仍然是一个主要的公共卫生问题，即使在总体患病率下降的国家也是如此。智利提供了一个独特的环境，可以在全国范围内审查这些不平等现象，并评估系统性氟化物提供方案的潜在缓解作用。该生态队列研究分析了2009年至2023年智利325个城市的1261690名12岁儿童的牙科检查，占合格国家记录的99.8%。根据地区社会经济剥夺（IDSE十分位数）对龋齿患病率进行建模，调整农村和系统性氟化物提供方案，并按城市/年对总检查次数进行加权。不平等指标包括绝对比率差（ARD）、不平等斜率指数（SII）和相对不平等指数（RII）。结果观察到强烈而持久的社会经济梯度：最贫困城市的青少年龋齿患病率比最贫困城市的青少年高出17个百分点（β = -0.17, 95% CI: -0.20, -0.14）。这种梯度符合剂量-反应模式，并通过汇总测量得到证实（ARD = 0.151; RRR = 1.234）。时间分析显示，不平等在大流行前达到峰值（SII = 0.17, 95% CI: -0.20, -0.14），随后在2018年后稳步下降，到2023年达到非显著水平（SII = 0.04, 95% CI: -0.15, 0.06）。氟化方案适度地将剥夺梯度减弱了24% (β = -0.13)，尽管它们解释了有限的方差（ΔR²= 0.04）。结论：智利青少年龋齿的社会经济不平等现象仍然存在，尽管全国的患病率有所下降。虽然系统性氟化有助于适度减少不平等，但结构性决定因素是持续不平等的主要驱动因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Caries Research 医学-牙科与口腔外科

CiteScore

6.30

自引率

7.10%

发文量

审稿时长

6-12 weeks

期刊介绍： ''Caries Research'' publishes epidemiological, clinical and laboratory studies in dental caries, erosion and related dental diseases. Some studies build on the considerable advances already made in caries prevention, e.g. through fluoride application. Some aim to improve understanding of the increasingly important problem of dental erosion and the associated tooth wear process. Others monitor the changing pattern of caries in different populations, explore improved methods of diagnosis or evaluate methods of prevention or treatment. The broad coverage of current research has given the journal an international reputation as an indispensable source for both basic scientists and clinicians engaged in understanding, investigating and preventing dental disease.