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

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.

Neighborhood-Level Inequalities in Dental Care of Adolescents and Young Adults in Southwestern Ontario

“…The geovisualization of these variables also showed that the changes in dental care outcomes were more pronounced in some FSA codes when compared to others The results of this study show neighborhood-level discrepancies in dental care outcomes in both the age groups studied. This is in keeping with a previous study on children in the same population [ 21 ]. However, the limited number of FSA codes did not allow for the use of more powerful geographic regression models in this study.…”

“…This was seen in both the 15–17-year age group as well as the 18–24-year age group, consistent with the findings of other studies showing that individuals from lower income families may end up spending more on dental care [ 32 , 33 ]. The findings are also in keeping with those of a similar study conducted on children below 15 years of age [ 21 ], suggesting that socioeconomic determinants of healthcare affect individuals across different age groups.…”

“…Andersen’s behavioral model suggests that healthcare (including dental care) is dependent on both individual and societal elements [ 24 , 25 ]. While much of the previous work on quality of dental care has focused on the individual [ 15 , 16 , 26 ], it is only recently that attempts have been made to visualize societal data at a geographic level [ 20 , 21 ]. The transition from adolescence to adulthood is affected by a number of personal conditions, such as beliefs or attitudes, SES, and societal conditions, such as marginalization, gender, and race or ethnicity, which can facilitate or impede the transition [ 27 , 28 ].…”

“…Coding was performed using criteria and methods that have been previously published [ 21 ]. Neighborhood-level dental care outcomes were geovisualized separately for each age group using the geographic information system software ArcGIS 10.8.1 (ESRI Canada, Toronto, ON, Canada).…”

“…Neighborhood-level sociodemographic data in Canada are available at the level of forward sortation area (FSA) postal codes [ 17 ], which have been used by both diabetes and cancer researchers as a measure of neighborhood-level socioeconomic status [ 18 , 19 ]. There is some data on the mapping of dental caries according to postal codes in children [ 20 ], and the relationship between dental billing data and neighborhood-level sociodemographic variables among Canadian children has recently been explored [ 21 ]. The present study examined whether the association of neighborhood-level socioeconomic status (SES) with the cost of dental care and dental care outcomes differs between adolescents and young adults.…”