Socioenvironmental sugar promotion and geographical inequalities in dental health of 5‐year‐old children in England

Author:

Ganbavale Suruchi G.12ORCID,Louca Chris2,Twigg Liz3,Wanyonyi Kristina4

Affiliation:

1. Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool Liverpool UK

2. University of Portsmouth Dental Academy Portsmouth UK

3. School of the Environment, Geography and Geosciences University of Portsmouth Portsmouth UK

4. THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care University of Cambridge Cambridge UK

Abstract

AbstractObjectivesTo investigate the relationship between socioenvironmental sugar promotion and geographical inequalities in the prevalence of dental caries amongst 5‐year‐olds living across small areas within England.MethodsEcological data from the National Dental Epidemiology Programme (NDEP) 2018–2019, comprising information on the percentage of 5‐year‐olds with tooth decay (≥1 teeth that are decayed into dentine, missing due to decay, or filled), and untreated tooth decay (≥1 decayed but untreated teeth), in lower‐tier local authorities (LAs) of England. These were analysed for association with a newly developed Index of Sugar‐Promoting Environments Affecting Child Dental Health (ISPE‐ACDH). The index quantifies sugar‐promoting determinants within a child's environment and provides standardized scores for the index, and its component domains that is, neighbourhood‐, school‐ and family‐environment, with the highest scores representing the highest levels of sugar promotion in lower‐tier LAs (N = 317) of England. Linear regressions, including unadjusted models separately using index and each domain, and models adjusted for domains were built for each dental outcome.ResultsParticipants lived across 272 of 317 lower‐tier LAs measured within the index. The average percentage of children with tooth decay and untreated tooth decay was 22.5 (SD: 8.5) and 19.6 (SD: 8.3), respectively. The mean index score was (0.1 [SD: 1.01]). Mean domain scores were: neighbourhood (0.02 [SD: 1.03]), school (0.1 [SD: 1.0]), and family (0.1 [SD: 0.9]). Unadjusted linear regressions indicated that the LA‐level percentage of children with tooth decay increased by 5.04, 3.71, 4.78 and 5.24 with increased scores of the index, and neighbourhood, school and family domains, respectively. An additional model, adjusted for domains, showed that this increased percentage predicted by neighbourhood domain attenuated to 1.37, and by family domain it increased to 6.33. Furthermore, unadjusted models indicated that the LA‐level percentage of children with untreated tooth decay increased by 4.72, 3.42, 4.45 and 4.97 with increased scores of the index, and neighbourhood, school, and family domains, respectively. The model, adjusted for domains, showed that this increased percentage predicted by neighbourhood domain attenuated to 1.24 and by family domain rose to 6.47. School‐domain was not significantly associated with either outcome in adjusted models.ConclusionsThis study reveals that socioenvironmental sugar promotion, particularly within neighbourhood‐ and family‐environments, may contribute to geographical inequalities in dental caries in children. Further research involving data on individual‐level dental outcomes and confounders is required.

Funder

University of Portsmouth

Publisher

Wiley

Reference42 articles.

1. Global, Regional, and National Levels and Trends in Burden of Oral Conditions from 1990 to 2017: A Systematic Analysis for the Global Burden of Disease 2017 Study

2. HolmesR PorterJ VernazzaC TsakosG RyanR DennesM.Children's Dental Health Survey 2013 Country Specific Report: England; 2015.https://files.digital.nhs.uk/publicationimport/pub17xxx/pub17137/cdhs2013‐england‐report.pdf

3. Global Economic Impact of Dental Diseases

4. Institute for Health Metrics and Evaluation. GBD Compare‐ IHME Viz Hub‐GBD.Global burden of disease study 2019.2019. Accessed January 10 2022.https://vizhub.healthdata.org/gbd‐compare/

5. Public Health England.Health Matters: Child dental health. Published 2017.https://publichealthmatters.blog.gov.uk/2017/06/14/health‐matters‐child‐dental‐health/

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