Immigrant Status and Ethnic Inequities in Dental Caries in Children: Bilbao, Spain
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population and Sources of Information
2.2. Variables
2.3. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Conflicts of Interest
Appendix A
Unadjusted | Model 1 | Model 2 | |
---|---|---|---|
dft | |||
Spanish | 1.00 | 1.00 | 1.00 |
Spanish Roma | 3.51 (2.81–4.38) | 3.44 (2.76–4.30) | 2.66 (2.03–3.48) |
Immigrant | 2.38 (1.93–2.93) | 2.41 (1.95–2.96) | 2.36 (1.90–2.94) |
DMFT | |||
Spanish | 1.00 | 1.00 | 1.00 |
Spanish Roma | 12.34 (7.19–21.17) | 8.49 (4.99–14.44) | 7.13 (3.94–12.91) |
Immigrant | 1.98 (1.08–3.63) | 1.90 (1.04–3.48) | 1.83 (1.02–3.29) |
References
- Frencken, J.E.; Sharma, P.; Stenhouse, L.; Green, D.; Laverty, D.; Dietrich, T. Global epidemiology of dental caries and severe periodontitis: A comprehensive review. J. Clin. Periodontol. 2017, 44 (Suppl. S18), 94–105. [Google Scholar] [CrossRef] [PubMed]
- Chen, K.J.; Gao, S.S.; Duangthip, D.; Lo, E.C.M.; Chu, C.H. Prevalence of early childhood caries among 5-year-old children: A systematic review. J. Investig. Clin. Dent. 2019, 10, e12376. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Kassebaum, N.J.; Smith, A.G.C.; Bernabe, E.; Fleming, T.D.; Reynolds, A.E.; Vos, T.; Murray, C.J.L.; Marcenes, W. Global, Regional, and National Prevalence, Incidence, and Disability-Adjusted Life Years for Oral Conditions for 195 Countries, 1990–2015: A Systematic Analysis for the Global Burden of Diseases, Injuries, and Risk Factors. J. Dent. Res. 2017, 96, 380–387. [Google Scholar] [CrossRef] [PubMed]
- Lima, S.L.A.; Santana, C.C.P.; Paschoal, M.A.B.; Paiva, S.M.; Ferreira, M.C. Impact of untreated dental caries on the quality of life of Brazilian children: Population-based study. Int. J. Paediatr. Dent. 2018, 28, 390–399. [Google Scholar] [CrossRef]
- Sheiham, A. Dental caries affects body weight, growth and quality of life in pre-school children. Br. Dent. J. 2006, 201, 625–626. [Google Scholar] [CrossRef] [Green Version]
- Souza, J.G.S.; Souza, S.E.; Noronha, M.D.S.; Ferreira, E.F.E.; Martins, A. Impact of untreated dental caries on the daily activities of children. J. Public Health Dent. 2018, 78, 197–202. [Google Scholar] [CrossRef]
- Early Child Development Knowledge Network (ECDKN). Early Child Development Knowledge Network (ECDKN). Early child development: A powerful equalizer. In Final Report of the Early Child Development Knowledge Network of the Commission on Social Determinants of Health; WHO: Geneva, Switzerland, 2007; Available online: https://www.who.int/social_determinants/resources/ecd_kn_report_07_2007.pdf (accessed on 30 October 2021).
- Kazeminia, M.; Abdi, A.; Shohaimi, S.; Jalali, R.; Vaisi-Raygani, A.; Salari, N.; Mohammadi, M. Dental caries in primary and permanent teeth in children’s worldwide, 1995 to 2019: A systematic review and meta-analysis. Head Face Med. 2020, 16, 22. [Google Scholar] [CrossRef]
- Julihn, A.; Cunha Soares, F.; Hjern, A.; Dahllof, G. Development level of the country of parental origin on dental caries in children of immigrant parents in Sweden. Acta Paediatr. 2021, 110, 2405–2414. [Google Scholar] [CrossRef]
- Shackleton, N.; Broadbent, J.M.; Thornley, S.; Milne, B.J.; Crengle, S.; Exeter, D.J. Inequalities in dental caries experience among 4-year-old New Zealand children. Community Dent. Oral Epidemiol. 2018, 46, 288–296. [Google Scholar] [CrossRef]
- Cvikl, B.; Haubenberger-Praml, G.; Drabo, P.; Hagmann, M.; Gruber, R.; Moritz, A.; Nell, A. Migration back ground is associated with caries in Viennese school children, even if parents have received a higher education. BMC Oral Health 2014, 14, 51. [Google Scholar] [CrossRef] [Green Version]
- André Kramer, A.C.; Petzold, M.; Hakeberg, M.; Ostberg, A.L. Multiple Socioeconomic Factors and Dental Caries in Swedish Children and Adolescents. Caries Res. 2018, 52, 42–50. [Google Scholar] [CrossRef] [PubMed]
- Mock-Munoz de Luna, C.J.; Vitus, K.; Torslev, M.K.; Krasnik, A.; Jervelund, S.S. Ethnic inequalities in child and adolescent health in the Scandinavian welfare states: The role of parental socioeconomic status—A systematic review. Scand. J. Public Health 2019, 47, 679–689. [Google Scholar] [CrossRef] [PubMed]
- Gonzalez-Rabago, Y.; Martin, U. Health and determinants of health in second generations of international immigrants: Social inequalities in health since childhood? Gac. Sanit. 2019, 33, 156–161. (In Spanish) [Google Scholar] [CrossRef] [PubMed]
- van der Tas, J.T.; Kragta, L.; Veerkamp, J.J.; Jaddoe, V.W.; Mol, H.A.; Ongkosuwito, E.M.; Elfrik, M.E.; Wolvius, E.B. Ethnic Disparities in Dental Caries among Six-Year-Old Children in the Netherlands. Caries Res. 2016, 50, 489–497. [Google Scholar] [CrossRef] [PubMed]
- Stecksen-Blicks, C.; Hasslof, P.; Kieri, C.; Widman, K. Caries and background factors in Swedish 4-year-old children with special reference to immigrant status. Acta Odontol. Scand. 2014, 72, 852–858. [Google Scholar] [CrossRef] [PubMed]
- Klein, J.; von dem Knesebeck, O. Inequalities in health care utilization among migrants and non-migrants in Germany: A systematic review. Int. J. Equity Health 2018, 17, 160. [Google Scholar] [CrossRef] [Green Version]
- Lambert, M.J.; Vanobbergen, J.S.N.; Martens, L.C.; De Visschere, L.M.J. Socioeconomic inequalities in caries experience, care level and dental attendance in primary school children in Belgium: A cross-sectional survey. BMJ Open 2017, 7, e015042. [Google Scholar] [CrossRef] [Green Version]
- World Health Organization. Roma Health in the European Region. 2018. Available online: https://www.euro.who.int/en/health-topics/health-determinants/roma-health/roma-health-in-the-european-region (accessed on 25 November 2021).
- European Union Agency for Fundamental Rights. A Persisting Concern: Anti-Gypsyism as a Barrier to Roma Inclusion; Publications Office of the European Union: Luxembourg, 2018; Available online: https://fra.europa.eu/sites/default/files/fra_uploads/fra-2018-anti-gypsyism-barrier-roma-inclusion_en.pdf (accessed on 25 November 2021).
- Fundación Secretariado Gitano. Guía Para la Promoción Personal de las Mujeres Gitanas. Madrid 2009. Available online: http://www.gitanos.org/servicios/documentacion/publicacionespropias/fichas/49119.html (accessed on 25 November 2021).
- Otero, B.; Mendoza, K. La diversidad infantil y juvenil de la CAE en cifras. In La Diversidad Infantil y Juvenil en la CAE; Las (mal llamadas) Segundas Generaciones; Oleaga, J.A., Ed.; Servicio Editorial de la Universidad del País Vasco: Bilbao, Spain, 2017; pp. 41–90. Available online: https://www.ikuspegi.eus/documentos/investigacion/es/diversidad_infantil/Diversidad_infantil_juvenil_CAE.pdf (accessed on 20 December 2021).
- Valcarcel Soria, R.; Bernabe, E.; Somacarrera Perez, M.L. Acculturation and Dental Caries Among Children in Spain. J. Immigr. Minor. Health 2019, 21, 699–705. [Google Scholar] [CrossRef] [Green Version]
- Lin, Y.T.; Chou, C.C.; Lin, Y.J. Caries experience between primary teeth at 3-5 years of age and future caries in the permanent first molars. J. Dent Sci. 2021, 16, 899–904. [Google Scholar] [CrossRef]
- Commission on Social Determinants of Health. Subsanar las Desigualdades en una Generación: Alcanzar la Equidad Sanitaria Actuando Sobre los Determinantes Sociales de la Salud Ginebra: Organizacion Mundial de la Salud. 2009. Available online: https://apps.who.int/iris/handle/10665/44084 (accessed on 30 October 2021).
- Sinclair, E.; Eaton, K.A.; Widstrom, E. The healthcare systems and provision of oral healthcare in European Union member states. Part 10: Comparison of systems and with the United Kingdom. Br. Dent. J. 2019, 227, 305–310. [Google Scholar] [CrossRef]
- Bravo Pérez, M.; Almerich Silla, J.M.; Ausina Márquez, V.; Avilés Gutiérrez, P.; Blanco González, J.M.; Canorea Díaz, E.; Casals, E.; Gómez-Santos, G.; Hita Iglesias, C.; Llodra Calvo, J.C.; et al. Encuesta de salud oral en España 2015. RCOE 2016, 21 (Suppl. S1), 8–48. [Google Scholar]
- Centros Escolares: Ayuntamiento de Bilbao. La Educación en Bilbao Distrito a Distrito. 2016. Available online: https://www.bilbao.eus/cs/Satellite?cid=1279124959336&language=en&pagename=Bilbaonet%2FPage%2FBIO_contenidoFinal (accessed on 1 June 2016).
- World Health Organization. Oral Health Surveys: Basic Methods, 5th ed.; WHO: Geneva, Switzerland, 2013; Available online: http://apps.who.int/iris/bitstream/10665/97035/1/9789241548649_eng.pdf?ua=1 (accessed on 20 April 2021).
- Iguacel, I.; Fernandez-Alvira, J.M.; Labayen, I.; Moreno, L.A.; Samper, M.P.; Rodriguez, G.; CALINA Study. Social vulnerabilities as determinants of overweight in 2-, 4- and 6-year-old Spanish children. Eur. J. Public Health 2018, 28, 289–295. [Google Scholar] [CrossRef] [PubMed]
- Shi, C.; Faris, P.; McNeil, D.A.; Paterson, S.; Potestio, M.L.; Thawer, S.; McLaren, L. Ethnic disparities in children’s oral health: Findings from a population-based survey of grade 1 and 2 schoolchildren in Alberta, Canada. BMC Oral Health 2018, 18, 1. [Google Scholar] [CrossRef] [PubMed]
- Llena, C.; Calabuig, E.; Sanz, J.L.; Melo, M. Risk Factors Associated with Carious Lesions in Permanent First Molars in Children: A Seven-Year Retrospective Cohort Study. Int. J. Environ. Res. Public Health 2020, 17, 1421. [Google Scholar] [CrossRef] [PubMed]
- Esnaola, S.; Montoya, I.; Calvo, M.; Ibáñez, B.; Audicana, C.; Ruiz, R.; Aldasoro, E.; Martin, U. Desigualdades socioeconómicas en la mortalidad en el País Vasco y sus capitales: Un análisis de áreas geográficas pequeñas (Proyecto MEDEA). Estud. Geográficos 2010, 70, 443–462. [Google Scholar] [CrossRef] [Green Version]
- Mahboobi, Z.; Pakdaman, A.; Yazdani, R.; Azadbakht, L.; Montazeri, A. Dietary free sugar and dental caries in children: A systematic review on longitudinal studies. Health Promot. Perspect. 2021, 11, 271–280. [Google Scholar] [CrossRef]
- Pilat, Z.; Galova, J.; Petrejcikova, E.; Mathia, M.; Boronova, I.; Bernasovska, J. Oral health status of 6- and 12-year-old children of Roma origin from Eastern Slovakia: A pilot study. Cent. Eur. J. Public Health 2020, 28, 292–296. [Google Scholar] [CrossRef]
- Tusek, I.; O’Rourke, B.; Lekic, C.; Tusek, J.; Tusek, B. Early childhood caries in multilingual community. Cent. Eur. J. Public Health 2020, 28, 286–291. [Google Scholar] [CrossRef]
- Pinilla, J.; González, B. Equity in children’s utilization of dental services: Effect of a children’s dental care programme. Community Dental Health 2006, 23, 152–157. [Google Scholar]
- Barriuso Lapresa, L.; Sanz Barbero, B. Multilevel analysis of the use of oral health services by the pediatric population. Gac. Sanit. 2011, 25, 391–396. (In Spanish) [Google Scholar] [CrossRef] [Green Version]
- Simón Salazar, F.; Aguirre Urízar, J.M. 25 años del PADI en el País Vasco (1990–2014). RCOE 2015, 20, 3–14. [Google Scholar]
- La Parra-Casado, D.; Arza-Porras, J.; Estévez, J.F. Health indicators of the National Roma Integration Strategy in Spain in the years 2006 and 2014. Eur. J. Public Health 2020, 30, 906–910. [Google Scholar] [CrossRef] [PubMed]
- Carrasco-Garrido, P.; López de Andrés, A.; Hernández Barrera, V.; Jiménez-Trujillo, I.; Jiménez-García, R. Health status of Roma women in Spain. Eur. J. Public Health 2011, 21, 793–798. [Google Scholar] [CrossRef] [PubMed]
- La Escolarización del Alumnado de Origen Extranjero en el Sistema Escolar de la CAPV: Diagnóstico y Nuevas Medidas de Intervención 2018. Gobierno Vasco. Available online: https://www.ikuspegi.eus/documentos/formacion/La_escolarizacion_alumnado_origen_extranjero.pdf (accessed on 25 March 2022).
Spanish n = 839 | Spanish Roma n = 136 | Immigrant n = 413 | Total n = 1388 | p-Value * | |
---|---|---|---|---|---|
%(n) | %(n) | %(n) | %(n) | ||
Age (years) | 0.359 | ||||
4–6 | 56.6 (475) | 52.2 (71) | 59.1 (244) | 56.9 (790) | |
7–9 | 43.4 (364) | 47.8 (65) | 41.0 (170) | 43.1 (598) | |
Sex | 0.150 | ||||
Female | 45.5 (382) | 46.3 (63) | 51.3 (212) | 47.3 (657) | |
Male | 54.5 (457) | 53.7 (73) | 48.7 (201) | 52.7 (731) | |
Parents’ educational attainment | <0.001 | ||||
Primary or less | 18.1 (152) | 91.2 (124) | 33.9 (140) | 30.0 (416) | |
Secondary or higher | 81.9 (687) | 8.8 (12) | 66.1 (273) | 70.0 (972) | |
School district deprivation | <0.001 | ||||
High (Q3–Q5) | 67.5 (566) | 86.0 (117) | 58.6 (242) | 66.6 (925) | |
Low (Q1–Q2) | 32.5 (273) | 14.0 (19) | 41.4 (171) | 33.4 (463) | |
Caries-related behaviors | |||||
Brushing teeth <2 times per day | 20.1 (169) | 38.2 (52) | 17.7 (73) | 21.2 (294) | <0.001 |
Cariogenic diet ≥3 times per week | 49.3 (414) | 77.2 (105) | 55.4 (229) | 53.9 (748) | <0.001 |
At least a dental visit in the past year | 34.1 (286) | 53.7 (73) | 53.7 (222) | 41.9 (581) | <0.001 |
Caries in primary teeth | |||||
Mean (SD) | 0.6 (1.40) | 2.5 (2.4) | 1.5 (2.5) | 1.0 (2.01) | <0.001 |
Caries ≥ 1 (%) | 24.1(202) | 70.6 (96) | 42.6 (176) | 34.1 (474) | <0.001 |
dft index a | |||||
Mean (SD) | 0.7 (1.5) | 2.5 (2.4) | 1.7 (2.6) | 1.2 (2.08) | <0.001 |
Index ≥ 1 | 27.8 (233) | 70.6 (96) | 45.0 (186) | 37.1 (515) | <0.001 |
Caries in permanent teeth | |||||
Mean (SD) | 0.0 (0.2) | 0.5 (1.8) | 0.1 (0.4) | 0.1 (0.5) | <0.001 |
Caries ≥ 1 (%) | 2.4 (20) | 24.3 (33) | 5.6 (23) | 5.5 (76) | <0.001 |
DMFT index b | |||||
Mean (SD) | 0.0 (0.28) | 0.6 (1.20) | 0.1 (0,42) | 0.1 (0.51) | <0.001 |
Index ≥ 1 | 3.3 (28) | 25.0 (34) | 6.1 (25) | 6.3 (87) | <0.001 |
Unadjusted | Model 1 | Model 2 | |
---|---|---|---|
Caries in primary teeth ≥ 1 | |||
Spanish | 1.00 | 1.00 | 1.00 |
Spanish Roma | 2.93 (2.49–3.45) | 2.88 (2.45–3.39) | 2.30 (1.87–2.82) |
Immigrant | 1.77 (1.50–2.09) | 1.78 (1.51–2.09) | 1.74 (1.47–2.07) |
dft ≥ 1 | |||
Spanish | 1.00 | 1.00 | 1.00 |
Spanish Roma | 2.54 (2.18–2.96) | 2.49 (2.13–2.91) | 2.04 (1.68–2.48) |
Immigrant | 1.62 (1.39–1.89) | 1.63 (1.40–1.90) | 1.63 (1.39–1.91) |
Caries in permanent teeth ≥ 1 | |||
Spanish | 1.00 | 1.00 | 1.00 |
Spanish Roma | 10.18 (6.02–17.21) | 7.44 (4.37–12.70) | 6.12 (3.19–11.74) |
Immigrant | 2.34 (1.30–4.20) | 2.29 (1.27–4.12) | 2.13 (1.14–3.97) |
DMFT ≥ 1 | |||
Spanish | 1.00 | 1.00 | 1.00 |
Spanish Roma | 7.49 (4.70–11.94) | 5.37 (3.33–8.68) | 4.83 (2.60–8.98) |
Immigrant | 1.81 (1.07–3.07) | 1.76 (1.04–2.98) | 1.74 (1.00–3.03) |
Unadjusted | Model 1 | Model 2 | |
---|---|---|---|
Caries in permanent teeth ≥1 | |||
Spanish | 1.00 | 1.00 | 1.00 |
Spanish Roma | 8.40 (5.09–13.86) | 8.27 (4.96–13.79) | 6.20 (3.18–12.12) |
Immigrant | 1.61 (0.85–3.08) | 1.60 (0.83–3.04) | 1.28 (0.63–2.60) |
DMFT ≥ 1 | |||
Spanish | 1.00 | 1.00 | 1.00 |
Spanish Roma | 6.00 (3.86–9.34) | 5.81 (3.64–9.26) | 4.52 (2.46–8.32) |
Immigrant | 1.31 (0.74–2.32) | 1.28 (0.72–2.28) | 1.11 (0.59–2.08) |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Rodriguez-Alvarez, E.; Borrell, L.N.; Marañon, E.; Lanborena, N. Immigrant Status and Ethnic Inequities in Dental Caries in Children: Bilbao, Spain. Int. J. Environ. Res. Public Health 2022, 19, 4487. https://doi.org/10.3390/ijerph19084487
Rodriguez-Alvarez E, Borrell LN, Marañon E, Lanborena N. Immigrant Status and Ethnic Inequities in Dental Caries in Children: Bilbao, Spain. International Journal of Environmental Research and Public Health. 2022; 19(8):4487. https://doi.org/10.3390/ijerph19084487
Chicago/Turabian StyleRodriguez-Alvarez, Elena, Luisa N. Borrell, Elena Marañon, and Nerea Lanborena. 2022. "Immigrant Status and Ethnic Inequities in Dental Caries in Children: Bilbao, Spain" International Journal of Environmental Research and Public Health 19, no. 8: 4487. https://doi.org/10.3390/ijerph19084487