race and ethnicity do not determine oral health disparities

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Socio-economics and geography determine oral health disparities, not race and ethnicity

Harvard University and University of California San Francisco researchers have suggested that the current standard of oral healthcare available to children through public insurance in America is not adequate to their needs. (Image: Xavier Gallego Morell/Shutterstock)

BOSTON, US: Astonishingly, ten million school days are missed owing to dental caries, the most common chronic disease of children in the US, and there are large oral health disparities by race/ethnicity among US children. In a new study, researchers have sought to measure these disparities and examine the factors underlying them to inform healthcare policies. They found that insurance type, receipt of certain dental procedures, and community-level socio-economic factors explained most of the observed disparities.

Abundant research has documented massive gaps in adolescent oral healthcare, especially among ethnic minority groups, resulting from individual health behaviours, lack of access to basic care, and community-related structural factors such as comprehensive health education and socio-economic status. Black and Hispanic children historically have had the lowest level of oral health in the US. The researchers in the present study focused on the contribution of these factors to associations between race/ethnicity and the identified risk of developing tooth decay.

The retrospective study was conducted by researchers at Harvard School of Dental Medicine, Harvard Medical School and the University of California San Francisco School of Dentistry in the US and employed data on more than 60,000 children in America. When analysed by age grouping, children aged younger than 5 years old of any race/ethnicity other than white were more likely to experience caries. Black and Hispanic children carried the highest caries prevalence in the 6- to 10-year-old age group, and only Black children had more caries than their white counterparts in the 11- to 18-year-old age group.

However, when the results were adjusted for individual-level variables, such as insurance type, dental treatment type and smoking status, and community-level variables, like education and ranking according to the Area Deprivation Index (ADI)—which organises neighbourhoods by socio-economic disadvantage—the disparities almost completely disappeared. In the youngest group, Black children no longer were at a higher risk of caries compared with white children, and none of the other racial/ethnic groups for children aged 6–18 years of age any longer had a higher risk than the white children. For children younger than 10 years old, ADI and the level of educational attainment by zip code showed association with caries risk. For older children, ADI was the only community-level variable that was connected with caries risk.

After accounting for dental procedures and community-level factors, the researchers determined that insurance type was the largest underlying factor regarding the racial/ethnic disparities in caries development for children. They suggested that public insurance like Medicaid and Children’s Health Insurance Program may not be adequately meeting children’s oral healthcare needs in the US.

By analysing the observed association between race/ethnicity and prevalence of caries according to possible underlying variables, such as socio-economic factors, quality of care, and living and working environments, the researchers clearly showed that disparities in health were mediated through differences in socio-economics and geography and not biological differences between racial/ethnic groups, all as part of the social construct of race/ethnicity. They suggested that interventions that consider the clinical significance of socio-economic and behaviour risk factors could help to reduce oral health disparities.

The study, titled “Analysis of race and ethnicity, socioeconomic factors, and tooth decay among US children”, was published online on 15 June 2023 in JAMA Network Open.

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