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Elimination of 'the Glasgow effect' in levels of dental caries in Scotland's five-year-old children: 10 cross-sectional surveys (1994-2012).

Blair YI, McMahon AD, Gnich W, Conway DI, Macpherson LM - BMC Public Health (2015)

Bottom Line: Decay levels for deprived Glasgow children have reduced to be similar to those in the Rest of Scotland.This reduced below unity in 2012, OR = 0.85(0.77, 0.93), p < 0.001.The SCIM 10 demonstrated further reductions in inequality across the population.

View Article: PubMed Central - PubMed

Affiliation: Oral Health Directorate, NHS Greater Glasgow & Clyde, Glasgow Dental Hospital, 378 Sauchiehall St, Glasgow, G2 3JZ, Scotland, UK. yvonne.blair@glasgow.ac.uk.

ABSTRACT

Background: Socioeconomic inequalities in health within Glasgow, Scotland, are among the widest in the world. This is largely attributed to socio-economic conditions. The 'Glasgow Effect' labels the finding that the high prevalence of some diseases cannot be fully explained by a conventional area-based socio-economic metric. This study aimed to investigate whether differences in dental caries between Glasgow's resident children and those in the Rest of Scotland could be explained by this metric and whether differences were of fixed magnitude, over time.

Methods: Scotland's National Dental Inspection Programme (NDIP) cross-sectional data for five-year-old children in years: 1994, 1996, 1998, 2000, 2003, 2004, 2006, 2008, 2010, and 2012 (n = 92,564) were utilised. Endpoints were calculated from the mean decayed, missing and filled teeth score (d3mft) and percentage with obvious decay experience. Socioeconomic status was measured by DepCat, a Scottish area-based index. The Glasgow Effect was estimated by the odds-ratio (OR) of decay for Glasgow versus the Rest of Scotland adjusted by age, gender and DepCat. Inequalities were also assessed by the Significant Caries Index (SIC), SIC 10, and Scottish Caries Inequality Metric (SCIM 10).

Results: Decay levels for deprived Glasgow children have reduced to be similar to those in the Rest of Scotland. In 1993, OR for d3mft > 0 for those living in the Glasgow area was 1.34(1.10, 1.64), p = 0.005. This reduced below unity in 2012, OR = 0.85(0.77, 0.93), p < 0.001. There were downward trends (p < 0.001) in absolute inequality measured by SIC and SIC 10 in each of the geographic areas. The SCIM 10 demonstrated further reductions in inequality across the population. The downward trends for all the inequality measures were larger for Glasgow than the Rest of Scotland.

Conclusions: Over the interval, Glasgow has eliminated the earlier extra health inequalities. When comparing 'like for like' by socioeconomic status there is now no higher level of dental caries in the Greater Glasgow area.

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Related in: MedlinePlus

Mean d3mft by deprivation category (DepCat: 1 = least deprived, 7 = most deprived).
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Fig1: Mean d3mft by deprivation category (DepCat: 1 = least deprived, 7 = most deprived).

Mentions: Figures 1 and 2 demonstrate the direct associations of children’s DepCat with their mean d3mft scores and the prevalence of those with obvious decay experience (%d3mft > 0), respectively. In spite of the marked trends towards diminished overall mean d3mft scores and percentages with d3mft > 0 evident in the two geographic areas over time, at each cross-sectional study the gradients in morbidity and prevalence of caries by DepCat within the individual study years have persisted in both Glasgow and the Rest of Scotland. The ‘gaps’ illustrated in Figure 1 between the values for mean d3mft recorded for the children resident in DepCat 7 postcodes and those from DepCat 1 small areas in the respective geographic areas at individual study points are indicative of the magnitudes of simple absolute inequality in area-based caries burden experienced by the DepCat 7 children at each point, likewise for prevalence (Figure 2) of d3mft > 0. Furthermore, comparison of the separate values for mean d3mft for each DepCat in Figure 1 graphs (a) Glasgow and (b) the Rest of Scotland illustrates that caries morbidity was less severe for all children from each DepCat category in the Rest of Scotland than in Glasgow, at baseline. A similar comparison of the graphs (a) and (b) in Figure 2 shows that prevalence of d3mft > 0 in the Rest of Scotland also was lower within each DepCat category.Figure 1


Elimination of 'the Glasgow effect' in levels of dental caries in Scotland's five-year-old children: 10 cross-sectional surveys (1994-2012).

Blair YI, McMahon AD, Gnich W, Conway DI, Macpherson LM - BMC Public Health (2015)

Mean d3mft by deprivation category (DepCat: 1 = least deprived, 7 = most deprived).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4352263&req=5

Fig1: Mean d3mft by deprivation category (DepCat: 1 = least deprived, 7 = most deprived).
Mentions: Figures 1 and 2 demonstrate the direct associations of children’s DepCat with their mean d3mft scores and the prevalence of those with obvious decay experience (%d3mft > 0), respectively. In spite of the marked trends towards diminished overall mean d3mft scores and percentages with d3mft > 0 evident in the two geographic areas over time, at each cross-sectional study the gradients in morbidity and prevalence of caries by DepCat within the individual study years have persisted in both Glasgow and the Rest of Scotland. The ‘gaps’ illustrated in Figure 1 between the values for mean d3mft recorded for the children resident in DepCat 7 postcodes and those from DepCat 1 small areas in the respective geographic areas at individual study points are indicative of the magnitudes of simple absolute inequality in area-based caries burden experienced by the DepCat 7 children at each point, likewise for prevalence (Figure 2) of d3mft > 0. Furthermore, comparison of the separate values for mean d3mft for each DepCat in Figure 1 graphs (a) Glasgow and (b) the Rest of Scotland illustrates that caries morbidity was less severe for all children from each DepCat category in the Rest of Scotland than in Glasgow, at baseline. A similar comparison of the graphs (a) and (b) in Figure 2 shows that prevalence of d3mft > 0 in the Rest of Scotland also was lower within each DepCat category.Figure 1

Bottom Line: Decay levels for deprived Glasgow children have reduced to be similar to those in the Rest of Scotland.This reduced below unity in 2012, OR = 0.85(0.77, 0.93), p < 0.001.The SCIM 10 demonstrated further reductions in inequality across the population.

View Article: PubMed Central - PubMed

Affiliation: Oral Health Directorate, NHS Greater Glasgow & Clyde, Glasgow Dental Hospital, 378 Sauchiehall St, Glasgow, G2 3JZ, Scotland, UK. yvonne.blair@glasgow.ac.uk.

ABSTRACT

Background: Socioeconomic inequalities in health within Glasgow, Scotland, are among the widest in the world. This is largely attributed to socio-economic conditions. The 'Glasgow Effect' labels the finding that the high prevalence of some diseases cannot be fully explained by a conventional area-based socio-economic metric. This study aimed to investigate whether differences in dental caries between Glasgow's resident children and those in the Rest of Scotland could be explained by this metric and whether differences were of fixed magnitude, over time.

Methods: Scotland's National Dental Inspection Programme (NDIP) cross-sectional data for five-year-old children in years: 1994, 1996, 1998, 2000, 2003, 2004, 2006, 2008, 2010, and 2012 (n = 92,564) were utilised. Endpoints were calculated from the mean decayed, missing and filled teeth score (d3mft) and percentage with obvious decay experience. Socioeconomic status was measured by DepCat, a Scottish area-based index. The Glasgow Effect was estimated by the odds-ratio (OR) of decay for Glasgow versus the Rest of Scotland adjusted by age, gender and DepCat. Inequalities were also assessed by the Significant Caries Index (SIC), SIC 10, and Scottish Caries Inequality Metric (SCIM 10).

Results: Decay levels for deprived Glasgow children have reduced to be similar to those in the Rest of Scotland. In 1993, OR for d3mft > 0 for those living in the Glasgow area was 1.34(1.10, 1.64), p = 0.005. This reduced below unity in 2012, OR = 0.85(0.77, 0.93), p < 0.001. There were downward trends (p < 0.001) in absolute inequality measured by SIC and SIC 10 in each of the geographic areas. The SCIM 10 demonstrated further reductions in inequality across the population. The downward trends for all the inequality measures were larger for Glasgow than the Rest of Scotland.

Conclusions: Over the interval, Glasgow has eliminated the earlier extra health inequalities. When comparing 'like for like' by socioeconomic status there is now no higher level of dental caries in the Greater Glasgow area.

Show MeSH
Related in: MedlinePlus