Multilevel analysis and geographic information systems in assessing dental health

Objectives: a) To identify variables associated with area deprivation at individual and contextual (districts) levels; b) to identify and to map areas at caries risk through a Geographic Information System (GIS). Methods: The random sample consisted of 1002 12 year-old schoolchildren attending 20 public and 5 private schools from Piracicaba, SP, Brazil in 2005-2006. Data on dental caries were collected by a single calibrated examiner, following the WHO recommendations. The DMFT index and Care Index were considered as dependent variables. At contextual level the following variables were studied: percentage of the head of the family receiving no income and percentage of the head of the family that was illiterate. At individual level, socioeconomic and behavioral data were used. The maps were constructed using the ArcView software. Results: Districts with lower social deprivation had best oral health status. At individual level, students with lower income (OR=1.8; CI=1.0-3.6), more people living in the household (OR=1.4; CI=1.0-1.8), more visits to the dentist (OR=1.8; CI=1.3-2.4), lower father's (OR=1.7; CI=1.0-3.3) and mother's (OR=1.7; CI=1.0-3.3) educational level were more likely to present a higher DMFT. The individuals with higher income (OR=3.9; CI=0.8-17.9) and more visits to the dentist (OR=4.7; CI=2.9-7.7) showed best Care Index. At conglomerates level, areas with social deprivation were not associated with the DMFT and the Care Indexes. Conclusion: Social and economic variables were associated with a higher prevalence of the disease at individual level; however, this relationship was not observed at territorial level.

(Supported by: FAPESP – Grant 05/56699-6)