School Socioeconomic Environment and Oral Health: an Ecological Study

Over the past 20 years a substantial decrease in the prevalence of chronic oral diseases (COD) has been observed. However, COD is polarized, occurring mostly among children in the lower social strata. Objective: To investigate the oral health status in 7-8 year-old schoolchildren in two different regions in Quebec, and determine whether it is associated with school socioeconomic indicators. Methods: An ecological study using a sample of 72 schools from two regions in the province of Québec: Montréal and Lanaudière. Data from two sources were linked using school identifiers: (i) School socioeconomic indices were obtained from publicly accessible databases from the Ministry of Education (indices of low-income cut-off (LICO) and socioeconomic environment (IMSE)); (ii) Oral health indicators from the Quebec Schoolchildren Oral Health Survey 1998-99 were aggregated at the school level. These included dental caries experience in permanent dentition (proportion of caries-free, mean DMF-S score, mean decayed surfaces) and proportion of children reporting oral pain. Descriptive statistics were carried out, and Spearman correlation coefficients were used to estimate the association between school socioeconomic indices and oral health indicators. Results: The schools in both regions presented similar levels of COD and oral pain, except for mean decayed surfaces which was lower in the Montréal region. There was no association between the low-income index (LICO) and oral health indicators. Conversely, unfavorable socioeconomic environment (IMSE) was strongly correlated with mean decayed surfaces in Montréal (r Spearman=0.34, p=0.04) and Lanaudière (r Spearman=0.41, p=0.02). In addition, unfavorable socioeconomic environment (IMSE) was also correlated, inversely with the proportion of caries-free (r Spearman=-0.26, p=0.10), and positively with oral pain (r Spearman=0.28, p=0.08) in Montréal. Conclusions: These preliminary results suggest differences on the associations between different indices used to measure school socioeconomic environment and oral health indicators. This research is supported by a scholarship from the Armand-Frappier Foundation.