title: Community risk indicators for dental caries in school children: an ecologic study.
abstract: A statewide survey of NC schoolchildren found wide variation in dental caries prevalence among sampled classrooms. This study examined factors associated with this variation using classrooms as a surrogate for the larger community, in order to identify community risk indicators (CRI). In all, 172 classrooms (3400 students) in Grades K-6 were available for analysis. Initially, 56 sociodemographic, environmental, health system, and clinical factors were evaluated for their association with caries prevalence (K-3: average dfs + DMFS; 4-6: average DMFS) using univariate and bivariate analyses. Of these, 21 factors met our criteria for evaluation using WLS multivariate regression. For Grades K-3 (n = 108), population density, parental education, and coastal residence were negatively associated with caries scores, while age, and medical and dental, Medicaid expenditures were positive. For Grades 4--6 (n = 64), age and fs:dfs ratio were positively associated with caries scores while population density, population:dentist ratio, and years of natural fluoride exposure were negative. CRIs for both models, when compared to individual models, explained a substantial portion of the variation in caries prevalence, 31% for Grades K-3 and 51% for Grades 4-6. Results suggest that a risk assessment model based on community rather than individual variables is feasible and further refinement may reveal factors useful in identifying high risk communities.
authors.affiliation: Directorate of Health Care Studies and Clinical Investigation, AMEDD Center & School, Ft. Sam Houston, Texas 78234-6060, USA.
authors.forename: R D
authors.initials: RD
authors.lastname: Amstutz
authors.forename: R G
authors.initials: RG
authors.lastname: Rozier
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D002648:Child; D002675:Child, Preschool; D004245:DMF Index; D003710:Demography; D003731:Dental Caries / Q000453:epidemiology*; D003752:Dental Health Services / Q000600:supply & distribution; D004463:Ecology; D015981:Epidemiologic Factors; D004812:Epidemiologic Methods; D005260:Female; D005457:Fluoridation; D005459:Fluorides / Q000627:therapeutic use; D006297:Health Services Accessibility; D006801:Humans; D016014:Linear Models; D008297:Male; D015233:Models, Statistical; D015999:Multivariate Analysis; D009657:North Carolina / Q000453:epidemiology; D016017:Odds Ratio; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D012959:Socioeconomic Factors
chemical_list: D005459:Fluorides