Race/ethnicity and untreated dental caries: the impact of material and behavioral factors.
OBJECTIVE
To use nationally representative data, group variables into categories of material and behavioral factors, and assess their relative contribution to racial/ethnic variation in untreated caries.


METHODS
Participants were from the Third National Health and Nutrition Examination Survey (NHANES III), aged 20-50 years. Material factors were income, education, employment status, dental insurance status, and urban residence. Behavioral factors were marital status, tobacco use, alcohol use, obesity, and social support. All models were additionally adjusted for age, gender, and quartile of missing teeth. The outcome was three or more carious teeth.


RESULTS
Non-Hispanic blacks and Mexican-Americans displayed excess risk of untreated caries compared with non-Hispanic whites when adjusted for age, sex, and missing teeth (adjusted odds ratios 1.73 and 1.69, respectively). The addition of behavioral factors to this model resulted in virtually no changes in the adjusted odds ratios for race/ethnicity and untreated caries. When material factors were added to the basic model the excess risk for untreated caries among non-Hispanic blacks was reduced by approximately 21% and that of Mexican-Americans was no longer statistically significant compared with non-Hispanic whites (adjusted odds ratios 1.36 and 0.83, respectively).


CONCLUSIONS
Much of the excess risk for untreated dental caries among non-Hispanic blacks and Mexican-Americans compared with non-Hispanic whites was eliminated when material factors were controlled, while no risk reductions were observed when behavioral factors were controlled. Addressing material factors may provide greater reductions in untreated caries disparities than behavioral interventions, and these risk reductions may vary with racial/ethnic group.
Reid
Britt C
BC
Department of Health Promotion and Policy, School of Dentistry, University of Maryland, Baltimore 21201, USA. BCR001@dental.umaryland.edu
Hyman
Jeffrey J
JJ
Macek
Mark D
MD
D000328:Adult; D044383:Black People / Q000706:statistics & numerical data; D003731:Dental Caries / Q000453:epidemiology / Q000208:ethnology*; D004812:Epidemiologic Methods; D005260:Female; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D017058:Mexican Americans / Q000706:statistics & numerical data; D008875:Middle Aged; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data; D001741:Black or African American