title: Social Context and Dental Pain in Adults of Colombian Ethnic Minority Groups: A Multilevel Cross-Sectional Study.
abstract: OBJECTIVE
  To estimate the effect of social context on dental pain in adults of Colombian ethnic minority groups (CEGs).
  
  
  METHODS
  Information from 34,843 participants was used. A multilevel model was constructed that had ethnic groups (ie, CEGs and non-CEGs) at level 1 and Colombian states at level 2. Contextual variables included gross domestic product (GDP), Human Development Index (HDI), and Unmet Basic Needs Index (UBNI).
  
  
  RESULTS
  Dental pain was observed in 12.3% of 6,440 CEGs. In an unadjusted logistic regression model, dental pain was associated with being a CEG (odds ratio [95% confidence interval], 1.34 [1.22-1.46]; P = .0001). This association remained significant after adjusting for possible confounding variables. An unconditional multilevel analysis showed that the variance in dental pain was statistically significant at the ethnic group level (β = 0.047 ± 0.015; P = .0009) and at the state level (β = 0.038 ± 0.019; P = .02) and that the variation between ethnic groups was higher than the variation between states (55% vs 45%, respectively). In a multivariate model, the variance in dental pain was also statistically significant at the ethnic group level (β = 0.029 ± 0.012; P = .007) and the state level (β = 0.042 ± .019; P = .01), but the variation between states was higher (40% vs 60%). The results of multilevel multivariate analyses showed that dental pain was associated with increasing age (β = 0.009 ± 0.001; P = .0001), lower education level (β = 0.302 ± 0.103; P = .0001), female sex (β = 0.031 ± 0.069; P = .003), GDP (β = 5.136 ± 2.009; P = .002) and HDI (β = 6.862 ± 5.550; P = .004); however, UBNI was not associated with dental pain.
  
  
  CONCLUSIONS
  The variance in dental pain was higher between states than between ethnic groups in the multivariate multilevel model. Dental pain in CEGs was associated with contextual and individual factors. Considering contextual factors, GDP and HDI may play a major role in dental pain prevalence.
authors.forename: Carlos M
authors.initials: CM
authors.lastname: Ardila
authors.forename: Andrés A
authors.initials: AA
authors.lastname: Agudelo-Suárez
mesh_terms: D000328:Adult; D000367:Age Factors; D003105:Colombia / Q000453:epidemiology / Q000208:ethnology; D003430:Cross-Sectional Studies; D004522:Educational Status; D005006:Ethnicity / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D059066:Gross Domestic Product; D006798:Housing; D006801:Humans; D007182:Income; D008136:Longevity; D008297:Male; D008913:Minority Groups / Q000523:psychology* / Q000706:statistics & numerical data; D020380:Needs Assessment; D012499:Sanitation; D012737:Sex Factors; D012923:Social Class; D064890:Social Determinants of Health / Q000208:ethnology* / Q000706:statistics & numerical data; D012931:Social Environment; D014098:Toothache / Q000453:epidemiology / Q000208:ethnology*