Socioeconomic Status, Food Security, and Dental Caries in US Children: Mediation Analyses of Data From the National Health and Nutrition Examination Survey, 2007–2008

摘要

Objectives. We examined associations of household socioeconomic status (SES) and food security with children’s oral health outcomes. Methods. We analyzed 2007 and 2008 US National Health and Nutrition Examination Survey data for children aged 5 to 17 years (n?=?2206) to examine the relationship between food security and untreated dental caries and to assess whether food security mediates the SES–caries relationship. Results. About 20.1% of children had untreated caries. Most households had full food security (62%); 13% had marginal, 17% had low, and 8% had very low food security. Higher SES was associated with significantly lower caries prevalence (prevalence ratio [PR]?=?0.77; 95% confidence interval?=?0.63, 0.94; P =?.01). Children from households with low or very low food security had significantly higher caries prevalence (PR?=?2.00 and PR?=?1.70, respectively) than did children living in fully food-secure households. Caries prevalence did not differ among children from fully and marginally food-secure households ( P =?.17). Food insecurity did not appear to mediate the SES–caries relationship. Conclusions. Interventions and policies to ensure food security may help address the US pediatric caries epidemic. Tooth decay (dental caries) is the most prevalent disease worldwide and the most common pediatric disease in the United States. 1,2 From 1999 to 2004, the prevalence of untreated tooth decay was 24.5% for children aged 6 to 11 years and 19.6% for adolescents aged 12 to 19 years. 3 Untreated tooth decay can lead to difficulties eating and sleeping, pain, the need for invasive restorative treatment, emergency department visits and inpatient hospitalizations, poor quality of life, systemic health problems, and, in rare cases, death. 4–7 To date, most public health efforts aimed at addressing the pediatric caries epidemic have focused on tooth-level interventions (e.g., topical fluorides, dental sealants). Although disparities in oral health are considered a measure of social injustice, 8 comparatively less research has been conducted on the social determinants of pediatric oral health. 9 Low socioeconomic status (SES), one of the strongest determinants of caries in children, 10–12 is associated with food insecurity, 10–17 defined as inadequate access to food resulting in food shortages, disrupted eating patterns, and hunger. 18 Food insecurity, in turn, is associated with oral health–related behaviors, including increased fermentable carbohydrate intake, 19,20 a risk factor for dental caries. 21,22 The American Dietetic Association recognizes the link between nutrition and oral health, 23 and numerous studies have drawn associations between dietary factors and disparities in dental caries. 24 Collectively, these studies suggest that food insecurity is related to caries and is a potential mechanism linking SES and caries, but these relationships have not yet been evaluated empirically. We used nationally representative data from the United States to test 3 hypotheses: (1) food insecurity is positively associated with untreated dental caries, (2) food insecurity mediates the SES–caries relationship, and (3) food insecurity mediates the SES–caries relationship differentially for children from higher- versus lower-SES households.