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Community Dent Oral Epidemiol. 2017 Jun;45(3):233-241. doi: 10.1111/cdoe.12281. Epub 2017 Jan 30.

The influence of social deprivation on dental caries in Swedish children and adolescents, as measured by an index for primary health care: The Care Need Index.

Author information

Public Dental Service, Region Västra Götaland, Göteborg, Sweden.
Department of Behavioral and Community Dentistry, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
Department for Data Analysis, Region Västra Götaland, Göteborg, Sweden.
Health Metrics Unit, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.



The objective was to examine associations between a primary Care Need Index (CNI) and dental caries experience.


Dental journal records for 300 988 individuals in western Sweden, aged 3-19 years in 2007-09, were completed with official socioeconomic information. The CNI (independent variable), originally developed for assessing primary care need, was calculated for residential areas (small areas, parishes, dental clinics) based on markers of material deprivation, sociodemographic characteristics, social instability and cultural needs. Dental caries (dependent variable) was registered using the decayed, missing, filled teeth (DMFT) system. Multilevel Poisson regression and logistic regression models were used. All analyses were adjusted for age and gender.


In the most deprived areas, the incidence rate ratio (IRR) for dental caries was up to five times higher than in the most affluent areas (reference); in small areas, the IRR for decayed teeth (DT) was 3.74 (95% CI: 3.39-4.12) and 5.11 (CI: 4.45-5.87) for decayed surfaces approximally (DSa). Caries indices including fillings (decayed filled teeth [DFT], decayed filled surfaces approximally [DFSa]) produced lower IRRs, with similar pictures at the parish and dental clinic level. The intracluster correlation was low overall, but stronger at lower geographical levels. The odds ratios for ≥3 caries lesions in the two most deprived areas of the CNI deciles were high, with a DT OR of 3.55 in small areas (95% CI: 3.39-3.73), compared with the eight more affluent deciles.


There were strong associations between an index for assessing need in primary care, the CNI and dental caries in Swedish children and adolescents.


area analysis; dental caries; multilevel analysis; social deprivation

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