Oral Health Data Analysis in National Child Cohort Surveys

Abstract

Objectives: The objectives of this research were to: (1) summarise dental caries trends and evaluate effectiveness of community water fluoridation at National, Regional, and County- levels in the Republic of Ireland from 1950 to 2021, (2) evaluate quality and comparability of oral health-related questionnaire data from nationally representative birth and child cohort surveys, (3) develop an analytical interactive dashboard and (4) investigate oral health inequalities in Irish adolescents and the potential role of behavioural, material and psychosocial factors in explaining these disparities. Methods: For each objective: (1) Seven databases were systematically searched followed by lateral searches from reference lists and the quality of included studies was evaluated using the Joanna Briggs Institute Critical Appraisal Checklist, (2) The Maelstrom Research Guidelines were followed for harmonisation potential evaluation, (3) The flexdashboard package was used within the R Studio framework to create the structure-elements of the dashboard and interactivity was added with the Shiny package and (4) Data from the first three waves of the Growing Up in Ireland child cohort survey was used. Logistic regression models were developed to study the hypothesis of mediation. Results: (1) Systematic review: Over the last seventy years, at National, Regional and County levels, mean dm]/DMFT (decayed, missing, and filled teeth) scores decreased and the percentage of caries free children increased in 5, 8, 12, and 15-year-olds. The decline in dental caries indices observed throughout the country was greater in children living in areas with CWF than those without CWF. (2) Data harmonisation: A DataSchema (a list of core variables representing the suitable version of oral health outcomes and risk factors) was compiled comprising 42 variables. For each study wave, the potential (or not) to generate each DataSchema variable was evaluated. Of the 2100 harmonisation status assessments, approximately 26% were complete. Approximately 50% of the DataSchema variables can be generated across at least 4 cohort surveys while only 10% variables can be generated across all surveys. For each survey, the DataSchema variables that can be generated ranged between 26% and 76%. Data harmonisation can improve the comparability of variables both within and across surveys, (3) Dashboard development: Examples of how to interact with the dashboard for selected oral health variables are illustrated. The deployed dashboard is openly accessible at heps://dduh.shinyapps.io/dduh/. (4) There were socioeconomic disparities in Irish adolescents' self-rated oral health (SROH) and parent-reported oral health (number of teeth with dental fillings). Young persons with a lower socioeconomic background at 13 years of age had poorer self and parent-reported oral health at 17 years of age than their peers with a higher socioeconomic background. There were gender based differences, females reported better SROH and positive oral health behaviours. Behaviour, material and psychosocial factors were important factors contributing to socioeconomic disparities in young males' SROH. Material factors contributed most to the explanation of parental education and family income-related SROH inequalities.