Inequalities by sex on remaining teeth in adults: A decomposition analysis.

OBJECTIVE: To identify which social determinants of health explain the gap in the remaining teeth between men and women. METHODS: A secondary analysis of data from the Chilean National Health Survey (CNHS) 2016-2017 was performed on the number of remaining teeth in adults. The explanatory variables were organized into structural and intermediate social determinants of health according to the WHO framework. The contribution of both groups and the contribution of each individual explanatory variable to the remaining teeth gap was estimated using the Blinder-Oaxaca decomposition analysis. RESULTS: The predicted average number of remaining teeth for men was 23.4 and 21.0 for women, thus a mean difference of 2.4 teeth. 49.8% of the inequality between men and women was due to the different distribution (endowments) of the predictors in the model. Among them, structural determinants of health, namely education level (15.8%) and employment status (17.8%), contributed the most. Intermediate determinants had no relevant contribution to explain the gap. CONCLUSIONS: Results revealed that the difference in the mean number of remaining teeth between men and women was mainly explained by two structural determinants: education level and employment status. The lack of explanatory power of intermediate determinants and the large explanatory power of structural determinants means that tackling oral health inequity in Chile requires strong political commitment. The role of intersectoral and intersectional public policies to address gender inequalities in oral health in Chile is discussed.

Tendencia de niños y niñas de 6 años libres de caries en Chile entrelos años 2012 y 2019 / Trend of 6-year-old children without caries experience in Chile between 2012 and 2019

RESUMEN: Objetivo: La caries dental es la patología más prevalente en niños*. En Chile se desconoce si el estado de salud bucal ha mejorado al implementar estrategias y programas preventivos dirigidos a la población infantil en la última década. El objetivo fue determinar la prevalencia de niños de 6 años sin experiencia de caries (ceod=0) del país, su distribución territorial y tendencia en el período 2012 a 2019. Materiales y método: Se realizó un estudio ecológico utilizando los registros de atención odontológica de 1.020.920 niños de 6 años en los Servicios de Salud (SS) de Chile. Se analizó la tendencia en el tiempo utilizando un test de tendencia lineal para proporciones. Resultados: La prevalencia de niños de 6 años sin experiencia de caries aumentó 1,2 puntos por año entre 2012 y 2019. La prevalencia en los SS Arica e Iquique y los tres de la Región de Valparaíso supera el 40% y en los cuatro SS de la Región del Biobío y el SS Chiloé es menor al 25%. Conclusiones: La prevalencia de niños de 6 años sin experiencia de caries ha mejorado en la última década y su distribución territorial presenta gran variabilidad, sin embargo, aún sigue siendo baja. *Se usará la palabra "niño" para referirse a "niños y niñas".

ABSTRACT: Objective: Dental caries is the most prevalent disease in children. In Chile, it is unknown whether the oral health status in children population has improved after the implementation of preventive strategies and programs in the last decade. The objective was to determine the prevalence of 6-year-old children with no caries experience (ceod=0) in the country, its territorial distribution and trend in the period 2012 to 2019. Methodology: An ecological study was carried out using the dental care records of 1,020,920 6-year-old children in the Chilean Health Services. The trend over time was analyzed using a linear trend test for proportions. Results: The prevalence of 6-year-old children without caries experience increased 1.2 points per year between 2012 and 2019. The prevalence in the Arica and Iquique Health Services and in the three Health Services in the Valparaíso Region exceeds 40%. In the four Health Services in the Biobío Region and in the Chiloé Health Service it is less than 25%. Conclusions: The prevalence of 6-year-old children without caries experience has improved in the last decade and its territorial distribution presents great variability; however, it still remains low.