Geo-mapping of caries risk in children and adolescents - a novel approach for allocation of preventive care

Ulf Strömberg, Kerstin Magnusson, Anders Holmén, Svante Twetman, Ulf Strömberg, Kerstin Magnusson, Anders Holmén, Svante Twetman

Abstract

Background: Dental caries in children is unevenly distributed within populations with a higher burden in low socio-economy groups. Thus, tools are needed to allocate resources and establish evidence-based programs that meet the needs of those at risk. The aim of the study was to apply a novel concept for presenting epidemiological data based on caries risk in the region of Halland in southwest Sweden, using geo-maps.

Methods: The study population consisted of 46,536 individuals between 3-19 years of age (75% of the eligible population) from whom caries data were reported in 2010. Reported dmfs/DMFS>0 for an individual was considered as the primary caries outcome. Each study individual was geo-coded with respect to his/her residence parish. A parish-specific relative risk (RR) was calculated as the observed-to-expected ratio, where the expected number of individuals with dmfs/DMFS>0 was obtained from the age- and sex-specific caries (dmfs/DMFS>0) rates for the total study population. Smoothed caries risk geo-maps, along with corresponding statistical certainty geo-maps, were produced by using the free software Rapid Inquiry Facility and the ESRI® ArcGIS system.

Results: The geo-maps of preschool children (3-6 years), schoolchildren (7-11 years) and adolescents (12-19 years) displayed obvious geographical variations in caries risk, albeit most marked among the preschoolers. Among the preschool children the smoothed relative risk (SmRR) varied from 0.33 to 2.37 in different parishes. With increasing age, the contrasts seemed to diminish although the gross geographical risk pattern persisted also among the adolescents (SmRR range 0.75-1.20).

Conclusion: Geo-maps based on caries risk may provide a novel option to allocate resources and tailor supportive and preventive measures within regions with sections of the population with relatively high caries rates.

Figures

Figure 1
Figure 1
Distribution of participants. Geo-map of the Halland region (southwest Sweden) showing the number of study person between 3-19 years of age in each of the 66 residential parishes. The thicker borderlines delimit the six municipalities of Halland. The coverage (i.e., proportion of the eligible population) varied between 61-89% in the different parishes, except in one parish (red background) where the coverage was only 12%.
Figure 2
Figure 2
Geo-map of caries risk in preschool children. Caries risk geo-map of the Halland region (southwest Sweden) displaying, for each of the 66 residential parishes, the smoothed relative risk (SmRR, range between 0.33-2.37) of caries (dmfs/DMFS >0) among preschoolers (3-6 years). The thicker borderlines delimit the six municipalities of Halland. The corresponding statistical certainty geo-map is also shown [red color, Pr(RR>1|data) > 0.95, i.e. a parish with data yielding strong statistical evidence of an elevated caries risk; green color, Pr(RR<1|data) > 0.95, i.e. a parish with data yielding strong statistical evidence of a low caries risk; and yellow color, the 90% credibility interval covers RR = 1, i.e. a parish with data yielding weaker statistical evidence for a high or low relative risk].
Figure 3
Figure 3
Geo-map of caries risk in schoolchildren. Caries risk geo-map of the Halland region (southwest Sweden) displaying, for each of the 66 residential parishes, the smoothed relative risk (SmRR, range between 0.36-1.47) of caries (dmfs/DMFS >0) among schoolchildren (7-11 years). The thicker borderlines delimit the six municipalities of Halland. The corresponding statistical certainty geo-map is also shown [red color, Pr(RR>1|data) > 0.95, i.e. a parish with data yielding strong statistical evidence of an elevated caries risk; green color, Pr(RR<1|data) > 0.95, i.e. a parish with data yielding strong statistical evidence of a low caries risk; and yellow color, the 90% credibility interval covers RR = 1, i.e. a parish with data yielding weaker statistical evidence for a high or low relative risk].
Figure 4
Figure 4
Geo-map of caries risk in adolescents. Caries risk geo-map of the Halland region (southwest Sweden) displaying, for each of the 66 residential parishes, the smoothed relative risk (SmRR, range between 0.75-1.20) of caries (dmfs/DMFS >0) among adolescents (12-19 years). The thicker borderlines delimit the six municipalities of Halland. The corresponding statistical certainty geo-map is also shown [red color, Pr(RR>1|data) > 0.95, i.e. a parish with data yielding strong statistical evidence of an elevated caries risk; green color, Pr(RR<1|data) > 0.95, i.e. a parish with data yielding strong statistical evidence of a low caries risk; and yellow color, the 90% credibility interval covers RR = 1, i.e. a parish with data yielding weaker statistical evidence for a high or low relative risk].

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