Income inequality and early childhood caries in Colombia: a multilevel analysis

Rodríguez-Godoy, Mauricio; Navarro-Saiz, Laura Marcela; Alzate, Juan Pablo; Guarnizo-Herreño, Carol Cristina

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TEMAS LIVRES • Ciênc. saúde coletiva 27 (06) • June 2022 • https://doi.org/10.1590/1413-81232022276.18452021 copy

Income inequality and early childhood caries in Colombia: a multilevel analysis

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The association between income inequality and dental caries on early childhood in Colombia was evaluated using a multi-level analysis. We analyzed data from the latest national oral survey (2014) and information about income in absolute and relative terms on a state-level. The outcomes were caries experience, and untreated caries. A multilevel logistic regression model was used (2 levels) with children/households nested within states. Age, gender, area-level socioeconomic position (SEP), household income and health insurance regime were the level 1 explanatory variables. For level 2, variables were the Gini coefficient, Unsatisfied Basic Needs (UBN) and Gross Domestic Product (GDP). Data from 5.250 children, aged 1, 3 and 5 years were evaluated. Prevalence of caries experience and untreated caries was 36.9% and 33.0% respectively. Both outcomes showed significant associations with age, low SEP and belonging to the subsidized health insurance regime: untreated dental caries was associated with living in low and very low SEP (OR: 1.72; 95%CI 1.42, 2.07 and OR: 1.69; 95%CI 1.36, 2.09 respectively), and subsidized health insurance scheme (OR: 1.58; 95%CI 1.11, 2.24). When the Gini, GDP and UBN indicators were included in the models, no significant associations were found.

Key words:
Inequality; Dental caries; Child; Multilevel analysis; Colombia

Variables de nivel niño/hogar		n	%^a
Edad (años)
	1	1,698	32.37
	3	1,694	32.45
	5	1,858	35.18
Sexo
	Femenino	2,546	47.78
	Masculino	2,704	52.22
Posición socioeconómica de la vivienda
	Media/Alta	1,059	18.81
	Baja	2,294	42.47
	Muy baja	1,897	38.72
Ingreso del Hogar
	Más de 3 SMLV ($1.768.501+)	424	7.48
	Más de 2 a 3 SMLV ($1.179.001 - $1.768.500)	684	12.71
	Más de 1 a 2 SMLV ($589.501 - $1,179.000)	2,056	38.90
	Menos de medio a 1 SMLV (<$294.750 - $589.500)	2,086	40.90
Régimen de aseguramiento en salud
	Excepcional/especial	211	4.50
	Contributivo	1,995	36.76
	Subsidiado	2,663	51.48
	No asegurado	381	7.26
Variables de nivel departamental		Media	DE
Coeficiente Gini		50.58	2.85
Índice de NBI		26.73	16.45
PIB		63.91	58.96
Prevalencia de los desenlaces de caries		%^a	IC95%
Experiencia de caries (coe-d>0)		36.90	35.30, 38.53
Presencia de caries no tratada (c>0)		33.03	31.48, 34.62

		Modelo 1	Modelo 2	Modelo 3
		OR (IC95%)	OR (IC95%)	OR (IC95%)
Variables de nivel niño/hogar
Edad (años)
	1	Ref.	Ref.	Ref.
	3	16.58 (13.06, 21.06)**	16.59 (13.06, 21.06)**	16.57 (13.04, 21.04)**
	5	30.21 (23.78, 38.37)**	30.20 (23.78, 38.36)**	30.18 (23.76, 38.34)**
Sexo
	Masculino	Ref.	Ref.	Ref.
	Femenino	0.91 (0.79, 1.03)	0.90 (0.79, 1.03)	0.90 (0.79, 1.03)
PSE de la vivienda
	Media/Alta	Ref.	Ref.	Ref.
	Baja	1.56 (1.30, 1.88)**	1.56 (1.30, 1.88)**	1.57 (1.31, 1.88)**
	Muy baja	1.54 (1.25, 1.90)**	1.54 (1.25, 1.91)**	1.57 (1.27, 1.95)**
Ingreso del Hogar
	Más de 3 SMLV	Ref.	Ref.	Ref.
	Más de 2 a 3 SMLV	1.11 (0.82, 1.49)	1.11 (0.82, 1.50)	1.11 (0.82, 1.50)
	Más de 1 a 2 SMLV	1.09 (0.84, 1.42)	1.09 (0.84, 1.42)	1.09 (0.84, 1.42)
	Menos de medio a 1 SMLV	1.17 (0.89, 1.54)	1.17 (0.89, 1.54)	1.17 (0.89, 1.54)
Régimen aseguramiento en salud
	Excepcional/especial	Ref.	Ref.	Ref.
	Contributivo	0.98 (0.70, 1.38)	0.98 (0.69, 1.37)	0.97 (0.69, 1.36)
	Subsidiado	1.47 (1.04, 2.07)*	1.47 (1.04, 2.07)*	1.46 (1.03, 2.06)*
	No asegurado	1.12 (0.74, 1.70)	1.12 (0.74, 1.69)	1.11 (0.74, 1.69)
Variables de nivel departamental
Coeficiente Gini			0.96 (0.91, 1.02)	0.99 (0.93, 1.05)
Índice de NBI				0.99 (0.98, 1.00)
PIB^b				1.00 (0.99, 1.01)
Varianza (EE) nivel departamental		0.443 (0.079)	0.419 (0.077)	0.383 (0.072)
CCI (%)		5.63%	5.06%	4.27%
Deviance		5359.76	5357.81	5354.61

		Modelo 1	Modelo 2	Modelo 3
		OR (IC95%)	OR (IC95%)	OR (IC95%)
Variables de nivel niño/hogar
Edad (años)
	1	Ref.	Ref.	Ref.
	3	14.59 (11.47, 18.56)**	14.59 (11.47, 18.56)**	14.58 (11.46, 18.54)**
	5	22.27 (17.53, 28.30)**	22.27 (17.53, 28.29)**	22.26 (17.52, 28.27)**
Sexo
	Masculino	Ref.	Ref.	Ref.
	Femenino	0.92 (0.81, 1.05)	0.92 (0.81, 1.05)	0.92 (0.81, 1.05)
PSE de la vivienda
	Media/Alta	Ref.	Ref.	Ref.
	Baja	1.71 (1.42, 2.06)**	1.71 (1.42, 2.06)**	1.72 (1.42, 2.07)**
	Muy baja	1.66 (1.34, 2.05)**	1.66 (1.34, 2.06)**	1.69 (1.36, 2.09)**
Ingreso del Hogar
	Más de 3 SMLV	Ref.	Ref.	Ref.
	Más de 2 a 3 SMLV	1.20 (0.89, 1.63)	1.20 (0.89, 1.63)	1.20 (0.89, 1.63)
	Más de 1 a 2 SMLV	1.13 (0.86, 1.48)	1.13 (0.86, 1.48)	1.13 (0.86, 1.48)
	Menos de medio a 1 SMLV	1.24 (0.94, 1.64)	1.24 (0.94, 1.65)	1.24 (0.94, 1.64)
Régimen aseguramiento en salud
	Excepcional/especial	Ref.	Ref.	Ref.
	Contributivo	1.04 (0.73, 1.48)	1.04 (0.73, 1.47)	1.03 (0.73, 1.46)
	Subsidiado	1.58 (1.12, 2.25)*	1.58 (1.12, 2.25)*	1.58 (1.11, 2.24)*
	No asegurado	1.35 (0.89, 2.05)	1.34 (0.88, 2.05)	1.34 (0.88, 2.04)
Variables de nivel departamental
Coeficiente Gini			0.96 (0.91, 1.01)	0.98 (0.92, 1.04)
Índice de NBI				0.99 (0.98, 1.01)
PIB^b				1.00 (0.99, 1.01)
Varianza (EE) nivel departamental		0.451 (0.081)	0.421 (0.079)	0.397 (0.076)
CCI (%)		5.81%	5.12%	4.58%
Deviance		5364.70	5362.61	5360.46

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[1] Colaboraciones

M Rodríguez-Godoy contribuyó con la concepción, la delineación de la idea, análisis e interpretación de los datos; la redacción del artículo o la revisión crítica, y la aprobación de la versión que se somete a la publicación. LM Navarro-Saiz contribuyo con delineación de la idea, interpretación, aprobación de la versión que se somete a la publicación. JP Alzate contribuyo con análisis e interpretación de los datos; aprobación de la versión que se somete a la publicación. CC Guarnizo-Herreño contribuyó con la concepción, la delineación de la idea, análisis e interpretación de los datos; la redacción del artículo o la revisión crítica, y la aprobación de la versión que se somete a la publicación.