We found significant differences in children’s dental health by race/ethnicity. Compared to whites, Hispanic children had the poorest dental health and lowest preventive dental care use, followed by African-American children. More importantly, we were able to explain most of these disparities especially for preventive dental care use, with lower household socioeconomic status, mainly lower maternal education and higher household poverty level, among Hispanic and African-American children, generally being the single most important factor for explaining these disparities. Other relevant factors for explaining disparities in dental health include maternal health, age and marital status, although the effects of these variables are less consistent compared to socioeconomic status.
To our knowledge, this is the first study to formally decompose and quantify the extent to which several conceptually relevant social, economic, demographic and neighborhood characteristics explain racial/ethnic gaps in children’s dental health and preventive care use, especially with a nationally representative sample. The study findings are important as they reveal that most of these disparities are socioeconomically driven. They also suggest that reducing racial/ethnic gaps in child dental health requires broad and comprehensive population-based interventions beginning with improving household socioeconomic status, which may be the most effective pathway to reduce these disparities, and also enhancing neighborhood quality. Our results are consistent with previous studies highlighting the importance of socioeconomic factors such as income and education for racial/ethnic disparities in dental health 5, 11, 23, 24
. The important role of socioeconomic status, mainly household poverty level and maternal education, is strongly supported theoretically which reinforces the validity of the results. Enabling characteristics such as income can substantially enhance access to preventive dental care both through increasing the ability to pay for dental care and to have better insurance, which is also relevant for explaining racial/ethnic disparities on its own. In addition, socioeconomic status and maternal education can strongly influence maternal/household knowledge and enforcement of optimal dental hygiene practices and dietary patterns. Higher unemployment, which explained part of the gap in fair/poor dental health rating between African-American and White children, may affect dental health beyond its effects on income and insurance, such as by affecting maternal psychosocial status and information gathering ability.
Demographics, maternal health, neighborhood characteristics, and geographic location also contribute on their own to racial/ethnic disparities in children’s dental health. This highlights the complexity of the pathways leading to disparities and the importance of recognizing these when considering policies and interventions to reduce health disparities. Of particular importance are the effects of maternal health, marital status and age, which vary by the outcome. Maternal health and marital status are relevant for explaining disparities in dental health, while maternal age is relevant for explaining disparities in preventive dental visits. These effects are consistent for both African-American and Hispanic children. A positive association between maternal age and child’s dental health through knowledge about child health and parenting skills that are relevant to dental health is supported in previous studies 25
The observed effect of state of residence in explaining part of the disparity in preventive dental visits between Hispanic and white children may reflect differences between states in policies and the distribution of dental care providers and their participation in public insurance programs (Medicaid and CHIP). Further, reduced neighborhood safety and social capital, which are the most relevant neighborhood characteristics for the observed disparities, may affect dental health through restricting visits to dental providers or reducing the availability of nearby dental providers who are more likely to locate in safer neighborhoods. Previous research supports the role of neighborhood characteristics in health and health behaviors, in part through sharing relevant information for health 26
. In addition, previous studies have found an association of neighborhood characteristics with dental health through neighborhood socioeconomic conditions, social capital, and availability of and access to, healthy foods 27–31
Understanding racial/ethnic disparities in child dental health is highly relevant since poor dental health affects children’s physical and social functions and lifetime outcomes related to general health, human capital, and socioeconomic status. Dental health problems during childhood have been found to affect behavioral and cognitive functioning and to have potential long term effects on language, nutrition, systemic health, and quality of life 4, 32–35
. The study highlights important pathways leading to racial/ethnic disparities and is informative for public health and population-wide interventions to improve child dental health and reduce disparities. Furthermore, the study provides a framework for future studies to further characterize such disparities, as further work is needed to fully characterize the underlying pathways and develop specific interventions. For example, the study had no information about household dental health-related behaviors, which may in part explain the observed effects of household socioeconomic status, or the unexplained gaps. Similarly, we had no data on maternal attitudes/behaviors that may explain the observed effects of maternal age and marital status. Future studies incorporating household dental health behaviors and knowledge are needed to explain the role of these factors for dental health disparities. Finally, we had no direct measures of preferences for dental health and prevention practices that may be related to cultural factors. While we were able to explain most of the disparities, cultural factors may still be relevant for the unexplained gaps and deserve further research.
In conclusion, the study finds that racial/ethnic disparities in child dental health and preventive care are largely explained by economic and social factors, but that they are complex by involving household and neighborhood contributors. Therefore, there is no single intervention or policy that can substantially reduce these disparities on its own. However, most of the pathways underlying these disparities are amenable to policy interventions. Policies aimed at reducing racial/ethnic disparities in child dental health should recognize the need for household- and neighborhood- level interventions.