Multilevel model to estimate county-level untreated dental caries among US children aged 6–9 years using the National Health and Nutrition Examination Survey

• Published in: Preventive medicine Vol. 111; pp. 291 - 298
• Main Authors: Lin, Mei, Zhang, Xingyou, Holt, James B., Robison, Valerie, Li, Chien-Hsun, Griffin, Susan O.
• Format: Journal Article
• Language: English
• Published: 01.06.2018
• ISSN: 0091-7435; 1096-0260
• DOI: 10.1016/j.ypmed.2017.11.015

Because conducting population-based oral health screening is resource intensive, oral health data at small-area levels (e.g., county-level) are not commonly available. We applied the multilevel logistic regression and poststratification method to estimate county-level prevalence of untreated dental caries among children aged 6–9 years in the United States using data from the National Health and Nutrition Examination Survey (NHANES) 2005–2010 linked with various area-level data at census tract, county and state levels. We validated model-based national estimates against direct estimates from NHANES. We also compared model-based estimates with direct estimates from select State Oral Health Surveys (SOHS) at state and county levels. The model with individual-level covariates only and the model with individual-, census tract- and county-level covariates explained 7.2% and 96.3% respectively of overall county-level variation in untreated caries. Model-based county-level prevalence estimates ranged from 4.9% to 65.2% with median of 22.1%. The model-based national estimate (19.9%) matched the NHANES direct estimate (19.8%). We found significantly positive correlations between model-based estimates for 8-year-olds and direct estimates from the third-grade State Oral Health Surveys (SOHS) at state level for 34 states (Pearson coefficient: 0.54, P = 0.001) and SOHS estimates at county level for 53 New York counties (Pearson coefficient: 0.38, P = 0.006). This methodology could be a useful tool to characterize county-level disparities in untreated dental caries among children aged 6–9 years and complement oral health surveillance to inform public health programs especially when local-level data are not available although the lack of external validation due to data unavailability should be acknowledged.