Effect of socio-demographic status on dental caries in pupils by using a multilevel hurdle model

Abstract

Introduction: Dental caries is the most prevalent chronic disease among schoolchildren. We aimed to investigate the association between dental caries index and socio-demographic status in schoolchildren by using a multilevel hurdle model. Materials and Methods: A cross-sectional epidemiological study was carried out on 906 primary school pupils in Kerman, Iran in 2012. The subjects were selected through a stratified cluster random sampling. At first, the whole target area was stratified according to two geographic areas, the north and south area. Then each area was stratified according to gender. In the next step, several schools were considered as clusters, which were selected randomly in each geographic area and gender strata. All the schoolchildren in these schools were included in this study as samples. Twelve-year-old pupils were examined for dental caries. The dependent variable in this study was the dmft/DMFT index. Eight variables, including socio-demographic information, were collected. Multilevel negative binomial hurdle model was employed for data analysis. Results: The prevalence of caries-free pupils was 30.1% and the mean dmft/DMFT was 3.6 ± 2.2. Negative binomial part of the adjusted model showed that the dmft/DMFT adjusted rate for females was 1.36 (95% CI: 1.10-1.79) times higher than males. Also, the dmft/DMFT adjusted rate for overweight pupils was 0.86 (95% CI: 0.74-0.98) times lower than those with normal weight. Logistic part of the adjusted model showed that the posibility of caries-free state in overweight pupils was 1.95 (95% CI: 1.22-3.11) times higher than those with normal weight. In addition, pupils whose fathers and mothers were workers and housewives, respectively, and those with a high maternal age were at a greater risk for caries experience than others (p