Social inequalities in overweight and obesity, and dental caries among adolescents in Northern Norway: a cross-sectional study from the Tromsø Study Fit Futures cohort [post]

2020 unpublished
Background. Non-communicable general and oral health conditions share common social determinants. We aimed to investigate how social inequalities (based on study program, parent's education and employment status) manifest in general health (BMI or waist circumference) and oral health (untreated caries) in a sample of adolescents from Northern Norway. Methods. Data from 464 girls and 494 boys from the population-based Tromsø study Fit Futures, which included first-year students attending upper
more » ... s attending upper secondary school in 2010-2011 from two municipalities in Northern Norway (1038 participants in total, 93% participation rate) was analyzed. Multivariable binary logistic regression analyses stratified by sex was used to investigate the association between socioeconomic position indicators and body weight, waist circumference, and untreated dental caries. Comparative models were adjusted for age, birth country, household composition, and health/health behavior variables. Results. Boys enrolled in the general studies and sports programs (versus vocational) had lower odds of being overweight/obese (OR 0.39, 95% CI 0.19-0.79 and OR 0.21, 95% CI 0.07-0.62, respectively), of having high waist circumference (OR 0.47, 95% CI 0.24-0.91 and OR 0.30, 95% CI 0.11-0.77, respectively), and more untreated caries (OR 0.54, 95% CI 0.31-0.96 and OR 0.46, 95% CI 0.22-0.97, respectively). Lower mother's education was positively associated with overweight/obesity (OR 3.68, 95% CI 1.38-9.79) and lower father's education was negatively associated with untreated caries (OR 0.42, 95% CI 0.18-0.98) among boys. Girls enrolled in the general studies program (versus vocational) had lower odds of having more untreated caries (OR 0.48, 95% CI 0.28-0.85). Conclusions. Social inequalities in general health and oral health were based on different social determinants for girls and boys. Based on study program social inequalities in general health were similar to social inequalities in oral health among boys. This suggests that the relationship between overweight and obesity, and dental caries maybe be explained by common social risk factors. Our findings support the broader concept of social context as a common risk factor for general and oral health. The common risk/health factor approach (CRHFA) suggests that non-communicable general and oral health conditions share common risk factors, such as behavioral variables (e.g., diet, hygiene, physical activity, tobacco use, and alcohol use) and psychosocial factors (e.g., stress and perceived control) [1] . The CRHFA aims to reduce "risk factors" and promote "health factors" common to noncommunicable general and oral health conditions. In this way, the CRHFA strives to simultaneously improve the general and oral health of the whole population and that of high-risk groups, thereby reducing social inequities [1]. The CRHFA was integrated into the conceptual model of social determinants of health. This framework, presented by the World Health Organization (WHO), shows that behavioral and psychosocial factors are only intermediate determinants of health, as these factors are shaped by one's social environment and are correlated with socioeconomic position (SEP), which itself is influenced by the socioeconomic and political context in which one lives, including governance, macroeconomics, social and public policies, culture, and societal values [2-4]. The general health conditions overweight and obesity are considered global epidemics [5] , and their prevalence among children and adolescents is increasing substantially [6] . In addition to amplifying multiple risk factors (e.g., metabolic syndrome, high blood pressure, deteriorated glucose tolerance) in childhood and adolescence, overweight and obesity are risk factors for cardiovascular diseases in adulthood, which are the leading annual cause of death worldwide, according to data from the Global Burden of Diseases Study [7] [8] [9] . Dental caries is a non-communicable oral health condition; untreated dental caries in the permanent dentition was cited as the most prevalent medical condition in the Global Burden of Diseases Study in 2015 [10] . A systematic review and meta-analysis found a significant relationship between obesity and dental caries in children from industrialized countries, but the authors concluded that future analyses should focus on common risk factors as confounders in this association [11] . Another recent systematic review and meta-analysis confirmed that, in highincome countries, overweight and obese children had more dental caries when compared to normalweight children [12] . The authors called for future studies to address confounding factors, including possible common risk factors. A study among adults in Australia found that, after adjustment for confounders, the association between overweight/obesity and dental caries experience disappeared,
doi:10.21203/rs.2.18717/v2 fatcat:f2jw5gykdna23hjxtv2tsycehu