Prevalence of Total and Untreated Dental Caries Among Youth: United States, 2015–2016

April 13, 2018

Eleanor Fleming, Ph.D., D.D.S., M.P.H., Dental Epidemiologist

Questions for Eleanor Fleming, Ph.D., D.D.S., M.P.H., Dental Epidemiologist and Lead Author of “Prevalence of Total and Untreated Dental Caries Among Youth: United States, 2015–2016

Q: What made you decide to focus on the prevalence of dental cavities in young children for this study, versus other dental conditions like gum disease or tooth grinding – or some other critical public health concerns today for America’s youth?

EF: Our intent in conducting this study was to provide up-to-date prevalence estimates for dental caries in children. We decided that our study would focus on dental caries because of the serious and negative impact untreated caries can have on children. By the way, dental “caries” is the scientific term for tooth decay or cavities. Dental caries are the most common chronic disease among youth aged 6-19 years. Untreated caries cause pain and infection. Children miss days from school and have their overall quality of life effected by untreated dental caries. This is an important public health concern for America’s youth. While dental conditions like gum disease or tooth grinding are important, the National Health and Nutrition Examination Survey (NHANES) Oral Health Component does not currently collect data on these dental conditions. The component focuses on collecting data on tooth loss, dental caries, and dental sealants.


Q: In your new report, you examine differences in the prevalence of tooth cavities by income level; what is the motivation to look at income, since many children’s dental care might be paid by either public or private health insurance?

EF: We examined family income in this study for a few reasons. One is that income is a significant social determinant of health. For our study, we decided to include family income in addition to age, race and Hispanic origin. We were curious about the differences in untreated and total caries (tooth decay) by family income level. For both total and untreated caries, prevalence decreased as family income level increased. There is also concern among the public health community that children who may have access to Medicaid dental benefits are not receiving the care that they need. The examination of income levels in our new report might offer some needed insight to this concern.

The prevalence of total dental caries decreased as family income levels increased, from 51.8% for youth from families living below the federal poverty level to 34.2% for youth from families with income levels greater than 300% of the federal poverty level.

The prevalence of untreated dental caries decreased from 18.6% for youth from families living below the federal poverty level to 7.0% for youth from families with incomes greater than 300% of the federal poverty level.


Q: Was there a result in your study that you hadn’t expected and that really surprised you?

EF: Because our motivation for this study was to provide updated national estimates on untreated and total caries (tooth decay) for 2015-2016, all of the results were very interesting in one way or another — and surprising. National estimates for age, race and Hispanic origin, and income are results that we need to understand for public health surveillance purposes. For me though, the overall estimates for youth by age were especially interesting.

While the untreated dental caries prevalence overall for youth is 13.0%, there were age differences that caught my eye. The low prevalence for 2-5 year-olds is an important and encouraging finding. While we don’t know if it is from prevention efforts, access to care, or other factors, the fact that our youngest youth have the lowest untreated and total caries prevalence shows they’re starting off their young lives with healthy teeth.

The prevalence was lowest in youth aged 2-5 years (8.8%) compared with youth aged 6-11 years (15.3%) and 12-19 years (13.4%). The prevalence of the 6-11 and 12-19 years-olds was significantly different from the prevalence of 2-5 year-olds.

The total caries experience was also lowest for youth aged 2-5 years (17.4%) compared to youth aged 6-11 years (45.2%) and 12-19 years (53.5%). As age increased, the total caries prevalence increased.


Q: What, if any, is the difference between the two terms you use in your report – primary teeth and permanent teeth?

EF: Primary teeth are baby teeth, or the first teeth that erupt, or come in, which are later shed and replaced by permanent teeth. Primary teeth erupt from around 6 months to age 2 or 3 years. The permanent teeth replace the primary teeth. These teeth start coming in around the age of 6 years and continue until the third molars, or wisdom teeth come in, somewhere between the ages of 17 to 21 years. In our analysis, we combined the two types of teeth in order to focus on dental caries (tooth decay) regardless of tooth type.


Q: In your report, are untreated dental cavities a subset of the number of total cavities, and therefore included in the total cavity statistics?

EF: Yes, untreated dental caries (tooth decay) are included in the total number of dental caries. When we describe total dental caries, we are focused on both untreated and treated dental caries. Essentially, the total of dental caries take into account any tooth decay experience that someone has had. Untreated dental caries represent tooth decay that has not been treated. Untreated dental caries are also known as cavities. What we capture in the untreated caries measure is the active disease of youth.


Q:  What differences or similarities did you see among race and ethnic groups, and various demographics, in this analysis?

EF: We noted a number of differences among youth by race and Hispanic origin in this analysis. Non-Hispanic black youth had the highest prevalence of untreated caries (tooth decay) (17.1%) compared to other race and Hispanic-origin groups. The prevalence for non-Hispanic black youth was significantly different from non-Hispanic whites (11.7%) and non-Hispanic Asians (10.5%). The prevalence of untreated dental caries in Hispanic youth was 13.5%.

Hispanic youth had the highest prevalence of total caries (52.0%) compared to other race and Hispanic-origin groups. The prevalence was also significantly different from non-Hispanic whites (39.0%) and non-Hispanic Asians (42.6%). The prevalence of total caries for non-Hispanic black youth was 44.3%.


Q: What sort of trend data do you have on this topic so we can see how prevalence has evolved over time?

EF: With six years of data, we can look at the trend in prevalence over time. Because dental caries (tooth decay) is the most common condition of childhood, we thought it was important to include trend analysis in our report.

The results show a significant linear decrease in total caries. From 2011-2012 to 2015-2016, the total caries prevalence decreased from 50.0% to 43.1%. The results show a different pattern for untreated dental caries. The prevalence of untreated dental caries increased from 2011-2012 (16.1%) to 2013-2014 (18.0%), and then decreased in 2015-2016 (13.05). There is significant quadratic trend – a single bend either upward or downward — in untreated dental caries from 2011-2012 to 2015-2016.


Q: What is the take-home message of this report?

EF: The take-home message from this report is that there are differences in untreated and total caries (tooth decay) by age group, race and Hispanic origin, and income. The trend analysis shows that the prevalence of untreated and total caries are decreasing. However, there are still disparities that exist. Because monitoring prevalence of untreated and total caries is key to preventing and controlling oral diseases, these disparities are important.

The prevalence of untreated dental caries in America’s youth is 13.0%. The prevalence decreased as family income increased, with youth with family incomes less than 100% of the federal poverty level having the highest prevalence. Disparities in untreated dental caries exist along race and Hispanic origin. Non-Hispanic black youth have the highest prevalence compared to Hispanic, non-Hispanic white, and non-Hispanic Asian youth.

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STAT OF THE DAY – April 11, 2018

April 11, 2018


QuickStats: Age-Adjusted Death Rates for Drug Overdose by Race/Ethnicity — National Vital Statistics System, United States, 2015–2016

April 2, 2018

During 2015–2016, the age-adjusted death rates from drug overdose for the total population increased from 16.3 per 100,000 standard population to 19.8 (21.5%).

The rate increased from 21.1 to 25.3 (19.9%) for non-Hispanic whites, from 12.2 to 17.1 (40.2%) for non-Hispanic blacks, and from 7.7 to 9.5 (23.4%) for Hispanics.

Source: National Vital Statistics System, Underlying cause of death data, 1999–2016. https://wonder.cdc.gov/ucd-icd10.html.

https://www.cdc.gov/mmwr/volumes/67/wr/mm6712a9.htm


Receipt of a Sexual Risk Assessment From a Doctor or Medical Care Provider in the Past Year Among Women and Men Aged 15–44 With Recent Sexual Activity

March 29, 2018

Questions for Casey Copen, Ph.D., M.P.H., Statistician and Author of “Receipt of a Sexual Risk Assessment From a Doctor or Medical Care Provider in the Past Year Among Women and Men Aged 15–44 With Recent Sexual Activity.”

Q: Why did you decide to examine the percentage of women and men aged 15-44 in the U.S. who received a sexual risk assessment?

CC: Sexually transmitted infections (STIs) including chlamydia and gonorrhea are among the most common reportable infections nationwide. If left untreated, STIs can result in serious health consequences, including infertility.   The first step in the prevention of HIV and other STIs is to identify the people who may be at risk.  Health care providers who talk to their patients about aspects of their sexual experience may make them aware of behaviors that may increase their risk, such as not using condoms and having multiple sexual partners.  In 2011 (for men) and 2013 (for women), four questions were added to the audio computer-assisted self-interview portion of the National Survey of Family Growth (NSFG) that asked whether a doctor or other medical care provider had questioned them in the past year about 1) their sexual orientation or the sex of their sexual partners; 2) their number of sexual partners; 3) their use of condoms; 4) the types of sex they have, whether vaginal, oral or anal.  Taken together, these questions comprise what is referred to in this report as a sexual risk assessment.  I conducted these analyses because it is important to have a general sense for whether doctors or other medical care providers ask their patients these types of questions.

Q: What are we seeing with the overall percentage of U.S. adults with recent sexual activity who received a sexual risk assessment?

CC: Overall, 47% of women and 23% of men aged 15-44 with recent sexual activity (i.e., sex with an opposite-sex or same-sex partner in the past year) received a sexual risk assessment from a doctor or other medical care provider in the past year.

Q: What differences did you see in the receipt of a sexual risk assessment by selected social, demographic and behavioral characteristics in this analysis?

CC: Receipt of a sexual risk assessment was higher among women and men aged 15-24, those who were Hispanic and Non-Hispanic black, those who had income below 300% of the poverty level, or who had public health insurance.  Additionally, receipt of a sexual risk assessment was higher among men who identified as gay or bisexual, lived in urban areas , or who had a usual place to go for medical care. Higher receipt of a sexual risk assessment was also seen for women and men who had two or more opposite-sex partners in the past compared with those who had only 1 opposite-sex sexual partner and for men who had a same-sex sexual partner in the past year or who had any HIV-related sexual risk behaviors in the past year.

Q:  Were there any findings that surprised you?

CC: It is not surprising that studies on the prevalence of sexual risk assessment are generally concerned with clinic populations (i.e., those who may be most at risk for HIV/STI infection).  However, I do find it interesting that, to my knowledge, this is the first time a nationally representative household survey has provided estimates of sexual risk assessment receipt in the general reproductive-aged population.

Q: What overall message do you hope to leave with the general public when it comes to sexual risk assessment?

CC: A sexual risk assessment is a primary prevention tool that can help identify persons at risk of HIV/STIs.  While about half of women aged 15-44 received a sexual risk assessment in the past year, for men, receipt was more focused among those who engaged in HIV risk-related behaviors in the past year.  In addition, both women and men who received a sexual risk assessment were more likely to have been tested for HIV/STI in the past year.  This positive relationship suggests that where clinical conversations about sexual behavior occur, HIV/STI testing may follow.


COLON CANCER DEATHS IN THE U.S.

March 23, 2018
1999-2016
Year Deaths Age Adjusted Death Rate
1999 48433 17.7
2000 48570 17.6
2001 47860 17
2002 47586 16.6
2003 46868 16.1
2004 44591 15.1
2005 43989 14.6
2006 44061 14.3
2007 43969 14
2008 43396 13.6
2009 42199 12.9
2010 42009 12.6
2011 41822 12.2
2012 41488 11.9
2013 41502 11.6
2014 41526 11.4
2015 42126 11.3
2016 41612 10.9
SOURCE: CDC WONDER   wonder.cdc.gov

FIREARM HOMICIDES & SUICIDES, U.S. 2016

March 23, 2018
FIREARM HOMICIDES AND SUICIDES 2016 CODE DEATHS Age-Adjusted Death Rate
Intentional self-harm by handgun discharge X72 6112 1.8
Intentional self-harm by rifle, shotgun and larger firearm discharge X73 2890 0.9
Intentional self-harm by other and unspecified firearm discharge X74 13936 4.1
Assault by handgun discharge X93 1053 0.3
Assault by rifle, shotgun and larger firearm discharge X94 522 0.2
Assault by other and unspecified firearm discharge X95 12840 4.1
Total 37353 11.4
SOURCE: CDC WONDER wonder.cdc.gov

Poisoning Deaths in U.S. from 1999-2016

March 19, 2018
Year
Deaths
1999
19,741
2000
20,230
2001
22,242
2002
26,435
2003
28,700
2004
30,308
2005
32,691
2006
37,286
2007
40,059
2008
41,080
2009
41,592
2010
42,917
2011
46,047
2012
46,150
2013
48,545
2014
51,966
2015
57,567
2016
68,995

Source: https://wonder.cdc.gov

Injury Mechanism & All Other Leading Causes: Poisoning