Does regional socioeconomic context affect the dental caries experience? A multilevel study of Korean adults

Recent thinking about the role of regional socioeconomic context in generating health inequalities has argued for the collection of true 'area' data that accurately reflect the characteristics of a region. We investigated whether a range of attributes of regional environments, constructed from factor analysis of various regional socioeconomic indices, is associated with the dental caries experience of adults, and whether the nature of this association changes according to age. A linked data set comprising information on 6,402 individuals from the Korean National Oral Health Survey of 2000 and regional information from 118 districts where our study population lived, were examined using multilevel analysis. The regional contextual variables, 'density of service and medical facilities' and 'dependence on manufacturing industry', were negatively associated with dental caries experience after controlling for individual characteristics, and these associations differed by age groups, especially in the older age group. Our findings suggest that hypotheses about specific chains of causation which might link service affluence or industrialization with dental caries need to be investigated further using more detailed indices.