Geo-mapping of caries and obesity in preschool children: a Swedish register-based study.

BACKGROUND: Lifestyle interventions addressing both oral health and obesity in childhood have attracted attention due to the shared risk factors. Prioritization of resources to lifestyle interventions within pediatric dental care should rely on a rational basis. We consider a dental care setting where geographically targeted interventions could be pursued, and develop an analytic approach, geo-mapping, to identify high-risk neighborhoods. METHODS: The population of interest comprised the children between 3 and 6 years old who resided in a Swedish region, Kronoberg (total population of 204,000), at the end of 2024. We used register data provided by all dental clinics and child health centers in the Kronoberg region. The binary outcomes caries (dfs > 0) and obesity (according to the internationally recommended classification) were analyzed combined. Multinomial outcome data aggregated at neighborhood-level (totally, 112 neighborhoods) were analyzed by Bayesian spatial modelling, with adjustments for sex and age. Furthermore, we estimated associations with neighborhood deprivation, classified according to national quintiles Q1 (least deprived) to Q5 (most deprived). RESULTS: The study population included 8,293 children (88% coverage), 888 of whom (10.7%) were assessed with caries, 226 (2.7%) with obesity, and 29 (0.3%) with coexisting caries and obesity. We found no statistical evidence for an individual-level association between caries and obesity; the prevalence-odds ratio of obesity for children with vs. without caries was estimated to 1.24, with a 95% confidence interval ranging from 0.83 to 1.84. Twenty-four neighborhoods were identified as having an elevated prevalence of children with caries (posterior probability > 0.80); comprising 1,960 children, 447 of whom (22.8%) were assessed with caries. Five of these 24 neighborhoods coincide with 5 of the 10 neighborhoods identified as having an elevated prevalence of obese children. The estimated association with neighborhood deprivation was more pronounced for caries (odds ratio Q5 vs. Q1 = 6.28; 95% credible interval [CrI]: 4.23–9.34) than for obesity (1.97; 95% CrI: 1.15–3.38). CONCLUSIONS: Even though this analysis yielded a rational basis for prioritizing resources to preventive measures focusing on oral health in early childhood – to providers of dental care for preschool children predominantly living in the most deprived neighborhoods – we found no support for a concurrent prioritization of more comprehensive lifestyle interventions, addressing both caries and obesity. CLINICAL TRIAL NUMBER: Not applicable.