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The Human Development Index and Per Capita Gross National Product as Predictors of Dental Caries Prevalence in Industrialized and Industrializing Countries

High prevalence of dental caries in children in industrialized communities has been associated with high levels of available sugar. More recently, however the relationship between dental caries and sugar availability in industrialized countries has come into question, because of the effectiveness of different methods of dental caries prevention, despite continuing high levels of available sugar. As there has been a decline in overall dental caries prevalence in industrialized countries, so material deprivation has emerged as a contributing or associated factor of high dental caries prevalence. Factors indicative of material deprivation in preschool children that have been investigated are low birth weight, low uptake of polio vaccination, and being a part of a single parent family. This study was undertaken to explore two issues: first, whether the relationship between sugar availability and dental caries prevalence demonstrated by Screebny in 1982 1 still holds, given the reductions in dental caries levels that have occurred in industrialized countries since then. Second, whether the relationship between dental caries and deprivation could be demonstrated internationally, between countries, at different levels of socioeconomic development. Data were obtained from three separate sources: dental caries data from the World Health Organization Global Oral Epidemiology Data Bank, 2 sugar data from the United Nations Food and Agricultural Organization (UNFAO), 3 calculated as the mean sugar availability for the five years preceding the date of the dental epidemiological survey given in the 1994 WHO report; and socioeconomic data from the United Nations Development Programme (UNDP). 4 Additional dental caries and sugar availability data were obtained from the 1982 paper of Screebny, which contained comparable data for 47 countries. Complete 1982 and 1994 sets of data were available for 26 of Screebny’s original 47 countries. These were grouped according to their 1978 GNP classification. The composition of the HDI was not finalized in 1982, so it was not used in this comparison. The Human Development Index (HDI score) and annual per capita share of the Gross National Product (GNP in US$) were used as proxy measures of economic and material disadvantage. The 1994 WHO