Supplementary Material for: The global prevalence and severity of dental caries among racially minoritized children: A systematic review and meta-analysis

Racially minoritized children often bear a greater burden of dental caries, but the overall magnitude of racial gaps in oral health and their underlying factors are unknown. A systematic review and meta-analysis were conducted to fill these knowledge gaps. We compared racially minoritized (E) children aged 5 to 11 years (P) with same-age privileged groups (C) to determine the magnitude and correlates of racial inequities in dental caries (O) in observational studies (S). Using the PICOS selection criteria, a targeted search was performed from inception to December 1st, 2021, in nine major electronic databases and an online web search for additional grey literature. The primary outcome measures were caries severity, as assessed by mean decayed, missing, and filled teeth (dmft) among children and untreated dental caries prevalence (% d>0). The meta-analysis used the random-effects model to calculate standardized mean differences (SMD) and 95% confidence intervals (95% CI). Subgroup analysis, tests for heterogeneity (I2, Galbraith plot), leave-one-out sensitivity analysis, cumulative analysis, and publication bias (Egger’s test and funnel plots) tests were carried out. The New Castle Ottawa scale was used to assess risk of bias. This review was registered with PROSPERO, CRD42021282771. A total of 75 publications were included in the descriptive analysis. The SMD of dmft score was higher by 2.30 (95% CI: 0.45, 4.15), and the prevalence of untreated dental caries was 23% (95% CI: 16, 31) higher among racially minoritized children, compared to privileged groups. Cumulative analysis showed worsening caries outcomes for racially marginalized children over time and larger inequities in dmft among high-income countries. Our study highlights the high caries burden among minoritized children globally by estimating overall trends and comparing against factors including time, country, and world income. The large magnitude of these inequities, combined with empirical evidence on the oral health impacts of racism and other forms of oppression, reinforce that oral health equity can only be achieved with social and political changes at a global level.

种族少数群体儿童往往承担着更为沉重的龋齿疾病负担，但口腔健康领域种族差异的整体规模及其潜在影响因素仍未明确。为填补这一知识空白，本研究开展了一项系统综述与荟萃分析。本研究遵循PICOS遴选标准，以5至11岁儿童为研究人群（P），将种族少数群体儿童作为暴露组（E），同年龄段特权群体儿童作为对照组（C），旨在明确观察性研究（S）中龋齿相关种族不平等的规模及其关联因素（O）。我们从各数据库建库起至2021年12月1日，在9个主流电子数据库中进行了针对性检索，并通过网络搜索补充获取灰色文献。本研究的主要结局指标包括：以儿童龋失补牙数（dmft）均值评估的龋齿严重程度，以及未治疗龋齿患病率（% d>0）。荟萃分析采用随机效应模型计算标准化均数差（SMD）与95%置信区间（95% CI）。此外，本研究还开展了亚组分析、异质性检验（I²、Galbraith图）、逐一剔除敏感性分析、累积分析及发表偏倚检验（Egger检验与漏斗图），并采用纽卡斯尔-渥太华量表（New Castle Ottawa scale）评估偏倚风险。本综述已在PROSPERO平台注册，注册号为CRD42021282771。本描述性分析共纳入75项发表成果。与特权群体儿童相比，种族少数群体儿童的dmft评分标准化均数差为2.30（95% CI：0.45, 4.15），未治疗龋齿患病率高出23%（95% CI：16, 31）。累积分析结果显示，随着时间推移，种族边缘化儿童的龋齿转归持续恶化，且在高收入国家中，dmft维度的种族不平等更为显著。本研究通过估算全球整体趋势，并对比时间、国家及世界收入水平等因素，凸显了全球范围内少数群体儿童沉重的龋齿负担。此类种族不平等的规模之大，结合种族主义与其他压迫形式对口腔健康影响的实证证据，进一步证实：唯有在全球层面推进社会与政治变革，方能实现口腔健康公平。