Socioeconomic status and dental service utilization among children and adolescents: systematic reviews and meta analysis

BACKGROUND: Dental health and care among children and adolescents are a major neglected area of public health, leading to both physical and mental health consequences in the long term. Several demographics, economic, and social factors influence dental service utilization, with Socio-Economic Status (SES) being a significant determinant. SES plays an important role in the utilization of dental services for children and adolescents. This systematic review and meta-analysis aim to explore the association between SES and dental service utilization in this population. METHODS: Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched PubMed, Web of Science, and Scopus for relevant articles published between January 2000 and September 2024. We selected global studies that examined the association between SES and dental service utilization among children and adolescents. Different subgroup analysis based on socioeconomic indicators (household income, parental educational level and/ or occupational level, household assets, SES index, and annual household consumption expenditure), economic classification of the country (high, upper-middle, or lower-middle), nature of the dental insurance system and type of outcome measure. Pooled Odd Ratio (OR) and 95% confidence intervals (CIs) were calculated for the outcome using a random-effects model. Furthermore, meta-regression and sensitivity analysis were conducted to identify the sources for heterogeneity. RESULTS: A total of 48 studies met the inclusion criteria for this review. The meta-analysis revealed that children and adolescents from higher SES were about twice as likely to utilize dental services (OR = 2.10, 95% CI: 1.32-2.89) compared to those from lower SES backgrounds. The subgroup analysis indicated that various factors influenced the association between SES and dental service utilization among children and adolescents. These included specific SES indicators-household income (OR = 1.65, 95% CI: 1.37-1.94), parental occupation and/or education level (OR = 3.30, 95% CI: 1.12-5.47), and household assets (OR = 1.47, 95% CI: 1.15-1.78)-as well as the economic classification of the country, with higher-income countries (OR = 2.57, 95% CI: 1.24-3.90) and upper-middle-income countries (OR = 1.52, 95% CI: 1.26-1.78) showing stronger associations. The type of dental insurance system also influenced the outcomes, with significant associations found in countries with universal coverage (OR = 1.73, 95% CI: 1.19-2.26), means-tested systems (OR = 1.70, 95% CI: 1.40-2.00), and mixed public-private systems (OR = 1.47, 95% CI: 1.09-1.85). Additionally, the type of outcome measure also played a role, with recent dental service use (OR = 2.21, 95% CI: 1.18-3.23) and preventive dental service use (OR = 2.01, 95% CI: 1.19-2.84) demonstrating significant effects. CONCLUSION: The findings provide evidence that children and adolescents with low SES are associated with lower utilization of dental services. Interventions focused on these groups targeting specific barriers to care are needed to improve equitable dental service utilization.