Association Between Area-Level Deprivation and Hospital Dental Admissions in Children Under Five

Aim:
To quantify the association between area-level socioeconomic deprivation and hospital admissions for dental caries among children aged under five years in England, and to assess whether this association remains robust after accounting for spatial autocorrelation.

Methods:
An ecological cross-sectional analysis was conducted using publicly available data. Socioeconomic deprivation was measured using the Index of Multiple Deprivation (IMD) 2019 and aggregated to upper-tier local authority level by calculating the mean IMD decile across constituent Lower-layer Super Output Areas. Hospital admission rates for dental caries (0–5 years) were obtained from the Office for Health Improvement and Disparities Fingertips platform for the 2021/22–23/24 rolling three-year period. Linear regression (ordinary least squares) examined associations between rounded mean IMD decile and admission rates. Residual spatial autocorrelation was assessed using Moran’s I, and a spatial error model was fitted to evaluate robustness. Analyses were restricted to authorities with complete data (n = 116).

Results:
A clear deprivation gradient was observed. Each one-decile increase in IMD decile (indicating lower deprivation) was associated with approximately 40 fewer hospital admissions per 100,000 children aged under five years (β = −40.38; 95% CI −64.70 to −16.06; p = 0.0013). Deprivation explained 8.7% of between-authority variation (R² = 0.087). Residual spatial autocorrelation was present (Moran’s I = 0.41; permutation p = 0.0001). In a spatial error model, the association remained statistically significant (β = −38.80; p = 0.00023), indicating that the deprivation gradient was robust to spatial adjustment.

Conclusions:
Substantial oral health inequalities persist across England. Higher levels of area-level deprivation are strongly associated with increased hospital admissions for dental caries in young children. The observed socioeconomic gradient remains robust after accounting for geographic clustering, underscoring the need for proportionate universalism and upstream preventive strategies.