Age-sex specific and sequela-specific disability-adjusted life years (DALYs) due to dental caries preventable through water fluoridation: An assessment at the national and subnational levels in Iran, 2016

Mehrnoosh Abtahi; Sina Dobaradaran; Sahand Jorfi; Ali Koolivand; Mohammad Reza Mohebbi; Ahmad Montazeri; Shokooh Sadat Khaloo; Saeed Keshmiri; Reza Saeedi

doi:10.1016/j.envres.2018.08.005

Age-sex specific and sequela-specific disability-adjusted life years (DALYs) due to dental caries preventable through water fluoridation: An assessment at the national and subnational levels in Iran, 2016

Environ Res. 2018 Nov:167:372-385. doi: 10.1016/j.envres.2018.08.005. Epub 2018 Aug 4.

Authors

Mehrnoosh Abtahi¹, Sina Dobaradaran², Sahand Jorfi³, Ali Koolivand⁴, Mohammad Reza Mohebbi⁵, Ahmad Montazeri⁵, Shokooh Sadat Khaloo⁶, Saeed Keshmiri⁷, Reza Saeedi⁸

Affiliations

¹ Department of Environmental Health Engineering, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Environmental and Occupational Hazards Control Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
² The Persian Gulf Marine Biotechnology Research Center, Bushehr University of Medical Sciences, Bushehr, Iran; Department of Environmental Health Engineering, Faculty of Health, Bushehr University of Medical Sciences, Bushehr, Iran; Systems Environmental Health, Oil, Gas and Energy Research Center, Bushehr University of Medical Sciences, Bushehr, Iran.
³ Environmental Technology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Department of Environmental Health Engineering, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
⁴ Department of Environmental Health Engineering, Faculty of Health, Arak University of Medical Sciences, Arak, Iran.
⁵ Water Quality Control Bureau, National Water and Wastewater Engineering Company, Tehran, Iran.
⁶ School of Health, Safety and Environment, Shahid Beheshti University of Medical Sciences, P.O. Box 16858-116, Tehran, Iran.
⁷ Faculty of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran.
⁸ Department of Health Sciences, School of Health, Safety and Environment, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Electronic address: r.saeedi@sbmu.ac.ir.

PMID: 30098524
DOI: 10.1016/j.envres.2018.08.005

Abstract

We assessed disability-adjusted life years (DALYs) due to dental caries preventable through water fluoridation apportioned by sex, age group, sequela, province, and community type in Iran, 2016. The burden of disease due to dental caries was extracted from the Global Burden of Disease Study 2016 (GBD 2016) and the caries preventive effect of water fluoridation was calculated using a database of fluoride levels in drinking water. All the preventable DALYs were caused by years lived with disability (YLDs) because of the non-fatal character of dental caries. DALYs and DALY rate (per 100,000 people) preventable through water fluoridation at the national level in 2016 were 14,971 (95% uncertainty interval 7348- 24,725) and 18.73 (9.19-30.93), respectively. The national population preventable fraction (PPF) of dental caries by water fluoridation was determined to be as high as 0.176 (0.141-0.189). The share of sequelae in the preventable DALYs at the national level were estimated to be 76.8% for edentulism and severe tooth loss, 21.4% for caries of permanent teeth, and 1.8% for caries of deciduous teeth. The national DALYs and DALY rate preventable through water fluoridation exhibited no difference by sex, but considerably increased by age from 110 (37-223) and 1.5 (0.5-3.1) for the age group 0-4 y to 4331 (2334-6579) and 88.9 (47.9-135.1) for the age group 65 y and older, respectively. Over 80% of the national preventable DALYs occurred in urban areas due to higher population and lower coverage of fluoridated drinking water. The highest provincial DALYs and DALY rate preventable by water fluoridation were observed in Tehran and Gilan to be 3776 (1866-6206) and 37.2 (18.6-60.8), respectively. The results indicated that water fluoridation can play a profound role in the promotion of dental public health and compensate the spatial inequality and increasing temporal trend of health losses from dental caries at the national level.

Keywords: Avoidable burden of disease; Fluoride level; Oral conditions; Protective factor; Spatial variation.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Dental Caries / epidemiology*
Dental Caries / prevention & control*
Female
Fluoridation*
Global Burden of Disease
Humans
Iran / epidemiology
Male
Quality-Adjusted Life Years