Socially unequal improvements in dental caries levels in Brazilian adolescents between 2003 and 2010 Roncalli AG, Sheiham A, Tsakos G, Watt RG. Socially unequal improvements in dental caries levels in Brazilian adolescents between 2003 and 2010. Community Dent Oral Epidemiol 2015. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. Abstract – Objectives: Although there are numerous reports on socioeconomic inequalities in dental caries, few studies have focused on whether improvements in dental status have been accompanied by changes in socioeconomic inequalities in caries. The objective of this study was to assess whether declines in caries between 2003 and 2010 were associated with reductions in inequalities in dental caries in adolescents. Methods: Data on dental caries in adolescents aged 15–19 were used from the Brazilian National Oral Health surveys conducted in 2003 (n = 16 833) and 2010 (n = 5445). The dependent variables were Decayed, Missing and Filled Teeth (DMFT) index and the percentage caries free. Household income and educational level were independent variables. Differences between surveys for DMFT and caries free were calculated, and measurement of inequality was performed using the Slope Index of Inequality (SII) and Relative Index of Inequality (RII). Results: Both DMFT and percentage caries free showed significant differences in absolute (SII) and relative (RII) inequalities between the two surveys for both education and income. The SII for DMFT rose from 0.54 to 2.01 and from 1.44 to 3.67 for income and education, respectively. For caries free, these values were 3.64– 19.40 and 5.06–22.93. Regarding to RII, a similar trend has been found. Conclusions: Despite the overall reduction in DMFT and an increase in caries free, there were increases in both income and education-related inequalities in caries in Brazilian adolescents. The findings on caries differ from those for other health conditions in Brazil, where there have been reductions in inequalities. Angelo G. Roncalli 1,2 , Aubrey Sheiham 2 , Georgios Tsakos 2 and Richard G. Watt 2 1 Department of Dentistry, Federal University of Rio Grande do Norte Natal, RN, Brazil, 2 Department of Epidemiology and Public Health, University College London London, UK Key words: caries; disparities; epidemiology; public health police Angelo G. Roncalli, Department of Epidemiology and Public Health, University College London, London WC1E 6BT, UK e-mail: roncalli@terra.com.br Submitted 19 August 2013 accepted 13 January 2015 Determinants of health inequalities are different from determinants of health (1). The former are about ‘the fundamental structures of social hierar- chy and the socially determined conditions these create in which people grow, live, work and age’ (2), whereas the latter are more related to proximal causes, such as health-compromising behaviours. Therefore, it is important to distinguish between the overall level of health and the social distribu- tion of health determinants, as there can be improvements in overall levels of health but not in levels of inequality. To reduce inequality in health ‘requires a rate of health gain that is greatest for the poorest, progressively lower for better-off groups and lowest for those in the most advan- taged circumstances’ (3). A number of health conditions have improved in Brazil in the past 30 years. However, the question that needs addressing is, have overall improve- ments in health been accompanied by reductions in health inequalities? Infant mortality declined by 4.4% per year between 2000 and 2008 (4). Since doi: 10.1111/cdoe.12156 1 Community Dent Oral Epidemiol All rights reserved Ó 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd