Vol. 66, No. 2, Spring2006 123 The Role of Location in Indigenous and Non-Indigenous Child Oral Health ~~ Lisa M. Jamieson, PhD; Jason M. Armfield, BA (Hons); Kaye F. Roberts-Thomson, MPH Abstract Objective: To examine the role of location in Indigenous and non-Indigenous child oral health in three Australian states and territories. The association of Indig- enous status and residential location with caries prevalence, severity and unmet treatment need was examined. Methods: Data were collected as part of a national monitoring suivey of 4-14-year-old children enrolled in school dental services in New South Wales, South Australia and the Northern Territory, Australia. Results: Of the 326,099 children examined, 10,473 (3.2%) were Indigenous. Fewer 41 O-year- old rural Indigenous children were caries-free in the deciduous dentition than their non-Indigenous counterparts and rural Indigenous children had almost twice the mean number of decayed, missing and filled teeth (dmft) of rural non-Indigenous children. The % d/dmft was higher among rural Indigenous children than rural non- Indigenous children. Fewer 6-14-year-old rural Indigenous children were caries- free in the permanent dentition than their non-Indigenous counterparts and rural Indigenous children had almost twice the mean DMFT of rural non-Indigenous children. The % D/DMFT was higher in rural Indigenous than rural non-Indigenous children. Living in a rural location was the strongest indicator of canes prevalence, severity and unmet treatment need in the deciduous dentition of Indigenous 4-10- year-olds while being socially disadvantaged was the strongest indicator of poor oral health outcomes among older indigenous and all non-Indigenous children. Conclusions: Living in a rural location exhibited the strongest association with poor oral health outcomes for young Indigenous children but was also associated with poorer oral health among older Indigenous and non-Indigenous children. Key Words: Indigenous, children, location, dental caries Introduction Indigenous children in Australia are those who identify as Aboriginal, Torres Strait Islander or both. Such children represent 4.7% of the child population of Australia, a country comprising 6 states and 2 principal territories of note (1). The demo- graphic distribution of the Indig- enous child population differs across states and territories. For example, almost 30%of Indigenous 4-14-year- olds live in New South Wales while only 1% live in the Australian Capi- tal Territory (1).Indigenous children comprise 3.9,3.3 and 40.1% of 4-14- year-old children in New SouthWales, South Australia and the Northern Territory respectively, and 60.1,52.5 and 80.1% of such children respec- tively live in rural or remote areas (1). Information from the Australian 2001 Census of Population and Hous- ing indicated that almost 3 times as many Indigenous than non-Indig- enous adults were not in the paid la- bor force, with unemployment levels among rural-dwelling Indigenous Australians being almost 70% in some communities (1). In the same Census, Indigenous Australians were 1% times more likely to have an income of less than $200 per week, 3 times more likely to be employed as un- skilled laborers, 2 % times more likely to not own their homes and five times more likely to have not gone to school than their non-Indigenous counter- parts (1). The average number of oc- cupants in Indigenous households was 5 compared with 2 for non-In- digenous residences. Fifteen percent of Indigenoushouseholdswere over- crowded, with 19% of houses requir- ing major repairs and 10% needing to be replaced (2). The lifestyle upheavals experi- enced by Indigenous Australians since European colonization in 1788 have had marked impacts on Indig- enous health, particularly Indigenous child health. Indigenous children are at higher risk of disease and injury (2, 3) and more likely to be hospitalized for most conditions than other Aus- tralian children. They experience greater disability and reduced qual- ity of life due to ill health, partake in higher levels of health risk behaviors and are more exposed to violence in the home. In 2002, Indigenous child mortality rates were 2.7 times those of non-Indigenous children (2). Indig- enous children are also more than twice as likely to have been born un- derweight than other Australian chil- dren (2), with low birth weight &ants being more prone to ill health, includ- ing dental ill health, in later life (4,5). Increasing exposure to non-hdig- enous lifestyles has also impacted on Indigenous child oral health. Recent evidence from localized investiga- tions suggest that Indigenous chil- dren now have, on average, twice as much (and in some communities, up to 5 times as much) tooth decay as non- Indigenous children (7).This change has largely been attributed to the in- creased availabilityand consump tion of cariogenicfood and beverage prod- ucts (8). The literature suggests that Send correspondence and requests for reprints to: Lisa M. Jamieson, Australian G e a r c h Centre for Population Oral Health, The University of Adelaide, South Australia 5005, Australia. E-mail address: lisa.iamieson8adelaide.edu.au. Dr. Jamieson, Mr. Armfield and Ms. Roberts-Thomson are affiliated with the Australian Research Centre for Population Oral Health, The University of Adelaide, South Australia 5005, Australia. Manuscript received 11/02/05; accepted for publication 1 /22/06