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caries among elementary schoolchildren in Japan.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Data were derived from four-wave longitudinal data of children in all public elementary schools in Adachi City, Tokyo, Japan, from 2015 to 2020 (n=4291, response rate: 80.1%\u201383.8%). Poverty status, defined as annual household income &lt;JPY3\u2009million, material deprivation or payment difficulties for lifeline utilities, was assessed by caregiver questionnaires when the children were in the first, second, fourth and sixth grades. School dentists assessed dental caries. We estimated the difference in the number of primary and permanent teeth with incidences of dental caries from second to sixth grade by persistent poverty and never having experienced poverty. Targeted maximum likelihood estimation was used to consider baseline and time-varying confounders.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Children with persistent poverty experienced more dental caries (mean: 3.81, SD: 3.73) than children who had never experienced poverty (mean: 2.39, SD: 3.27). After controlling for confounders, being in persistent poverty was significantly associated with having more dental caries than never being in poverty (mean difference: 1.54, 95% CI 0.60, 2.48). The magnitude of the association was greater than that of poverty assessed at first grade only (mean difference: 0.75, 95% CI 0.35, 1.16) or experience of poverty at any of the four waves (mean difference: 0.69, 95% CI 0.39, 0.99).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>The cumulative impact of persistent poverty could be larger than the poverty assessed at a single time point.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/jech-2022-220073","type":"journal-article","created":{"date-parts":[[2023,7,19]],"date-time":"2023-07-19T13:34:12Z","timestamp":1689773652000},"page":"670-675","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Persistent poverty and child dental caries: time-varying exposure analysis"],"prefix":"10.1136","volume":"77","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6114-5604","authenticated-orcid":false,"given":"Yusuke","family":"Matsuyama","sequence":"first","affiliation":[{"name":"Department of Global Health Promotion, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan"},{"name":"Department of Oral Health Promotion, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aya","family":"Isumi","sequence":"additional","affiliation":[{"name":"Department of Health Policy, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Satomi","family":"Doi","sequence":"additional","affiliation":[{"name":"Department of Health Policy, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1074-3954","authenticated-orcid":false,"given":"Takeo","family":"Fujiwara","sequence":"additional","affiliation":[{"name":"Department of Global Health Promotion, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,7,19]]},"reference":[{"key":"2025100304252720000_77.10.670.1","doi-asserted-by":"publisher","DOI":"10.1177\/0022034517693566"},{"key":"2025100304252720000_77.10.670.2","doi-asserted-by":"crossref","unstructured":"Tsakos G , Allen F . Oral health-related quality of life. In: Peres MA , Antunes JLF , Watt RG , eds. Oral Epidemiology: A Textbook on Oral Health Conditions, Research Topics and Methods. Textbooks in Contemporary Dentistry. Springer International Publishing, 2021: 319\u201332. doi:10.1007\/978-3-030-50123-5","DOI":"10.1007\/978-3-030-50123-5_20"},{"key":"2025100304252720000_77.10.670.3","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1177\/0022034517750572","article-title":"Global-, Regional-, and country-level economic impacts of dental diseases in 2015","volume":"97","author":"Righolt","year":"2018","journal-title":"J Dent Res"},{"key":"2025100304252720000_77.10.670.4","unstructured":"World Health Organization . Executive board resolution: EB 148.R1. 2021. 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