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Open AccessArticle

The Association between Community Water Fluoridation and Bone Diseases: A Natural Experiment in Cheongju, Korea

Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul 08826, Korea
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Int. J. Environ. Res. Public Health 2020, 17(24), 9170; https://doi.org/10.3390/ijerph17249170
Received: 26 October 2020 / Revised: 4 December 2020 / Accepted: 5 December 2020 / Published: 9 December 2020
The present study aimed to investigate the association between bone diseases and community water fluoridation (CWF). An ecological study with a natural experiment design was conducted in Cheongju, South Korea, from 1 January 2004 to 31 December 2013. The community water fluoridation program was implemented in Cheongju and divided into CWF and non-CWF areas. To observe adverse health effects related to bone diseases, we conducted a spatio-temporal analysis of the prevalence of hip fracture, osteoporosis, and bone cancer in residents who have lived in CWF and non-CWF areas using National Health Insurance Service data. First, we used standardized incidence ratios to estimate the disease risk. Second, the hierarchical Bayesian Poisson spatio-temporal regression model was used to investigate the association between the selected bone diseases and CWF considering space and time interaction. The method for Bayesian estimation was based on the R-integrated nested Laplace approximation (INLA). Comparing the CWF area with the non-CWF area, there was no clear evidence that exposure to CWF increased health risks at the town level in Cheongju since CWF was terminated after 2004. The posterior relative risks (RR) of hip fracture was 0.95 (95% confidence intervals 0.87, 1.05) and osteoporosis was 0.94 (0.87, 1.02). The RR in bone cancer was a little high because the sample size very small compared to the other bone diseases (RR = 1.20 (0.89, 1.61)). The relative risk of selected bone diseases (hip fractures, osteoporosis, and bone cancer) increased over time but did not increase in the CWF area compared to non-CWF areas. CWF has been used to reduce dental caries in all population groups and is known for its cost-effectiveness. These findings suggest that CWF is not associated with adverse health risks related to bone diseases. This study provides scientific evidence based on a natural experiment design. It is necessary to continue research on the well-designed epidemiological studies and develop public health prevention programs to help in make suitable polices. View Full-Text
Keywords: community water fluoridation; adverse health effect; bone diseases; natural experiment; spatio-temporal analysis community water fluoridation; adverse health effect; bone diseases; natural experiment; spatio-temporal analysis
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MDPI and ACS Style

Lee, N.; Kang, S.; Lee, W.; Hwang, S.-s. The Association between Community Water Fluoridation and Bone Diseases: A Natural Experiment in Cheongju, Korea. Int. J. Environ. Res. Public Health 2020, 17, 9170. https://doi.org/10.3390/ijerph17249170

AMA Style

Lee N, Kang S, Lee W, Hwang S-s. The Association between Community Water Fluoridation and Bone Diseases: A Natural Experiment in Cheongju, Korea. International Journal of Environmental Research and Public Health. 2020; 17(24):9170. https://doi.org/10.3390/ijerph17249170

Chicago/Turabian Style

Lee, Naae; Kang, Sungchan; Lee, Woojoo; Hwang, Seung-sik. 2020. "The Association between Community Water Fluoridation and Bone Diseases: A Natural Experiment in Cheongju, Korea" Int. J. Environ. Res. Public Health 17, no. 24: 9170. https://doi.org/10.3390/ijerph17249170

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