Association between state-level socioeconomic vulnerability and access to community water fluoridation in the United States

To evaluate associations between state-level socioeconomic vulnerability and community water fluoridation (CWF) in the U.S. Data from calendar year 2022 were drawn from the U.S. Census Bureau to develop four state-level markers of socioeconomic vulnerability (percentages non-white, Hispanic/Latino, below federal poverty level, and <high school education) and the U.S. Centers for Disease Control and Prevention’s Water Fluoridation Reporting System to assess mean state-level CWF percent. Fractional logit regression models with robust standard errors, weighted by state population, were used to assess non-adjusted associations between each socioeconomic vulnerability marker and CWF (α < 0.05). Poverty-adjusted models were also run. The mean state-level CWF was 72.8% (SD = 20.0%; range:8.5%−100%). In the non-adjusted models, only state-level percentages of non-white and Hispanic/Latino individuals were significantly associated with lower state-level CWF percent. In the poverty-adjusted models, higher percentages of non-whites, Hispanic/Latinos, and individuals who did not complete high school at the state-level were associated with a significantly lower state-level CWF percent (p = 0.01, p < 0.01, and p < 0.01, respectively). Individuals living in more socioeconomically vulnerable states in the U.S. may face inequities in CWF access.