Privación y baja actividad dental persistente del Servicio Nacional de Salud en los distritos de Inglaterra

Introduction: Access to National Health Service dentistry in England deteriorated during the COVID-19 pandemic, but how activity per population changed across areas and which areas remain persistently under-served is unclear. Methods: Ecological longitudinal study of 287 English local authority districts. Units of dental activity delivered per 1000 population were derived from NHSBSA dental statistics for financial years 2019/20 to 2023/24 and linked to the English Index of Multiple Deprivation 2019. Persistent low activity was defined as activity in the lowest quintile in at least four of five years. Logistic regression and gradient boosting were compared with five-fold cross-validation. Results: Mean activity fell from 1,370.5 per 1000 in 2019/20 to 1,245.5 per 1000 in 2023/24, a decline of −125.0 per 1000, with an acute collapse to 425.0 per 1000 in 2020/21 and only partial recovery. Activity correlated positively with deprivation (r = 0.42). Districts with persistent low activity were less deprived (mean IMD score 16.5 versus 20.4) and smaller (mean population 151,027 versus 188,984). Deprivation and population predicted persistent low activity only modestly (area under the curve 0.61 and 0.54). Conclusions: National Health Service dental activity collapsed during the pandemic and recovered incompletely. Activity is pro-poor in its geographic distribution, and persistently low activity concentrates in less deprived districts, consistent with substitution by private dentistry rather than an inverse care gradient.