Country level ecological analysis of per capita sugar and alcohol consumption and their association with dental caries prevalence in South Asian countries

Abstract Background Dental caries remains a significant public health concern globally. Dental caries is highly prevalent in South Asia, but the contribution of population-level dietary exposures remains unclear. Dietary sugar is a well-established risk factor, while alcohol consumption may influence oral health outcomes in adults. This study examined the ecological associations between per capita refined sugar availability, adult alcohol consumption, and the prevalence of untreated dental caries in South Asian countries. Methods Country-level data for seven South Asian countries (Afghanistan, Bangladesh, India, Iran, Maldives, Pakistan, and Sri Lanka) were obtained from the WHO Global Health Observatory. Variables included per capita refined sugar availability, adult per capita alcohol consumption, and prevalence of untreated dental caries in children (1–9 years) and adults (≥ 5 years). Simple linear regressions assessed ecological associations between dietary variables and caries prevalence. Results Sugar availability showed negligible associations with caries in both children (R² = 0.052) and adults (R² = 0.031). Adult alcohol consumption demonstrated a modest negative association with adult caries prevalence (R² = 0.222). These ecological associations likely reflect country-level confounding factors such as oral health infrastructure, socioeconomic status, and diet patterns rather than causal relationships. Conclusion Ecological analysis of South Asian countries showed limited correlation between sugar and alcohol consumption and dental caries prevalence. These findings highlight the multifactorial nature of caries and the influence of population-level health system and socioeconomic factors in oral health research. Ecological correlations were weak, indicating that national dental caries burdens in South Asia are influenced more by oral health systems and social determinants than by population-level sugar availability or alcohol exposure.