Background Socioeconomic inequalities in oral health are well-established. However, evidence on the influence of neighbourhood or area-level socioeconomic factors on poor oral health in older populations is limited. Therefore, we examined the extent to which area-level deprivation is associated with poor oral health (number of teeth, periodontal/gum disease and self-rated oral health) in older age, and whether this association is independent of individual-level socioeconomic position.
Methods The investigation is based on a cross-sectional study of a representative cohort of men aged 71–92 years in 2010–12 drawn from general practices across Britain. A dental examination of 1622 men included number of teeth, and periodontal disease measures of loss of attachment (cumulative marker of periodontal disease) and periodontal pocket (active disease). Self-rated oral health (excellent, good, fair and poor) was assessed through postal questionnaires in 2147 men. Neighbourhood deprivation was based on the national Index of Multiple Deprivation (IMD), a composite score based on neighbourhood-level factors including income, employment, housing and access to services. Individual socioeconomic position was based on longest-held occupational social class. Multilevel logistic regression was used to obtain odds ratios according to IMD quintiles (quintile 1 being least deprived and used as a reference group).
Results The risk of deep periodontal pockets and loss of teeth increased from IMD quintile 1 to 5; age-adjusted odds ratios (OR) for quintile 5 were 3.25 (95% CI 2.05–5.17) and 3.58 (95% CI 2.38–5.39) respectively, compared to quintile 1. These associations were attenuated only slightly by adjustment for individual social class, smoking and BMI and remained statistically significant. Age-adjusted odds of severe periodontal disease (based on loss of attachment and pocket depth) were increased only in quintile 5 compared to quintile 1 (OR = 1.90, 95% CI 1.07–3.35) and were not significant after adjustment for individual social class. The odds of self-reported fair/poor oral health was greater in more deprived IMD quintiles (OR for most deprived compared to least deprived quintile = 1.73, 95% CI 1.28–2.35), and remained statistically significant after adjustment for individual social class.
Conclusion Marked differences in poor oral health in relation to neighbourhood-level factors were observed in this study of older men. Neighbourhood deprivation was associated with increased risks of loss of teeth, periodontal disease and poor self-rated oral health in older age, independent of individual social class. Neighbourhood level factors are likely to play an important role in reducing inequalities in oral health in older populations, and merit further research.
- oral health
- older people
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