Background The influence of socioeconomic disadvantage in early life and later life on oral health in older ages is not established. Studies are mostly in middle-aged populations or have limited oral health measures. We examined the relationships between socioeconomic factors in childhood, middle-age and older age with clinical and self-reported oral health measures in older ages, and tested which conceptual life-course model (sensitive period, accumulation of risk or social mobility) explains the relationships between socioeconomic factors across the life-course and adverse oral health outcomes in older age.
Methods The study comprised a socially representative cohort of 1,903 British men aged 71–92 years in 2010–12 drawn from general practices across Britain. Socioeconomic factors were available for childhood (father’s occupational social class); middle-age (longest-held occupation at 40–59 years); and older age at 60–79 years (socioeconomic deprivation). Oral health examination at 71–92 years included number of teeth, and periodontal disease measures in index teeth in each sextant (loss of attachment, periodontal pocket, gingival bleeding), and self-rated oral health (excellent, good, fair and poor). Life-course models, adjusted for age and town, were compared with a saturated model using Likelihood-ratio tests.
Results Socioeconomic disadvantage in childhood, middle-age and older ages was associated with edentulism at 71–92 years – age-adjusted odds ratios (95% CI:) were 1.39 (1.02–1.90), 2.26 (1.70–3.01), 1.83 (1.35–2.49) respectively. Poor self-rated oral health was associated with socioeconomic disadvantage in childhood and middle-age; age-adjusted odds ratios (95% CI:) were 1.48 (1.19–1.85), 1.45 (1.18–1.78) respectively. Comparing competing life-course hypotheses, the sensitive period model for socioeconomic disadvantage in middle-age showed the best fit for edentulism (complete loss of natural teeth) and having <21 teeth at 71–92 years. Accumulation of risk across the life span model was strongest for poor self-rated oral health at 71–92 years. Periodontal disease measures were not significantly associated with socioeconomic disadvantage at any time-point and none of the life-course models fitted the data.
Conclusion Socioeconomic disadvantage in middle-age has a particularly strong influence on tooth loss in older age. Overall self-rated oral health is influenced by socioeconomic disadvantage across the life-course.
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