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Social disparities in periodontitis among US adults: the effect of allostatic load
  1. L N Borrell1,
  2. N D Crawford2
  1. 1Department of Health Sciences, Lehman College, City University of New York, New York, USA
  2. 2Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
  1. Correspondence to Luisa N Borrell, Graduate Program in Public Health, Department of Health Sciences, Lehman College, CUNY, 250 Bedford Park Boulevard West, Bronx, NY 10468, USA; luisa.borrell{at}


Background Periodontitis has been shown to be associated with allostatic load, a measure of physiological instability across biological systems from cumulative or repeated adaptation to stressors. Minority racial/ethnic and low socioeconomic groups tend to have higher prevalence of periodontitis and are more likely to be exposed to stress. The association between periodontitis and allostatic load and whether this association differed by race/ethnicity, education, income and age among US adults were examined.

Methods Using data from the National Health and Nutrition Examination Survey 1999–2004, prevalence ratios were calculated using logistic regression to estimate the strength of the association between allostatic load and the prevalence of periodontitis before and after adjusting for selected characteristics.

Results After adjustment for selected characteristics, including race/ethnicity, income and education, US adults with a high allostatic load were 55% (95% CI 1.05 to 2.29) more likely to have periodontitis than their counterparts with low allostatic load. This association varied by race/ethnicity where Mexican Americans with a high allostatic load were almost five (PR 4.62; 95% CI 2.52 to 8.50) times more likely to have periodontitis than their counterparts with low allostatic load.

Conclusions These data suggest that stress may be associated with periodontitis in the USA, with Mexican Americans exhibiting the strongest association. Furthermore, this group may lack appropriate coping responses to process chronic stressors that other groups may have historically been conditioned to handle. More research is needed to understand allostatic load in Mexican Americans and its influence on periodontitis.

  • Periodontitis
  • allostatic load
  • cumulative stress
  • US
  • survey
  • race/ethnicity
  • education
  • income
  • dental public health
  • ethnic minorities SI
  • social epidemiology
  • stress
  • surveys ME

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  • Funding This study was supported by the National Institute for Dental and Craniofacial Research (R03DE017901, LNB) and the Initiative for Maximising Student Diversity (R25GM062454, NDC).

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.