Background Socioeconomic inequalities in oral health are established. However, the influence of neighbourhood-level socioeconomic factors on the oral health of older people is not well-established. We investigated both objective and perceived neighbourhood characteristics and their associations with a range of oral health measures in older age.
Methods The British Regional Heart Study comprises a representative sample of men drawn from 24 general practices across Britain at 40–59 years in 1978–80. In 2010–12, the participants when aged 71–92 years had a follow-up a physical examination including a dental assessment (n=1622), and completed a questionnaire (n=2137). Oral health assessment included objective measures (tooth count and periodontal (gum) disease), and self-reported fair/poor oral health and dry mouth symptoms. Neighbourhood deprivation was based on the Index of Multiple Deprivation (IMD); a composite score of neighbourhood-level factors (income, employment, education, disability, crime, housing, living environment). Perceived neighbourhood characteristics included local area services, safety, environment, and a cumulative index of these characteristics. Multilevel and multivariate logistic regression models were used to obtain odds ratios according to quintiles of IMD and perceived neighbourhood characteristics.
Results The risk of periodontal disease and tooth loss increased from IMD quintile 1 (least deprived) to 5 (most deprived); 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 on adjustment for individual social class, smoking, depression, social interactions and history of cardiovascular disease or diabetes, and remained statistically significant. Age-adjusted odds of dry mouth was increased only in quintile 2 (OR=1.41, 95% CI 1.04–1.91) and quintile 5 (1.50, 95% CI 1.09–2.07) compared to quintile 1 and was not significant after adjustments for the remaining covariates. The odds of self-reported fair/poor oral health was greater only in quintile 5 (OR=1.73, 95% CI 1.28–2.35), and remained statistically significant after adjustment for covariates. For perceived neighbourhood characteristics, significant trends were observed across quintiles of local area services, safety and a cumulative index of neighbourhood characteristics, with greater levels of tooth loss, periodontal disease, fair/poor self-rated oral health and dry mouth from quintile 1 (best rated) to quintile 5 (worse rated).
Conclusion Markers of poor oral health in older age were associated with both objective and perceived neighbourhood-level socioeconomic factors. Wider socioeconomic determinants are potentially important influences on the oral health of older people. Prospective studies are needed to establish these associations.
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