Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Oral Health
Published in: BMC Oral Health 1/2015

Open Access 01-12-2015 | Research article

Individual- and community-level social gradients of edentulousness

Authors: Kanade Ito, Jun Aida, Tatsuo Yamamoto, Rika Ohtsuka, Miyo Nakade, Kayo Suzuki, Katsunori Kondo, Ken Osaka, for the JAGES group

Published in: BMC Oral Health | Issue 1/2015

Login to get access

Abstract

Background

Community-level factors as well as individual-level factors affect individual health. To date, no studies have examined the association between community-level social gradient and edentulousness. The aim of this study was to investigate individual- and community-level social inequalities in edentulousness and to determine any explanatory factors in this association.

Methods

We analyzed the data from the Japan Gerontological Evaluation Study (JAGES). In 2010-2012, 112,123 subjects aged 65 or older responded to the questionnaire survey (response rate = 66.3%). Multilevel logistic regression analysis was applied to determine the association between community-level income and edentulousness after accounting for individual-level income and demographic covariates. Then, we estimated the probability of edentulousness by individual- and community-level incomes after adjusted for covariates.

Results

Of 79,563 valid participants, the prevalence of edentulousness among 39,550 men (49.7%) and 40,013 women (50.3%) were both 13.8%. Living in communities with higher mean incomes and having higher individual-level incomes were significantly associated with a lower risk of edentulousness (odds ratios [ORs] by 10,000 USD increments were 0.37 (95% confidence interval [CI] [0.22-0.63]) for community-level and 0.85 (95% CI [0.84-0.86]) for individual-level income). Individual- and community-level social factors, including density of dental clinics, partially explained the social gradients. However, in the fully adjusted model, both community- and individual-level social gradients of edentulousness remained significant (ORs = 0.43 (95% CI [0.27-0.67]) and 0.90 (95% CI [0.88-0.91]), respectively). One standard deviation changes in community- and individual-level incomes were associated with 0.78 and 0.84 times lower odds of edentulousness, respectively. In addition, compared to men, women living in communities with higher average incomes had a significantly lower risk of edentulousness (p-value for interaction < 0.001).

Conclusions

Individual- and community-level social inequalities in dental health were observed. Public health policies should account for social determinants of oral health when reducing oral health inequalities.
Literature
1.
Marcenes W, Kassebaum NJ, Bernabe E, Flaxman A, Naghavi M, Lopez A, et al. Global burden of oral conditions in 1990–2010: a systematic analysis. J Dent Res. 2013;92(7):592–7.PubMedCrossRef
2.
Kassebaum NJ, Bernabe E, Dahiya M, Bhandari B, Murray CJ, Marcenes W. Global Burden of Severe Periodontitis in 1990–2010: A Systematic Review and Meta-regression. J Dent Res. 2014;93(11):1045–53.PubMedCrossRef
3.
Sheiham A, Steele JG, Marcenes W, Lowe C, Finch S, Bates CJ, et al. The relationship among dental status, nutrient intake, and nutritional status in older people. J Dent Res. 2001;80(2):408–13.PubMedCrossRef
4.
Yamamoto T, Kondo K, Hirai H, Nakade M, Aida J, Hirata Y. Association between self-reported dental health status and onset of dementia: a 4-year prospective cohort study of older Japanese adults from the Aichi Gerontological Evaluation Study (AGES) Project. Psychosom Med. 2012;74(3):241–8.PubMedCrossRef
5.
Aida J, Kondo K, Yamamoto T, Hirai H, Nakade M, Osaka K, et al. Oral health and cancer, cardiovascular, and respiratory mortality of Japanese. J Dent Res. 2011;90(9):1129–35.PubMedCrossRef
6.
Matsuyama Y, Aida J, Takeuchi K, Tsakos G, Watt RG, Kondo K, et al. Inequalities of dental prosthesis use under universal healthcare insurance. Community Dent Oral Epidemiol. 2013;42(2):122–8.PubMedCrossRef
7.
Aida J, Kondo K, Kondo N, Watt RG, Sheiham A, Tsakos G. Income inequality, social capital and self-rated health and dental status in older Japanese. Soc Sci Med. 2011;73(10):1561–8.PubMedCrossRef
8.
Sanders AE, Turrell G, Slade GD. Affluent neighborhoods reduce excess risk of tooth loss among the poor. J Dent Res. 2008;87(10):969–73.PubMedCrossRef
9.
Watt RG, Sheiham A. Integrating the common risk factor approach into a social determinants framework. Community Dent Oral Epidemiol. 2012;40(4):289–96.PubMedCrossRef
10.
Kawachi I, Kennedy BP. Income inequality and health: pathways and mechanisms. Health Serv Res. 1999;34(1 Pt 2):215–27.PubMedCentralPubMed
11.
Coogan PE, Wise LA, Cozier YC, Palmer JR, Rosenberg L. Lifecourse educational status in relation to weight gain in African American women. Ethn Dis. 2012;22(2):198–206.PubMedCentralPubMed
12.
Brennan SL, Holloway KL, Williams LJ, Kotowicz MA, Bucki-Smith G, Moloney DJ, et al. The social gradient of fractures at any skeletal site in men and women: data from the Geelong Osteoporosis Study Fracture Grid. Osteoporos Int. 2015. doi:10.1007/s00198-014-3004-y.
13.
Nguyen AB, Moser R, Chou WY. Race and health profiles in the United States: an examination of the social gradient through the 2009 CHIS adult survey. Public Health. 2014;128(12):1076–86.PubMedCrossRef
14.
Astrom AN, Ekback G, Lie SA, Ordell S. Life-course social influences on tooth loss and oral attitudes among older people: evidence from a prospective cohort study. Eur J Oral Sci. 2015;123(1):30–8.PubMedCrossRef
15.
Sgan-Cohen HD, Evans RW, Whelton H, Villena RS, MacDougall M, Williams DM. IADR Global Oral Health Inequalities Research Agenda (IADR-GOHIRA(R)): a call to action. J Dent Res. 2013;92(3):209–11.PubMedCrossRef
16.
Williams DM. Global oral health inequalities: the research agenda. J Dent Res. 2011;90(5):549–51.PubMedCrossRef
17.
Marmot M, Friel S, Bell R, Houweling TA, Taylor S. Closing the gap in a generation: health equity through action on the social determinants of health. Lancet. 2008;372(9650):1661–9.PubMedCrossRef
18.
Meijer M, Rohl J, Bloomfield K, Grittner U. Do neighborhoods affect individual mortality? A systematic review and meta-analysis of multilevel studies. Soc Sci Med. 2012;74(8):1204–12.PubMedCrossRef
19.
Takeuchi K, Aida J, Kondo K, Osaka K. Social participation and dental health status among older Japanese adults: a population-based cross-sectional study. PLoS One. 2013;8(4):e61741.PubMedCentralPubMedCrossRef
20.
Yamamoto T, Kondo K, Aida J, Fuchida S, Hirata Y. Association between the longest job and oral health: Japan Gerontological Evaluation Study project cross-sectional study. BMC Oral Health. 2014;14:130.PubMedCentralPubMedCrossRef
21.
Ministry of Internal Affairs and Communications. Status Survey of Tax on Municipalities. The System of Social and Demographic Statistics of Japan, Basic data of Shi, Ku, Machi, Mura by Statistics Bureau, Ministry of Internal Affairs and Communications. 2010.
22.
Fukuda Y, Hiyoshi A. Associations of household expenditure and marital status with cardiovascular risk factors in Japanese adults: analysis of nationally representative surveys. J Epidemiol. 2013;23(1):21–7.PubMedCrossRef
23.
Evans TG. Socioeconomic consequences of blinding onchocerciasis in west Africa. Bull World Health Organ. 1995;73(4):495–506.PubMedCentralPubMed
24.
Wennstrom A, Ahlqwist M, Stenman U, Bjorkelund C, Hakeberg M. Trends in tooth loss in relation to socio-economic status among Swedish women, aged 38 and 50 years: repeated cross-sectional surveys 1968–2004. BMC Oral Health. 2013;13:63.PubMedCentralPubMedCrossRef
25.
Natto ZS, Aladmawy M, Alasqah M, Papas A. Factors contributing to tooth loss among the elderly: A cross sectional study. Singapore Dent J. 2014;35:17–22.PubMedCrossRef
26.
Sabbah W, Tsakos G, Chandola T, Sheiham A, Watt RG. Social gradients in oral and general health. J Dent Res. 2007;86(10):992–6.PubMedCrossRef
27.
Hanibuchi T, Aida J, Nakade M, Hirai H, Kondo K. Geographical accessibility to dental care in the Japanese elderly. Community Dent Health. 2011;28(2):128–35.PubMed
28.
Lupi-Pegurier L, Clerc-Urmes I, Abu-Zaineh M, Paraponaris A, Ventelou B. Density of dental practitioners and access to dental care for the elderly: a multilevel analysis with a view on socio-economic inequality. Health Policy. 2011;103(2–3):160–7.PubMedCrossRef
29.
Yun WJ, Rhee JA, Kim SA, Kweon SS, Lee YH, Ryu SY, et al. Household and area income levels are associated with smoking status in the Korean adult population. BMC Public Health. 2015;15(1):39.PubMedCentralPubMedCrossRef
30.
Ministry of Health, Labour and Welfare. Survey of Medical Institutions. The System of Social and Demographic Statistics of Japan, Basic data of Shi, Ku, Machi, Mura by Statistics Bureau, Ministry of Internal Affairs and Communications. 2010.
31.
Merlo J, Chaix B, Yang M, Lynch J, Rastam L. A brief conceptual tutorial on multilevel analysis in social epidemiology: interpreting neighbourhood differences and the effect of neighbourhood characteristics on individual health. J Epidemiol Community Health. 2005;59(12):1022–8.PubMedCentralPubMedCrossRef
32.
Schempf AH, Kaufman JS. On the percent of excess risk explained. J Epidemiol Community Health. 2011;65(2):190.PubMedCrossRef
33.
Al-Haboubi M, Klass C, Jones K, Bernabe E, Gallagher JE. Inequalities in the use of dental services among adults in inner South East London. Eur J Oral Sci. 2013;121(3 Pt 1):176–81.PubMedCrossRef
34.
35.
Cummins S, Stafford M, Macintyre S, Marmot M, Ellaway A. Neighbourhood environment and its association with self rated health: evidence from Scotland and England. J Epidemiol Community Health. 2005;59(3):207–13.PubMedCentralPubMedCrossRef
36.
Morland K, Wing S, Diez Roux A, Poole C. Neighborhood characteristics associated with the location of food stores and food service places. Am J Prev Med. 2002;22(1):23–9.PubMedCrossRef
37.
Turrell G, Bentley R, Thomas LR, Jolley D, Subramanian S, Kavanagh AM. A multilevel study of area socio-economic status and food purchasing behaviour. Public Health Nutr. 2009;12(11):2074–83.PubMedCrossRef
38.
Forsyth A, Macintyre S, Anderson A. Diets for disease? Intraurban variation in reported food consumption in Glasgow. Appetite. 1994;22(3):259–74.PubMedCrossRef
39.
40.
Lula EC, Ribeiro CC, Hugo FN, Alves CM, Silva AA. Added sugars and periodontal disease in young adults: an analysis of NHANES III data. Am J Clin Nutr. 2014;100(4):1182–7.PubMedCrossRef
41.
42.
Chiou LJ, Yang YH, Hung HC, Tsai CC, Shieh TY, Wu YM, et al. The association of psychosocial factors and smoking with periodontal health in a community population. J Periodontal Res. 2010;45(1):16–22.PubMedCrossRef
43.
44.
Stafford M, Cummins S, Macintyre S, Ellaway A, Marmot M. Gender differences in the associations between health and neighbourhood environment. Soc Sci Med. 2005;60(8):1681–92.PubMedCrossRef
45.
Kavanagh AM, Bentley R, Turrell G, Broom DH, Subramanian SV. Does gender modify associations between self rated health and the social and economic characteristics of local environments? J Epidemiol Community Health. 2006;60(6):490–5.PubMedCentralPubMedCrossRef
46.
Riley JC, Lennon MA, Ellwood RP. The effect of water fluoridation and social inequalities on dental caries in 5-year-old children. Int J Epidemiol. 1999;28(2):300–5.PubMedCrossRef
47.
Watt RG. Social determinants of oral health inequalities: implications for action. Community Dent Oral Epidemiol. 2012;40 Suppl 2:44–8.PubMedCrossRef
48.
49.
Yamamoto T, Kondo K, Fuchida S, Aida J, Nakade M, Hirata Y. Validity of self-reported oral health variables: Aichi Gerontological Evaluation Study (AGES) project. Health Sci Health Care. 2012;12:4–12.
Metadata
Title
Individual- and community-level social gradients of edentulousness
Authors
Kanade Ito
Jun Aida
Tatsuo Yamamoto
Rika Ohtsuka
Miyo Nakade
Kayo Suzuki
Katsunori Kondo
Ken Osaka
for the JAGES group
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Oral Health / Issue 1/2015
Electronic ISSN: 1472-6831
DOI
https://doi.org/10.1186/s12903-015-0020-z

Other articles of this Issue 1/2015

BMC Oral Health 1/2015 Go to the issue

Research article

Oral findings in chronic kidney disease: implications for management in developing countries

Research article

Association of breastfeeding and three-dimensional dental arch relationships in primary dentition

Research article

One-year follow-up of Atraumatic Restorative Treatment(ART) for dental caries in children undergoing oncohematological treatment: a pragmatic trial

Research article

The prevalence and pattern of deciduous molar hypomineralization and molar-incisor hypomineralization in children from a suburban population in Nigeria

Research article

Using community participation to assess acceptability of “Contra Caries”, a theory-based, promotora-led oral health education program for rural Latino parents: a mixed methods study

Research article

Erosive esophageal reflux vs. non erosive esophageal reflux: oral findings in 71 patients