Life course socioeconomic inequalities and oral health status in later life: ELSI-Brazil

Evaluating socioeconomic inequalities in self-rated oral health and its contributing factors in Brazilian older adults

OBJECTIVES

This study aimed to evaluate socioeconomic inequalities in self-reported oral health among community-dwelling Brazilian older adults and evaluate the oral health factors contributing to the inequalities.

METHODS

This was a cross-sectional study with data from the Brazilian National Health Survey conducted in 2019. The dependent variable is the self-report of oral health categorized as good or poor. Household per capita income in quintiles and schooling were used as socioeconomic variables. The explanatory covariates were age; gender; limitation in basic activities of daily living; number of teeth, use of dental prostheses; difficulty in eating; and recent dental visit. The Oaxaca-Blinder two-fold decomposition for binary outcomes was used to evaluate the factors contributing to the inequalities in self-reported oral health.

RESULTS

Self-reported poor oral health was found among 35.8% of the dentate and 29.6% of the edentulous individuals. Poor self-reported oral health was more prevalent among older adults with low income and educational levels. Among dentate individuals, the difference in the proportion of poor self-reported oral health (the gap) between those with no schooling and those with some schooling was 12.8 percent points (p.p.), favoring the poor. The gap between dentate in the lowest and highest income groups was 14.8 p.p. favoring the poor. Among edentulous individuals, those with no schooling had a higher proportion of self-reported oral health (total gap 10.6 p.p.). Concerning income inequalities, the gap favored the poorer group and was 5.4 p.p. higher among individuals in the lowest income group.

CONCLUSION

The decomposition analyses suggested that oral health variables explained most of the education and income inequalities; difficulties in eating were the most contributing factor in both the dentate and edentulous groups. There was a relatively reduced contribution of recent dental visits to socioeconomic inequality.

Tooth loss from the perspective of studies employing a life course approach: a systematic review

The life course approach scrutinizes factors that shape the development of diseases over time. Tooth loss, which is influenced by social, behavioral and biological factors, can occur at various stages of life and tends to become more prevalent in later years. This systematic review examined the influence of socioeconomic, psychosocial, biological and behavioral adversities in life on the likelihood of tooth loss. Searches were conducted in the Embase, PubMed, Web of Science, Ovid, PsycINFO, Scopus and LILACS databases. Reference management was performed using EndNote online. The risk of bias was appraised using the Newcastle-Ottawa Scale (NOS). The electronic searches yielded 1366 records, 17 of which (13 cohort and four cross-sectional studies) met the inclusion criteria. According to the NOS, all studies had a low risk of bias. Two studies found a link between a lower education and higher incidence of tooth loss and socioeconomic status exerted a significant influence in 47% of the studies. Disadvantaged socioeconomic trajectories and health-related factors, such as smoking, general health perception and oral health behaviors, increased the likelihood of tooth loss. Factors such as dental visits, a history of toothache and exposure to fluoridated water influenced the likelihood of tooth loss. Individuals who experienced adversities in socioeconomic, behavioral and biological aspects throughout their life course were more prone to tooth loss.

Preventive dental service use and oral health-related quality of life in Brazilian older adults

BACKGROUND

Information on the use of preventive dental services and associated variables is needed to guide policy for the old adult population and consequently promote better oral health-related quality of life (OHRQoL).

OBJECTIVE

To investigate the association between preventive dental service use and OHRQoL by older Brazilians.

MATERIALS AND METHODS

This cross-sectional study was carried out using the baseline data of participants of the Brazilian Longitudinal Stud of Aging (ELSEI-Brazil) who were aged 60 years or more. Associations with the use of preventive dental services were carried out using Poisson regression models with robust variance, adjusting for confounders.

RESULTS

The final sample consisted of 5432 older adults. Almost all (90.7%) participants reported not having sought preventive dental services in the last year. Individuals who used dental services for prevention had fewer impacts on their OHRQoL (RR: 0.74; [95% CI: 0.57-0.97]).

CONCLUSION

Preventive dental service use is associated with a better OHRQoL in older Brazilians. Policies to improve access to preventive dental services may result in improved OHRQoL in this age group.

Age-group-specific association of oral health and systemic health on cognitive function: a cross-sectional study of Korean elders

BACKGROUND

Although the importance of oral and systemic healthcare for elderly people is increasing owing to the rapid ageing of the population in South Korea, studies on the relationship between oral health, systemic health, and cognitive function, as well as on the prediction of cognitive function by oral and systemic health depending upon age groups are lacking.

METHODS

We included 5,975 out of 6,488 participants from the 8th wave of the Korean Longitudinal Study of Aging (KLoSA) panel data, divided the participants into three age groups, and performed a hierarchical multiple linear regression analysis to explain cognitive function with four types of predictors: oral health status, sociodemographic factors, objective health status, and subjective health status.

RESULTS

Oral health status was positively correlated with systemic health status and cognitive function. Of all ages over 54, cognitive function was significantly predicted by oral health variables, such as the number of functional teeth, masticatory ability, and Geriatric Oral Health Assessment Index (GOHAI); sociodemographic variables, such as age, sex, education level, and residence; and systemic health variables, such as diagnosis of diabetes mellitus, cancer or malignant tumours, cerebrovascular disease and rheumatoid arthritis, depressive symptom, and self-rated health status. Oral health variables explained cognitive function differently by age group; GOHAI appeared important predictor in the group aged < 75 years, whereas the number of functional teeth did in the group aged ≥ 75 years. Educational level, masticatory ability, depressive symptoms, and self-rated health status were pivotal factors age-independently.

CONCLUSIONS

The general and age-group-specific association between oral health, systemic health, and cognitive function were confirmed, suggesting that age-group-specific oral healthcare should be emphasized for the effective management of systemic and cognitive health in the elderly group.

The mediating role of social capital in socioeconomic inequalities of oral health behaviours among Brazilian older adults

OBJECTIVES

Knowledge of the possible pathways linking socioeconomic status (SES) to oral health-related behaviours can improve the understanding of inequalities in oral health. Therefore, in this study, it was investigated whether social capital mediates the relationship between SES and oral health behaviours.

METHODS

Through a cross-sectional study, data were analysed from participants aged ≥60 years from the Brazilian National Health Survey 2019 (n = 21 575). Structural equation modelling was used to test the direct and indirect pathways from a latent variable for SES to a latent variable for oral health behaviours: daily flossing, toothbrushing frequency and the use of dental care services.

RESULTS

The maximum likelihood estimator was used for complex samples with robust standard errors, and the final model demonstrated an adequate fit. The findings demonstrated that a higher SES was directly associated with better oral health-related behaviours (standardized coefficient [SC]: 0.82; [90% CI: 0.78-0.85]) and indirectly via structural social capital (SC: 0.05; [90% CI: 0.02-0.07]). The total effect of SES on oral health-related behaviours was (SC: 0.87, [90% CI: 0.85-0.89]).

CONCLUSION

The findings demonstrate that structural social capital in older Brazilian adults might partly mediate the pathways to socioeconomic inequalities in oral health behaviours. However, there is a direct effect on oral health behaviours, reinforcing the hypothesis that SES is associated with oral health, based on paths that link income inequality to oral health.

Social capital and dental service use in older Brazilians

OBJECTIVES

To estimate the prevalence of dental services use and its association with social capital among Brazilian older adults.

BACKGROUND

Health inequities can be explained by the social determinants of health, which are the social, environmental, cultural and behavioural factors that directly or indirectly affect people's health. Among these determinants is social capital, that seem to affect health behaviours, such as use of dental services among older adults.

MATERIALS AND METHODS

This was a cross-sectional study using baseline data from the Longitudinal Study of the Health of the Brazilian Elderly, nationally representative of people aged 50 years or older. The baseline survey was carried out between 2015 and 2016, using structured questionnaires. The dependent variable was use of dental services in the last year. The main exposure variable was social capital, assessed through two dimensions: structural and cognitive. The covariates used were sex, skin colour, age, education, wealth, need for dental treatment, self-perception of oral health, tooth loss, type of dental services used, reason for dental care, smoking and alcohol consumption. Descriptive analyses and Poisson regression modelling were used.

RESULTS

The sample consisted of 9323 individuals. The prevalence of dental services use was 32.6% (95% CI: 30.7-34.5). No associations were found between social capital and the use of dental services.

CONCLUSION

This study did not find an association between structural and cognitive social capital and dental services use in Brazilian older adults. Further researches using instruments with different assessments of social capital are needed.

Difference in the prevalence of hypertension and its risk factors depending on area-level deprivation in Japan

Objectives

Area-level deprivation is an important factor related to mortality or health behaviors; however, a study investigating differences in hypertension prevalence depending on area-level deprivation has not been conducted in Japan. We investigated differences in the prevalence of hypertension and its risk factors, i.e. obesity, smoking, alcohol consumption, and heavy alcohol drinking depending on area-level deprivation using nationwide health checkups data in 2018.

Results

Area-level deprivation was derived from census data. An analysis of the data by secondary medical areas revealed that the age-standardized proportions of individuals whose systolic blood pressure was ≥ 140 mmHg, those whose diastolic blood pressure was ≥ 90 mmHg, those whose body mass index was ≥ 25 or 30 kg/m², smokers, and heavy alcohol drinkers showed an increasing trend with an increase in the deprivation level. The relative index of inequality, which can be interpreted as the ratio of the age-standardized proportion for the most deprived area compared with that for the least deprived area, was significantly greater than 1 for all proportions, except for the proportion of drinkers in women. Overall, there was a disparity in the prevalence of hypertension and its risk factors depending on area-level deprivation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13104-022-05931-6.

Measuring health inequalities: implications of choosing different socioeconomic indicators

We aimed to verify the association between different socioeconomic indicators and self-rated health in a nationally representative sample of older adults. This cross-sectional study analyzed the baseline data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil), a population-based cohort study of persons aged 50 years or older. Data was collected using a household and an individual questionnaire at participants' households. Self-rated health was assessed by a global self-rating item. Three socioeconomic indicators were assessed: individual income, per capita household income, and wealth index. Poisson regression models were performed to estimate the prevalence ratio (PR) and 95% confidence intervals (95%CI) of self-rated health and each socioeconomic indicator, adjusting for covariates. In total, 9,390 older adults answered the outcome question. Whilst for the individual income indicator only the richest quintile showed a statistically significant association with the outcome (PR: 0.90; 95%CI: 0.87; 0.93), for the per capita household income, the fourth (PR: 0.95; 95%CI: 0.91; 0.98) and the fifth quintiles (PR: 0.90; 95%CI: 0.86; 0.94) remained associated with the outcome. Regarding the wealth index, only the second quintile was not associated with the outcome, with lower prevalence of poor self-rated health as richer was the quintile, showing a social gradient. The wealth index seems to be a more adequate indicator, as it reflects resources accumulated over the life course.

Tooth loss, dental prostheses use and cognitive performance in older Brazilian adults: The SABE cohort study

AIM

To investigate the within- and between-person longitudinal effects of tooth loss and the use of dentures, clinically assessed by dentists, on cognitive decline in a representative sample of community-dwelling older Brazilian adults.

METHODS

Data came from 1265, 1112 and 1021 individuals aged ≥60 years who participated in the second (2006), third (2010) and fourth (2015) waves, respectively, of the Health, Well-being and Aging study (SABE). Cognitive performance was evaluated with the abbreviated version of the Mini-Mental State Examination (MMSE). The number of natural teeth was classified according to three categories: none, 1-19 and ≥20 teeth. The presence of removable full or partial dentures in each dental arch (yes/no) was recorded. Hybrid regression models, adjusted for sociodemographic, behavior and health-related covariates, were used to estimate the between- and within-person effects of the longitudinal association between cognitive performance and oral health.

RESULTS

Participants with 1-19 and no teeth had, respectively, 1.15 (95% CI 0.65-1.66) and 1.54 (95% CI 0.99-2.09) units lower MMSE score than those with ≥20 teeth. Denture wearers had 1.54 (95% CI 1.13-1.95) units greater MMSE score than non-denture wearers, and those who started wearing dentures during the follow up had 0.83 (95% CI 0.21-1.45) units greater MMSE score after the transition.

CONCLUSION

Our main findings showed that the use of dental prostheses might be a protective factor for cognitive decline. Geriatr Gerontol Int 2021; 21: 1093-1098.

Individual social capital and dental pain in older adults

OBJECTIVES

To investigate the association between the structural and cognitive dimensions of social capital and dental pain in Brazilian adults aged 50 years and over.

METHODS

This cross-sectional study conducted individual assessments of 6154 Brazilians aged 50 years or older. Four individual variables based on structural and cognitive dimensions of social capital were assessed. We used hierarchical logistic regression models to estimate the odds ratio for dental pain with individual structural and cognitive social capital variables adjusted for associated factors. The model followed hypothetical pathways linking social capital to oral health.

RESULTS

Cognitive social capital was associated with dental pain. Participants who did not trust their neighbourhood had a 28% greater chance (OR, 1.28; 95% CI, 1.02-1.60) of dental pain than those who did.

CONCLUSION

Elements of cognitive dimension of social capital, particularly trust, reciprocity and support, as part of a common risk factor approach, should be considered when planning oral health promotion and preventive activities for older people.

Impact of adopting different socioeconomic indicators in older adults' oral health research

This study aimed to evaluate the influence of choosing different socioeconomic status indicators in research regarding older adults' oral health. This is a cross-sectional study that analyzed baseline data from the Brazilian Longitudinal Study on Aging (ELSI-Brazil). The outcomes were edentulism (n = 9,073) and self-reported oral health (n = 9,365). The following socioeconomic indicators were assessed: individual income, per capita household income, and wealth index. Poisson regression analysis with robust variance was performed to estimate prevalence ratios (PR), with their respective 95% confidence intervals (CI), after adjusting for socioeconomic and oral health behavior variables. Absolute inequality measures were also estimated. The individual income indicator was not statistically associated with the results after adjustments. When using per capita household income indicator, individuals in the richest quintile showed a 12% lower prevalence of poor self-reported oral health [PR: 0.88 (CI: 0.78-0.98)], relative to the poorest, and there was no association with edentulism. When the wealth index was chosen, there was a 22% lower prevalence of edentulism [PR: 0.78 (CI: 0.64-0.94)] and 15% lower prevalence of self-reported poor oral health [PR: 0.85 (CI: 0.78-0.93)] in individuals of the richest quintile, both relative to the poorest quintile. Regarding absolute inequality measures, for edentulism, the wealth index showed the highest absolute inequality. When considering self-reported oral health, per capita household income showed the greatest absolute inequality. Despite scientific challenges and the difficulty of socioeconomic indicator metrics, further investments in its development are critical to measure, promote, and improve population oral health.

Social capital and self-reported oral health at baseline of the brazilian longitudinal study of aging

OBJECTIVES

This cross-sectional study aimed to estimate the association between the structural and cognitive dimensions of social capital and self-reported oral health.

METHODS

This study conducted individual assessments of 9,365 individuals aged 50 years or older from Brazil. Four individual variables based on structural and cognitive dimensions of social capital were assessed. We used hierarchical Poisson regression models to estimate the prevalence ratio of self-reported oral health with individual structural and cognitive social capital variables adjusted for associated factors.

RESULTS

Cognitive social capital was associated with self-reported oral health. Individuals who reported lack of neighbourhood trust and not having friends presented 14% (RP: 1.14; 95% CI: 1.07-1.21) and 9% (RP: 1.09; 95% CI: 1.01-1.19), respectively, higher prevalence of poor self-reported oral health, relative to those who trust in their neighbourhood and reported having friends.

CONCLUSION

The cognitive dimension of social capital may be linked with self-reported oral health. Therefore, social capital can be stimulated in the context of social policies as its encouragement can be an efficient tool for improving individuals' health and, consequently, the oral health of the older people.

Factors Related to Oral Healthcare Service Utilization among Korean Adults Aged 25-79 Years

The factors related to oral healthcare service utilization (OHSU) among Korean adults aged 25-79 years were assessed using the Andersen model with the sixth Korean National Health and Nutrition Examination Survey data. The study included 12,937 participants aged 25-79 years who answered questions on the predisposing, enabling, and need factors related to OHSU at dental clinics within the past 1 year. Age, sex, and education level were selected as predisposing factors; household income, residence region, and national and private health insurance status as enabling factors; and self-perceived oral health, dental pain, chewing status, and discomfort while speaking as need factors. These factors were assessed using multivariable complex logistic regression models. OHSU at dental clinics within the past 1 year was lower among less-educated participants, those with low, middle-low, and middle-high household income levels, rural participants, those benefiting from the Medicaid system, and non-insured participants. OHSU was higher among older participants, those who rated their self-perceived oral health status as bad, those with experience of dental pain, and those who experienced discomfort while chewing and speaking. The need factors were the most influential. Thus, interventions to reduce inequalities in OHSU are required to promote oral health for all.

Life expectancy with negative physical oral health impact on quality of life in older adults

Abstract: Oral impairments can affect overall health and life expectancy in older adults. Our study evaluates the life expectancy with negative physical oral health impact on quality of life (POHIQoL) among older adults. Life expectancy with negative POHIQoL was estimated by the Sullivan method, using the prevalence of POHIQoL - obtained in the Health, Well-being and Ageing (SABE Study); and official mortality data for adults aged 60 years or older living in São Paulo, Brazil. Between 2000 and 2010, negative POHIQoL increased from 23.4% (95%CI: 20.2-26.9) to 30.4% (95%CI: 27.0-34.3) among older adults; total life expectancy increased from 22 and 17.5 to 23.7 and 19.4 years among 60-year-old women and men, respectively; and the proportion of remaining years to be lived with negative POHIQoL increased from 25.1% to 32.1% for the same age group. In both years, individuals aged 60 years with lower education level were expected to live more years with negative POHIQoL when compared with the most schooled ones (2000: 15.9 [95%CI: 15.0-16.8] vs. 14.3 [95%CI: 13.7-14.8]; 2010: 16.3 [95%CI: 15.1-17.4] vs. 14.1 [95%CI: 13.2-15.1]). Similarly, women were expected to live more years with negative POHIQoL than men. Within ten years, life expectancy with negative POHIQoL increased, as well as the existence of inequalities in sex and education level among Brazilian older adults. Expansion in coverage and focus on equity in dental care are still necessary to overcome persistent dental-related problems and inequalities and, therefore, contribute to healthy ageing.

Out-Of-Pocket Expenditures on Dental Care for Schoolchildren Aged 6 to 12 Years: A Cross-Sectional Estimate in a Less-Developed Country Setting

Aim: The objective of this study was to estimate the Out-Of-Pocket Expenditures (OOPEs) incurred by households on dental care, as well as to analyze the sociodemographic, economic, and oral health factors associated with such expenditures. Method: A cross-sectional study was conducted among 763 schoolchildren in Mexico. A questionnaire was distributed to parents to determine the variables related to OOPEs on dental care. The amounts were updated in 2017 in Mexican pesos and later converted to 2017 international dollars (purchasing power parities-PPP US $). Multivariate models were created: a linear regression model (which modeled the amount of OOPEs), and a logistic regression model (which modeled the likelihood of incurring OOPEs). Results: The OOPEs on dental care for the 763 schoolchildren were PPP US $53,578, averaging a PPP of US $70.2 ± 123.7 per child. Disbursements for treatment were the principal item within the OOPEs. The factors associated with OOPEs were the child's age, number of dental visits, previous dental pain, main reason for dental visit, educational level of mother, type of health insurance, household car ownership, and socioeconomic position. Conclusions: The average cost of dental care was PPP US $70.2 ± 123.7. Our study shows that households with higher school-aged children exhibiting the highest report of dental morbidity-as well as those without insurance-face the highest OOPEs. An array of variables were associated with higher expenditures. In general, higher-income households spent more on dental care. However, the present study did not estimate unmet needs across the socioeconomic gradient, and thus, future research is needed to fully ascertain disease burden.