Association of childhood socioeconomic status with edentulism among Chinese in mid-late adulthood

The pathways from disadvantaged socioeconomic status in childhood to edentulism in mid-to-late adulthood over the life-course

BACKGROUND

This study aimed to examine the direct and indirect pathways from childhood socioeconomic status (SES) to the prevalence of edentulism in mid-to-late age Chinese individuals using structural equation modeling (SEM).

METHODS

This study analyzed data from 17,032 mid- to-late age Chinese individuals in the 2014 and 2015 China Health and Retirement Longitudinal Study (CHARLS). Childhood SES was determined based on the parents' education and occupation, financial situation of the family, primary residence, food availability, and medical convenience. Adulthood SES was established according to educational achievements of the individuals. Edentulism is defined as the loss of all natural teeth. SEM was used to examine the statistical significance of the association between childhood SES and edentulism, mediated by childhood health, adulthood SES, and adult health.

RESULTS

Childhood SES had significant indirect (β = -0.026, p < 0.01), and total (β = -0.040, p < 0.01) effects on edentulism. It was determined that 65% of the total effect of childhood SES on edentulism was indirect, and mainly mediated by adult SES. Also, the goodness-of-fit indices of the best-fitting model were acceptable.

CONCLUSION

This study revealed that childhood health, adult health and adult SES are mediators that explain the relationship between childhood SES and edentulism. The global attention to alleviate the inequality in edentulism should focus on exploring recommendations and intervention strategies from childhood to adulthood, by considering adult SES, childhood and adult health.

Long-term trends in the burden of edentulism in China over three decades: A Joinpoint regression and age-period-cohort analysis based on the global burden of disease study 2019

Background

To investigate secular trends in edentulism incidence, prevalence, and years lived with disability (YLDs) rates in Chinese men and women from 1990 to 2019.

Methods

Data were obtained from the Global Burden of Disease Study 2019. The annual percentage change and average annual percentage change were calculated using Joinpoint regression analysis. The age-period-cohort (APC) analysis estimated the independent age, period, and cohort effects.

Results

From 1990 to 2019, the crude incidence, prevalence, and YLDs of edentulism in the Chinese population increased year by year, while the age-standardized incidence, prevalence, and YLDs decreased, and the latter was higher in women than in men. The APC analysis showed that the age effect increased in men and women from age 20 to 74 and decreased thereafter. The risk of tooth loss increased with age. However, the relationship was not linear. The temporal effect showed a gradual increase; the risk of missing teeth gradually increased with the changing modern living environment. The cohort effect showed a single decreasing trend, with the early birth cohort having a higher risk of tooth loss than the later birth cohort population. The age, period, and cohort effects were consistent for both sexes.

Conclusion

Although the standardized incidence, prevalence, and YLD rate and cohort effect of dentition loss in China are declining, they are still causing a severe burden to China due to the continued aging of the population and the rising period effect. Despite the decreasing trends of the standardized incidence and prevalence of dentition loss and the rate of YLDs, China should develop more effective oral disease prevention and control strategies to reduce the increasing burden of edentulism in the older adult, especially in older women.

Adverse Childhood Experiences and Oral Health Conditions Among Middle-aged and Older Chinese Adults: Exploring the Moderating Roles of Education and Gender

This study aims to examine whether adverse childhood experiences (ACEs) are associated with oral health conditions (denture use, difficulty in chewing, and edentulism) among middle-aged and older adults in China and if gender and adulthood education moderate the associations. Data were obtained from the 2014 and 2018 surveys from the China Health and Retirement Longitudinal Study (N = 17,091) and logistic regressions were carried out. Results show that childhood hunger (OR = 1.12), loneliness (OR = 1.10) and family relations (OR = 1.07) were significantly associated with higher odds of denture use and there were significant associations between hunger (OR = 1.16) and difficulty in chewing. For the female subsample, education significantly moderated the adverse effect of childhood hunger on denture use and difficulty in chewing. Findings suggest that ACEs have long-lasting impacts on oral health conditions in later life and adulthood education might offer critical resources for females, helping them buffer the detrimental health impacts of ACEs.

Childhood socioeconomic status and adulthood dietary diversity among Indonesian adults

Food insecurity problems still exist among people in low-to-middle income countries. The long-term disadvantages of socioeconomic status may contribute to chronic food insecurity. However, whether childhood socioeconomic status factors are related to food insecurity in adulthood remains unclear. Thus, the aim of this study was to test the association between childhood socioeconomic status factors and one of the proxies for adulthood food security, dietary diversity. This study used the 2014 RAND Indonesia Family Life Survey dataset with 22,559 adult participants as study samples. The childhood socioeconomic status factors consisted of 16 questions about the participants’ conditions when they were 12 years old. Adult dietary diversity was assessed using the United Nations World Food Programme’s food consumption score. A linear regression model was used to analyze the association between variables. This study found that the number of owned books (β coef.: 3.713–7.846, p < 0.001), the use of safe drinking-water sources (β coef.: 0.707–5.447, p < 0.001–0.009) and standard toilets (β coef.: 1.263–4.955, p < 0.001–0.002), parents with the habit of alcohol consumption (β coef.: 2.983, p = 0.044) or the combination with smoking habits (β coef.: 1.878, p < 0.001), self-employed with the permanent worker (β coef.: 2.904, p = 0.001), still married biological parents (β coef.: 1.379, p < 0.001), the number of rooms (β coef.: 0.968, p < 0.001), people (β coef.: 0.231, p < 0.001), and younger siblings (β coef.: 0.209–0.368, p < 0.001–0.039) in the same house were positively and significantly associated with the outcome variable. Furthermore, in the order of childhood socioeconomic status factors, self-employment without permanent workers and casual work types (β coef.: –9.661 to –2.094, p < 0.001–0.001), houses with electricity facilities (β coef.: –4.007, p < 0.001), and parents with smoking habits (β coef.: –0.578, p = 0.006) were negatively and significantly associated with the food security proxy. In conclusion, childhood and early socioeconomic disadvantage is related to adult food security status and may lead to poor health.

Edentulism and select chronic diseases among adults aged ≥45 years in China, 2011-2018: A longitudinal study

OBJECTIVES

Information on the association between edentulism and chronic medical conditions in developing countries is lacking. We investigated such information among adults aged ≥45 years in China.

METHODS

A national longitudinal data set from the China Health and Retirement Longitudinal Study (CHARLS) 2011-2018 was analysed. A multilevel logistic regression model was applied to analyse the association between edentulism and select chronic diseases.

RESULTS

There were 74 240 Chinese adults aged ≥45 years in this study. The prevalence of self-reported edentulism was 8.8% in 2011 and had increased to 16.4% by 2018.

CONCLUSION

Edentulism was a factor associated with a higher risk of various self-reported chronic diseases among adults aged ≥45 years in China. Edentulism is one of the comorbidities among ageing people with chronic conditions. Preventive public health policy should consider controlling shared risk factors at an earlier age.

Social Mobility and Tooth Loss: A Systematic Review and Meta-analysis

This study systematically reviews the evidence of the association between life course social mobility and tooth loss among middle-aged and older people. PubMed, Scopus, Embase, and Web of Science were systematically searched in addition to gray literature and contact with the authors. Data on tooth loss were collated for a 4-category social mobility variable (persistently high, upward or downward mobility, and persistently low) for studies with data on socioeconomic status (SES) before age 12 y and after age 30 y. Several study characteristics were extracted to investigate heterogeneity in a random effect meta-analysis. A total of 1,384 studies were identified and assessed for eligibility by reading titles and abstracts; 21 original articles were included, of which 18 provided sufficient data for a meta-analysis with 40 analytical data sets from 26 countries. In comparison with individuals with persistently high social mobility, the pooled odds ratios (ORs) for the other categories were as follows: upwardly mobile, OR = 1.73 (95% CI, 1.53 to 1.95); downwardly mobile, OR = 2.52 (95% CI, 2.19 to 2.90); and persistently low, OR = 3.96 (95% CI, 3.13 to 5.03). A high degree of heterogeneity was found(I² > 78%), and subgroup analysis was performed with 17 study-level characteristics; however, none could explain heterogeneity consistently in these 3 social mobility categories. SES in childhood and adulthood is associated with tooth loss, but the high degree of heterogeneity prevented us from forming a robust conclusion on whether upwardly or downwardly mobile SES may be more detrimental. The large variability in effect size among the studies suggests that contextual factors may play an important role in explaining the difference in the effects of low SES in different life stages (PROSPERO CRD42018092427).

Life-course pathways from childhood socioeconomic status to type 2 diabetes in mid-late Chinese adulthood

The relationship between childhood socioeconomic status (SES) and type 2 diabetes (T2D) remains inconclusive, and the pathways and mechanisms driving this relationship have yet to be clarified. This study aimed to examine the pathways linking childhood SES to T2D prevalence in mid-late adulthood in a low- and middle-income country. The incidence of T2D diagnosed in mid-late Chinese adulthood was assessed using self-reports from the Health and Retirement Longitudinal Study (CHARLS). Childhood SES was assessed by the education, occupation, survivorship of the parents and the financial situation of the family, whereas adulthood SES was assessed by education and wage. This study performed structural equation modeling to clarify the direct and indirect pathways from childhood SES to T2D via childhood health, childhood food shortage, adulthood SES and physical activity. A total of 15,132 participants were included, and the prevalence of T2D was 5.24%. This study found that childhood SES was directly associated with T2D in mid-late adulthood, the probability of developing T2D increased by 9.20% of the standard deviation for each decrease in standard deviation in childhood SES. Childhood SES was indirectly associated with T2D via adulthood SES, physical activity, childhood health and food shortage. Adulthood SES and physical activity mainly mediated the indirect pathway from childhood SES and T2D. This study showed direct and indirect pathways from disadvantaged childhood SES to increased risk of T2D in mid-late Chinese adulthood. Childhood SES, adulthood SES, physical activity, childhood health and food shortage were identified as life-course interventional targets that should be considered in the development of effective strategies to reduce the burden of T2D and SES-related health inequities in childhood.