Department of Periodontology, Service of Odontology, Rothschild Hospital, AP-HP, Paris 7-Denis Diderot University, U.F.R. of Odontology, Paris, France.
PLoS One. 2011;6(7):e21508. doi: 10.1371/journal.pone.0021508. Epub 2011 Jul 21.
The impact of socioeconomic inequalities on health is well-documented. Despite the links of periodontal disease with cardiovascular diseases, adverse pregnancy outcomes and diabetes, no meta-analysis of socioeconomic variations in periodontal disease exists. This meta-analytic review was conducted to determine the extent to which education attainment influences risk of periodontitis in adults aged 35+ years in the general population.
The authors searched studies published until November 2010 using EMBASE and MEDLINE databases. References listed were then scrutinised, our own files were checked, and, finally, we contacted experts in the field. The authors included only general population-based studies conducted in adults aged 35 years and more. All articles were blind reviewed by two investigators. In the case of disagreement, a third investigator arbitrated. Using PRISMA statement, two reviewers independently extracted papers of interest.
Relative to the higher education group, people with low education attainment experience a greater risk of periodontitis (OR: 1.86 [1.66-2.10]; p<0.00001). The association was partially attenuated after adjustment for covariates (OR: 1.55 [1.30-1.86]; p<0.00001). Sensitivity analyses showed that methods used to assess periodontitis, definition of cases, study country and categorization of education are largely responsible for the heterogeneity between studies. No significant bias of publication was shown using both the Egger (p = 0.16) and rank correlation tests (p = 0.35).
In the studies reviewed, low educational attainment was associated with an increased risk of periodontitis. Although this evidence should be cautiously interpreted due to methodological problems in selected studies, efforts to eliminate educational inequalities in periodontitis should focus on early life interventions.
社会经济不平等对健康的影响已有充分的记录。尽管牙周病与心血管疾病、不良妊娠结局和糖尿病有关，但目前尚没有牙周病社会经济差异的荟萃分析。本荟萃分析旨在确定教育程度对 35 岁及以上人群牙周炎风险的影响程度。
作者使用 EMBASE 和 MEDLINE 数据库搜索截至 2010 年 11 月发表的研究。然后仔细审查参考文献、检查我们自己的文件，最后与该领域的专家联系。作者仅纳入了在 35 岁及以上成年人中进行的基于一般人群的研究。所有文章均由两位研究人员进行盲法审查。如果存在分歧，则由第三位研究人员进行仲裁。使用 PRISMA 声明，两位审查员独立提取感兴趣的论文。
与较高教育程度的人群相比，受教育程度较低的人群患牙周炎的风险更高（OR：1.86 [1.66-2.10]；p<0.00001）。调整协变量后，该关联部分减弱（OR：1.55 [1.30-1.86]；p<0.00001）。敏感性分析表明，用于评估牙周炎的方法、病例定义、研究国家和教育分类在很大程度上导致了研究之间的异质性。Egger 检验（p=0.16）和秩相关检验（p=0.35）均未显示出显著的发表偏倚。
在审查的研究中，低教育程度与牙周炎风险增加相关。尽管由于选定研究中的方法学问题，该证据应谨慎解释，但消除牙周炎教育不平等的努力应侧重于生命早期的干预。
