Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, North East England, UK.
Department of Primary Care and Population Health, UCL, London, UK.
J Dent Res. 2024 Apr;103(4):434-441. doi: 10.1177/00220345231224337. Epub 2024 Feb 27.
The aim of this study was to examine the extent to which neighborhood-level socioeconomic factors (objective and perceived) are associated with poor oral health in older adults over time, independent of individual socioeconomic position. Data for this cross-sectional and longitudinal observation study came from a socially and geographically representative cohort of men aged 71 to 92 y in 2010-12 ( = 1,622), drawn from British general practices, which was followed up in 2018-19 (aged 78-98 y; = 667). Dental measures at both times included number of teeth, periodontal pocket depth, self-rated oral health, and dry mouth. Neighborhood deprivation was based on Index of Multiple Deprivation (IMD) and a cumulative index measuring perceptions about local environment. Individual-level socioeconomic position was based on longest-held occupation. Multilevel and multivariate logistic regressions, adjusted for relevant sociodemographic, behavioral, and health-related factors, were performed to examine the relationships of dental measures with IMD and perceived neighborhood quality index, respectively. Cross-sectionally, risks of tooth loss, periodontal pockets, and dry mouth increased from IMD quintiles 1 to 5 (least to most deprived); odds ratios (ORs) for quintile 5 were 2.22 (95% confidence interval [CI], 1.41-3.51), 2.82 (95% CI, 1.72-4.64), and 1.51 (95% CI, 1.08-2.09), respectively, after adjusting for sociodemographic, behavioral, and health-related factors. Risks of increased pocket depth and dry mouth were significantly greater in quintile 5 (highest problems) of perceived neighborhood quality index compared to quintile 1. Over the 8-y follow-up, deterioration of dentition (tooth loss) was significantly higher in the most deprived IMD quintiles after full adjustment (OR for quintile 5 = 2.32; 95% CI, 1.09-4.89). Deterioration of dentition and dry mouth were significantly greater in quintile 5 of perceived neighborhood quality index. Neighborhood-level factors were associated with poor oral health in older age, both cross-sectionally and longitudinally, particularly with tooth loss, and dry mouth, independent of individual-level socioeconomic position.
本研究旨在考察在个体社会经济地位之外，随着时间的推移，邻里层面的社会经济因素（客观和主观）与老年人较差的口腔健康之间的关联程度。这项横断面和纵向观察研究的数据来自于一个社会和地理代表性的男性队列，年龄在 71 至 92 岁之间，来自于 2010-12 年的英国普通诊所（n=1622），并在 2018-19 年进行了随访（年龄 78-98 岁；n=667）。两次的口腔测量包括牙齿数量、牙周袋深度、自我评估的口腔健康和口干。邻里剥夺程度基于多指标剥夺指数（IMD）和衡量对当地环境感知的累积指数。个体层面的社会经济地位基于最长持有的职业。进行多水平和多变量逻辑回归分析，调整了相关的社会人口统计学、行为和健康相关因素，以分别检验口腔测量指标与 IMD 和感知邻里质量指数的关系。在横截面上，牙齿缺失、牙周袋和口干的风险从 IMD 五分位数 1 到 5（最贫困到最富裕）逐渐增加；五分位数 5 的比值比（OR）分别为 2.22（95%置信区间 [CI]，1.41-3.51）、2.82（95% CI，1.72-4.64）和 1.51（95% CI，1.08-2.09），在调整了社会人口统计学、行为和健康相关因素后。与五分位数 1（问题最少）相比，感知邻里质量指数五分位数 5（问题最多）的牙周袋深度和口干的风险显著更高。在 8 年的随访中，在充分调整后，最贫困的 IMD 五分位数（OR 为 5=2.32；95%CI，1.09-4.89）的牙齿恶化（牙齿缺失）发生率明显更高。在感知邻里质量指数的五分位数 5 中，牙齿恶化和口干的情况明显更为严重。邻里层面的因素与老年人较差的口腔健康有关，无论是在横断面还是纵向研究中，特别是与牙齿缺失和口干有关，而与个体层面的社会经济地位无关。
