Hong J, Watt R G, Tsakos G, Heilmann A
Department of Epidemiology and Public Health, University College London, London, UK.
National Institute for Health Research Applied Research Collaboration West, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
JDR Clin Trans Res. 2025 Apr;10(2):169-179. doi: 10.1177/23800844241297533. Epub 2024 Dec 9.
We investigated associations between socioeconomic position (SEP) across childhood, adulthood, and older age and number of teeth among Chinese older adults.
Data came from 15,136 participants aged 65 to 105 y in the Chinese Longitudinal Healthy Longevity Survey (2018 wave). The outcome was number of teeth. Pathways and sensitive period models were tested simultaneously via structural equation modeling. Ordinal logistic regression assessed the accumulation of risk and social mobility models. Differences were examined across 4 birth cohorts.
Adult and older age SEP had direct effects on number of teeth in older age (adulthood, direct β = 0.182, < 0.001; older age, direct β = 0.093, = 0.005), supporting the sensitive period model. Childhood SEP had an indirect effect on number of teeth (indirect β = 0.130, < 0.001) through adult and older age SEP, supporting the pathway/accumulation of risk and social mobility models. Effects of SEP on number of teeth were more pronounced in younger cohorts. Graded associations in the expected directions were found between the number of periods in which participants experienced disadvantaged SEP and number of teeth, as well as social mobility trajectories and number of teeth.
Among Chinese older adults, the number of remaining teeth is subject to marked social inequalities. Our findings document the simultaneous applicability of life course models and a widening of oral health inequalities in China across generations. Interventions earlier in child and adult life are needed to address this problem and reduce oral health inequalities.Knowledge Transfer Statement:The findings of this study suggest marked socioeconomic inequalities in oral health among Chinese older adults. These inequalities are generated throughout the life course and appear to have widened across cohorts. This study emphasizes that interventions are needed to address the social determinants of oral health at all life stages.
我们研究了中国老年人在童年、成年和老年时期的社会经济地位（SEP）与牙齿数量之间的关联。
数据来自中国健康与养老追踪调查（2018年）的15136名65至105岁的参与者。结果变量为牙齿数量。通过结构方程模型同时检验路径模型和敏感期模型。有序逻辑回归评估风险累积模型和社会流动模型。对4个出生队列的差异进行了检验。
成年期和老年期的SEP对老年时期的牙齿数量有直接影响（成年期，直接β = 0.182，P < 0.001；老年期，直接β = 0.093，P = 0.005），支持敏感期模型。童年期SEP通过成年期和老年期SEP对牙齿数量有间接影响（间接β = 0.130，P < 0.001），支持路径/风险累积模型和社会流动模型。SEP对牙齿数量的影响在较年轻队列中更为明显。在参与者经历不利SEP的时期数量与牙齿数量之间，以及社会流动轨迹与牙齿数量之间，发现了预期方向的分级关联。
在中国老年人中，剩余牙齿数量存在明显的社会不平等。我们的研究结果证明了生命历程模型的同时适用性，以及中国各代人之间口腔健康不平等的扩大。需要在儿童和成年早期进行干预，以解决这一问题并减少口腔健康不平等。知识转移声明：本研究结果表明，中国老年人在口腔健康方面存在明显的社会经济不平等。这些不平等在整个生命历程中产生，并且在各队列中似乎有所扩大。本研究强调，需要在生命的各个阶段进行干预，以解决口腔健康的社会决定因素。
