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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 10  |  Issue : 4  |  Page : 183-186

Association of low socioeconomic status and limited dental health-care access on poor oral health outcomes among United States adults


1 School of Public Health at Georgia State University, Atlanta, Georgia, USA
2 Rutgers University School of Public Health, Newark, New Jersey, USA
3 Department of Otolaryngology, Emory University Hospital Midtown, Atlanta, Georgia, USA
4 Periodontist and President at Gujarat State Dental Council, Ahmedabad, Gujarat, India

Date of Submission27-Jun-2019
Date of Acceptance11-Oct-2019
Date of Web Publication22-Jan-2020

Correspondence Address:
Dr. Apexa B Patel
School of Public Health, Georgia State University, Atlanta
USA
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DOI: 10.4103/srmjrds.srmjrds_46_19

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  Abstract 

Objective: The objective was to examine the association of having poor oral health-care access and low socioeconomic status on poor oral health outcomes such as gingivitis/periodontitis and severe periodontitis in United States (US) adults.
Methods: A cross-sectional analysis of 4745 US adults 30 years and older from the National Health and Nutrition Examination Survey (NHANES) 2015–2016 was done. Poor oral health outcomes were determined by the response of the respondents to the questionnaire. Logistic and regression analyses were used to determine the association of having poor oral health-care access and low socioeconomic status on poor oral health outcomes. To take into account the complex survey sampling methods, all the analyses were weighted.
Results: This research study found an increased association between limited dental health-care access and poor oral health outcomes such as gingivitis/periodontitis and severe periodontitis among US adults aged 30 years and older. The low socioeconomic status and severe periodontitis results of the unadjusted model of the regression analysis suggest that people who belong to the low socioeconomic group were less likely to have severe periodontitis than people who belong to the high socioeconomic group. In all the other regression models, low socioeconomic status did not have a significant association with poor oral health outcomes such as gingivitis/periodontitis and severe periodontitis.
Conclusion: On analyzing the NHANES 2015–2016 data, an increased association between limited dental health-care access and poor oral health outcomes such as gingivitis/periodontitis and severe periodontitis was found in US adults aged 30 years and older. A decreased association was found for low socioeconomic status and severe periodontitis from the unadjusted model of the regression analysis. More research is needed to solve the issue of having poor oral health outcomes such as gingivitis and periodontitis due to not having enough access to dental health care among low-income US adults.

Keywords: Gingivitis, health-care access, oral health, periodontitis, severe periodontitis


How to cite this article:
Patel AB, Sanghvi K, Shelly S, Patel V. Association of low socioeconomic status and limited dental health-care access on poor oral health outcomes among United States adults. SRM J Res Dent Sci 2019;10:183-6

How to cite this URL:
Patel AB, Sanghvi K, Shelly S, Patel V. Association of low socioeconomic status and limited dental health-care access on poor oral health outcomes among United States adults. SRM J Res Dent Sci [serial online] 2019 [cited 2020 Apr 2];10:183-6. Available from: http://www.srmjrds.in/text.asp?2019/10/4/183/276367


  Introduction Top


The lack of dental coverage and having not enough access to dental health care contribute to health-care disparities and poor oral health outcomes in people who have low socioeconomic status and limited access to dental care. Gingivitis is a common and mild form of periodontal disease which causes irritation, redness, and swelling of the gingiva. Periodontitis is a more severe inflammatory disease caused by specific microorganisms or a group of microorganisms that damage the soft tissue and destroy the bone supporting the teeth, which causes the tooth to loosen or even lead to loss of the tooth. Periodontitis is the leading cause of tooth loss in older adults in the United States (US). It also increases the risk of aspiration pneumonia in older adults and has been associated with the pathogenesis of chronic inflammation, impairing the overall health of the individuals.[1],[2]

In the US, approximately 47% of adults aged 30 years and older are affected by either gingivitis or periodontitis, and approximately 47 million US population is affected by access to dental health care. Furthermore, as the population of US adults ages, it is more likely that they would retain more teeth than their previous generations and hence, the prevalence of gingivitis and periodontitis would also increase, so better understanding of association of poor oral health access and low socioeconomic status on poor oral health outcomes such as gingivitis and periodontitis will also help us to find ways to improve and create awareness for the oral health-care access and reducing the oral health disparities. This study restricted the analysis to US adults aged 30 years and older because of the above reasons. Limited access to preventive dental services can adversely affect the health of the US individuals and by this study, the aim is to find if there is an association between limited access to care and low socioeconomic status among US adults aged 30 years and older.[3],[4]

Using data from 2015 to 2016 National Health and Nutrition Examination Survey (NHANES), the aim of this study is to examine the relationship between access to dental health care and poor health outcomes such as gingivitis and periodontitis among a representative sample of US adults of the low socioeconomic group, 30 years or older. The research question was “what is the association between limited dental health-care access and low socioeconomic status on poor oral health outcomes among US adults 30 years old or older?” The independent variables were limited dental health-care access and socioeconomic status, and dependent variables were gingivitis/periodontitis and severe periodontitis.


  Methods Top


The NHANES is a nationally representative sample of noninstitutionalized participants of the USA who complete an examination and a detailed interview for the survey. In this study, publicly available dataset which does not contain any private or identifiable data was used. This study used data from the 2015–2016 NHANES of US adults aged 30 years and older.

The variables of interest were as follows: (1) the last visit to a dentist, (2) limited access to dental care which is defined as participants who in the past year needed dental treatment but couldn't get it, (3) age in years at screening, (4) socioeconomic status which is defined as the ratio of family income to poverty, (5) gingivitis/periodontitis, and (6) severe periodontitis. For measuring poor oral health outcomes, variables such as gingivitis/periodontitis and severe periodontitis were used. The data for this study included people who were 30 years and older, and three age categories were created: (1) 30–44 years. (2) 45–64 years, and (3) 65 years and older. The variables limited dental health care access, gingivitis/ periodontitis, and severe periodontitis were categorized into 2 categories:Yes and No. Ratio of family income to poverty was used as socioeconomic status variable, were ≤1 represented as low socio-economic status and >1 represented a high socio-economic status. The last visit to a dentist variable had seven different categories in the original dataset, so recoding of the variable was done to include two categories: survey participants who had visited a dentist within ≤1 year and survey participants who had visited a dentist in >1 year. There were a total of 4745 variables obtained at the end by recoding the variables. To find out the distribution of the dependent variables among the independent variables and covariates, Chi-square tests were done. To find out the odds ratio among the dependent and independent variables, logistic regression analysis was done for both the adjusted and crude (unadjusted) regression models.


  Results Top


General description of the sample for this study had 31.63% of participants from 30 to 44 years' age category, 43.32% of participants from 45 to 64 years' age category, and 25.05% of participants from 65 years and older age category. Participants from the low socioeconomic status category constituted 20.42% and participants from high socioeconomic status category constituted 79.58%. Participants who had visited a dentist within the past year constituted 60.35% and participants who had visited a dentist more than 1 year ago constituted 39.65%. Participants who had limited dental health-care access constituted 18.11% and participants who did not have limited dental health-care access constituted 81.89%. Participants who had gingivitis/periodontitis constituted 24.23% and participants who did not have gingivitis/periodontitis constituted 75.77%. Participants who had severe periodontitis constituted 16.38% and participants who did not have severe periodontitis constituted 83.62% [Table 1].
Table 1: A general description of the sample

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[Table 2] summarizes the Chi-square distribution of the dependent variables among the independent variables and covariates and frequencies and P values. In the table, for the independent variable socioeconomic status and outcome variable gingivitis/periodontitis, P value was less than the significance level alpha (0.05), so the null hypothesis was rejected, and it can be concluded that the low socioeconomic status had a significant relationship with gingivitis/periodontitis. In addition, for the independent variable socioeconomic status and outcome variable severe periodontitis, the P value was less than the significance level alpha (0.05), so the null hypothesis was rejected, and it can be concluded that the low socioeconomic status had a significant relationship with severe periodontitis. Furthermore, for the independent variable limited dental health-care access and outcome variable gingivitis/periodontitis, P value was less than the significance level alpha (0.05), so the null hypothesis was rejected, and it can be concluded that the limited dental health-care access had a significant relationship with gingivitis/periodontitis. However, for the independent variable limited dental health-care access and outcome variable severe periodontitis, P value was more than the significance level alpha (0.05), so the null hypothesis was not rejected, and it can be concluded that the limited dental health-care access did not have a significant relationship with severe periodontitis.
Table 2: Chi-square distribution of dependent variables gingivitis/periodontitis and severe periodontitis among independent variables and covariates

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[Table 3] summarizes the results of logistic regression using both the crude and adjusted models among the variables. The results suggest that survey participants who had limited dental health-care access had an increased association to have gingivitis/periodontitis than the people who did not have limited dental health-care access. When adjusted for age, last visit to the dentist, and socioeconomic status, the results of regression analysis suggest that survey participants who had limited dental health-care access were more likely to have gingivitis/periodontitis than the survey participants who did not have limited access to dental health care. For limited dental health-care access and severe periodontitis, results of unadjusted model regression analysis were not statistically significant. When adjusted for age, last visit to the dentist, and socioeconomic status, the results of the adjusted model suggest that people who had limited dental health-care access were more likely to have severe periodontitis than the people who did not have limited dental health-care access. For the variables low socioeconomic status and gingivitis/periodontitis, results of the regression analysis did not find statistically significant findings for both the adjusted and unadjusted models. For the variables low socioeconomic status and severe periodontitis, results of the regression analysis suggest that people who belong to the low socioeconomic group were less likely to have severe periodontitis than people who belong to the high socioeconomic group. When adjusted for age, last visit to the dentist, and limited dental health-care access, results of the regression analysis did not find statistically significant findings.
Table 3: Results of logistic regression

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  Discussion Top


From analyzing the results of the logistic regression of the NHANES 2015–2016 data, an increased association between limited dental health-care access and poor oral health outcomes such as gingivitis/periodontitis and severe periodontitis was found in US adults aged 30 years and older, which is similar to the results of the study by Fischer et al. where the researchers found that poor oral health outcomes are prevalent among US adults who have poor access to dental care.[5] Results of the unadjusted regression analysis suggest that people who belong to the low socioeconomic group were less likely to have severe periodontitis than people who belong to the high socioeconomic group. The results also suggest that survey participants from low socioeconomic status had decreased association with periodontal diseases, which is similar to the findings of the study by Bertoldi et al., in which the researchers found that increase in socioeconomic status was more likely to be associated with worsening of the periodontal diseases.[6]

Limitations and future recommendations

Regarding the limitations of this study, there could be response bias among the participants because they were given a questionnaire and also recall bias from difficulty in recalling past events. Information bias could have influenced responses of the survey participants because they might have lack of oral health literacy to understand some of the terminologies used in the survey questions and therefore, the responses from the survey participants from the low socioeconomic status may suggest underestimation or overestimation of the association for gingivitis or periodontitis. Furthermore, the NHANES is a cross-sectional survey; hence, it is not much reliable to infer causality, but an association between limited dental health-care access on poor oral health outcomes such as gingivitis/periodontitis and severe periodontitis was found in US adults aged 30 years and older. More research is needed to solve the issue of having poor oral health outcomes due to not having enough access to dental health care among low-income US adults as approximately 47 million Americans are affected by access to dental health care and about 50% of Americans over the age of 30 years will suffer from some kind of gingivitis or periodontitis.[7],[8],[9],[10],[11]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
MacDougall H. Dental disparities among low-income American adults: A social work perspective. Health Soc Work 2016;41:208-10.  Back to cited text no. 1
    
2.
Nishide A, Fujita M, Sato Y, Nagashima K, Takahashi S, Hata A. Income-related inequalities in access to dental care services in Japan. Int J Environ Res Public Health 2017;14. pii: E524.  Back to cited text no. 2
    
3.
U.S. Census Bureau, Population Division, Fertility & Family Statistics Branch. Current Population Survey: Definitions and explanations. U.S. Census Bureau, Population Division, Fertility & Family Statistics Branch; 2004. Available from: http://www.census.gov/population/www/cps/cpsdef.html. [Last accessed on 2018 Dec 14].  Back to cited text no. 3
    
4.
National Health and Nutrition Examination Survey; 2015-2016. Available from: https://wwwn.cdc.gov/nchs/nhanes/search/datapage.aspx?Component=Questionnaire&CycleBeginYear=2015. [Last accessed on 2018 Dec 14].  Back to cited text no. 4
    
5.
Fischer DJ, O'Hayre M, Kusiak JW, Somerman MJ, Hill CV. Oral health disparities: A perspective from the national institute of dental and craniofacial research. Am J Public Health 2017;107:S36-8.  Back to cited text no. 5
    
6.
Bertoldi C, Lalla M, Pradelli JM, Cortellini P, Lucchi A, Zaffe D. Risk factors and socioeconomic condition effects on periodontal and dental health: A pilot study among adults over fifty years of age. Eur J Dent 2013;7:336-46.  Back to cited text no. 6
  [Full text]  
7.
Page RC, Eke PI. Case definitions for use in population-based surveillance of periodontitis. J Periodontol 2007;78:1387-99.  Back to cited text no. 7
    
8.
Pace CC, McCullough GH. The association between oral microorgansims and aspiration pneumonia in the institutionalized elderly: Review and recommendations. Dysphagia 2010;25:307-22.  Back to cited text no. 8
    
9.
Lamster IB, DePaola DP, Oppermann RV, Papapanou PN, Wilder RS. The relationship of periodontal disease to diseases and disorders at distant sites: Communication to health care professionals and patients. J Am Dent Assoc 2008;139:1389-97.  Back to cited text no. 9
    
10.
Eke PI, Dye BA, Wei L, Thornton-Evans GO, Genco RJ; CDC Periodontal Disease Surveillance workgroup: James Beck (University of North Carolina, Chapel Hill, USA), Gordon Douglass (Past President, American Academy of Periodontology), Roy Page (University of Washin. et al. Prevalence of periodontitis in adults in the United States: 2009 and 2010. J Dent Res 2012;91:914-20.  Back to cited text no. 10
    
11.
Thornton-Evans G, Eke P, Wei L, Palmer A, Moeti R, Hutchins S. Periodontitis among adults aged ≥30 years – United States, 2009-2010. MMWR Suppl 2013;62:129-35.  Back to cited text no. 11
    



 
 
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