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Type: Theses
Title: Socioeconomic position and periodontal disease: a life-course approach
Author: Silveira Schuch, Helena
Issue Date: 2018
School/Discipline: School of Dentistry
Abstract: Background: Periodontal disease is a chronic condition affecting more than 537 million people worldwide, with a prevalence of 7.6% for all ages combined. Although important factors associated with periodontal disease are already known, little is known about the influence of the socioeconomic position (SEP) across the life stages on periodontal disease in adults. There is an increasing understanding that the true risk factors to health inequalities lie in social, economic and political circumstances. Thesis objectives: The overarching purpose of the thesis was to investigate the influence of SEP during the life-course on periodontal disease in adulthood. The specific objectives of the thesis were: to theoretically explore how life-course epidemiology theories can be applied to explain the relationship between SEP and periodontal disease; to systematically review all longitudinal prospective studies that studied the association between SEP and periodontal disease; to quantify the impact of life-course income trajectories on the occurrence of periodontal disease in adulthood, in the inter-relationship of income with other socioeconomic indicators; and to evaluate the direct effect of early life income on periodontal disease occurrence in adulthood that was not mediated by adulthood income and adulthood education attainment, and behavioural risk factors for periodontal disease, namely smoking status and oral hygiene. Main findings: To address the objectives, four papers were developed. The first paper presented and discussed a theoretical basis for the use of life-course epidemiology theories, namely the critical period model, critical period with modifier effect model, accumulation of risk model and chain-of-risk model, in explaining the relationship between SEP during the life-course and periodontal disease in adulthood. Through a systematic review, it has been observed that individuals who were exposed to lower socioeconomic conditions earlier in life presented with worse periodontal disease in adulthood. This finding was consistent across the broad range of SEP indicators and measures of disease adopted in the primary studies. The first empirical study, using data from a nested oral health study of the 1982 Pelotas Birth Cohort Study in Brazil (n=539), demonstrated the influence of income trajectories during the first 30 years of life on the occurrence of moderate-to-severe periodontal disease at the age of 31 years. Finally, the findings from the last study, also using data from the same study, supported the hypothesis that early life socioeconomic position has a direct effect on periodontal disease at age 31 that is not mediated by socioeconomic position in adult life, smoking status, or oral hygiene. The findings of the thesis have presented a strong case for applying life-course epidemiological research in investigating the development of periodontal disease. The study has contributed evidence to identifying socioeconomic position as an upstream determinant of the disease since early in life.
Advisor: Do, Loc Giang
Peres, Marco Aurelio
Peres, Karen Glazer
Dissertation Note: Thesis (Ph.D.) (Research by Publication) -- University of Adelaide, Adelaide Dental School, 2018
Keywords: social epidemiology
socioeconomic position
oral health
Research by Publication
Provenance: This electronic version is made publicly available by the University of Adelaide in accordance with its open access policy for student theses. Copyright in this thesis remains with the author. This thesis may incorporate third party material which has been used by the author pursuant to Fair Dealing exceptions. If you are the owner of any included third party copyright material you wish to be removed from this electronic version, please complete the take down form located at:
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