The shape of the socioeconomic-oral health gradient: implications for theoretical explanations

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dc.contributor.authorSanders, A.
dc.contributor.authorSlade, G.
dc.contributor.authorTurrell, G.
dc.contributor.authorSpencer, A.
dc.contributor.authorMarcenes, W.
dc.date.issued2006
dc.descriptionThe definitive version is available at www.blackwell-synergy.com
dc.description.abstractObjectives: The nature of the relationship between status and health has theoretical and applied significance. To compare the shape of the socioeconomic -oral health relationship using a measure of relative social status (MacArthur Scale of Subjective Social Status) and a measure of absolute material resource (equivalised household income); to investigate the contribution of behaviour in attenuating the socioeconomic gradient in oral health status; and to comment on three hypothesised explanatory mechanisms for this relationship (material, psychosocial, behavioural). Methods: In 2003, cross-sectional self-report data were collected from 2,915 adults aged 43–57 years in Adelaide, Australia using a stratified cluster design. Oral conditions were (1) <24 teeth, (2) 1+ impact/s reported fairly often or very often on the 14-item Oral Health Impact Profile; (3) fair or poor self-rated oral health, and (4) low satisfaction with chewing ability. Prevalence ratios and 95% confidence intervals (PR, 95%CI) were calculated from a logistic regression model. Covariates were age, sex, country of birth, smoking, alcohol use, body mass index, frequencies of toothbrushing and interdental cleaning. Results: There was an approximately linear relationship of decreasing prevalence for each oral condition across quintiles of increasing relative social status. In the fully adjusted model the gradient was steepest for low satisfaction with chewing (PR = 4.1, 95%CI = 3.0–5.4). Using equivalised household income, the shape more closely resembled a threshold effect, with an approximate halving of the prevalence ratio between the first and second social status quintiles for the adverse impact of oral conditions and fair or poor self-rated oral health. Adjustment for covariates did not attenuate the magnitude of PRs. Conclusion: The nature of the relationship between social status and oral conditions differed according to the measure used to index social status. Perception of relative social standing followed an approximately straight-line relationship. In contrast, there was a discrete threshold of income below which oral health deteriorated, suggesting that the benefit to oral health of material resources occurs mostly at the lower end of the across the full socioeconomic distribution.
dc.description.statementofresponsibilityAnne E. Sanders, Gary D. Slade, Gavin Turrell, A. John Spencer and Wagner Marcenes
dc.identifier.citationCommunity Dentistry and Oral Epidemiology, 2006; 34(4):310-319
dc.identifier.doi10.1111/j.1600-0528.2006.00286.x
dc.identifier.issn0301-5661
dc.identifier.issn1600-0528
dc.identifier.orcidSpencer, A. [0000-0002-3462-7456]
dc.identifier.urihttp://hdl.handle.net/2440/22652
dc.language.isoen
dc.publisherBlackwell Munksgaard
dc.source.urihttps://doi.org/10.1111/j.1600-0528.2006.00286.x
dc.subjectHumans
dc.subjectTooth Loss
dc.subjectDental Health Surveys
dc.subjectHealth Status Indicators
dc.subjectLogistic Models
dc.subjectCross-Sectional Studies
dc.subjectHealth Behavior
dc.subjectMastication
dc.subjectSocial Class
dc.subjectAdult
dc.subjectMiddle Aged
dc.subjectOral Health
dc.subjectIncome
dc.subjectFemale
dc.subjectMale
dc.subjectSelf-Assessment
dc.subjectSurveys and Questionnaires
dc.titleThe shape of the socioeconomic-oral health gradient: implications for theoretical explanations
dc.typeJournal article
pubs.publication-statusPublished

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