TY - JOUR
T1 - Individual- and community-level social gradients of edentulousness
AU - Ito, Kanade
AU - Aida, Jun
AU - Yamamoto, Tatsuo
AU - Ohtsuka, Rika
AU - Nakade, Miyo
AU - Suzuki, Kayo
AU - Kondo, Katsunori
AU - Osaka, Ken
N1 - Funding Information:
This study used data obtained from the Japan Gerontological Evaluation Study (JAGES), conducted by the Nihon Fukushi University Center for Well-Being and Society as one of their research projects. This study was supported in part by Grants-in-Aid for Scientific Research (A) (KAKENHI 23243070), (B) (22390400 and 24390469), and (C) (22592327) from the Japan Society for the Promotion of Science. The study was also supported by a Health and Labour Sciences Research Grant, and grants for Comprehensive Research on Aging and Health (H24-Choju-Wakate-009) and Comprehensive Research on Lifestyle-Related Diseases including Cardiovascular Diseases and Diabetes Mellitus (H24-Junkanki [Seishu]-Ippan-007) from the Ministry of Health, Labour and Welfare (MHLW), Japan. The sponsors of the study had no role in the study design, data collection, data analysis, data interpretation, or writing of the paper.
Publisher Copyright:
© 2015 Ito et al.
PY - 2015/12/12
Y1 - 2015/12/12
N2 - Background: Community-level factors as well as individual-level factors affect individual health. To date, no studies have examined the association between community-level social gradient and edentulousness. The aim of this study was to investigate individual- and community-level social inequalities in edentulousness and to determine any explanatory factors in this association. Methods: We analyzed the data from the Japan Gerontological Evaluation Study (JAGES). In 2010-2012, 112,123 subjects aged 65 or older responded to the questionnaire survey (response rate = 66.3%). Multilevel logistic regression analysis was applied to determine the association between community-level income and edentulousness after accounting for individual-level income and demographic covariates. Then, we estimated the probability of edentulousness by individual- and community-level incomes after adjusted for covariates. Results: Of 79,563 valid participants, the prevalence of edentulousness among 39,550 men (49.7%) and 40,013 women (50.3%) were both 13.8%. Living in communities with higher mean incomes and having higher individual-level incomes were significantly associated with a lower risk of edentulousness (odds ratios [ORs] by 10,000 USD increments were 0.37 (95% confidence interval [CI] [0.22-0.63]) for community-level and 0.85 (95% CI [0.84-0.86]) for individual-level income). Individual- and community-level social factors, including density of dental clinics, partially explained the social gradients. However, in the fully adjusted model, both community- and individual-level social gradients of edentulousness remained significant (ORs = 0.43 (95% CI [0.27-0.67]) and 0.90 (95% CI [0.88-0.91]), respectively). One standard deviation changes in community- and individual-level incomes were associated with 0.78 and 0.84 times lower odds of edentulousness, respectively. In addition, compared to men, women living in communities with higher average incomes had a significantly lower risk of edentulousness (p-value for interaction < 0.001). Conclusions: Individual- and community-level social inequalities in dental health were observed. Public health policies should account for social determinants of oral health when reducing oral health inequalities.
AB - Background: Community-level factors as well as individual-level factors affect individual health. To date, no studies have examined the association between community-level social gradient and edentulousness. The aim of this study was to investigate individual- and community-level social inequalities in edentulousness and to determine any explanatory factors in this association. Methods: We analyzed the data from the Japan Gerontological Evaluation Study (JAGES). In 2010-2012, 112,123 subjects aged 65 or older responded to the questionnaire survey (response rate = 66.3%). Multilevel logistic regression analysis was applied to determine the association between community-level income and edentulousness after accounting for individual-level income and demographic covariates. Then, we estimated the probability of edentulousness by individual- and community-level incomes after adjusted for covariates. Results: Of 79,563 valid participants, the prevalence of edentulousness among 39,550 men (49.7%) and 40,013 women (50.3%) were both 13.8%. Living in communities with higher mean incomes and having higher individual-level incomes were significantly associated with a lower risk of edentulousness (odds ratios [ORs] by 10,000 USD increments were 0.37 (95% confidence interval [CI] [0.22-0.63]) for community-level and 0.85 (95% CI [0.84-0.86]) for individual-level income). Individual- and community-level social factors, including density of dental clinics, partially explained the social gradients. However, in the fully adjusted model, both community- and individual-level social gradients of edentulousness remained significant (ORs = 0.43 (95% CI [0.27-0.67]) and 0.90 (95% CI [0.88-0.91]), respectively). One standard deviation changes in community- and individual-level incomes were associated with 0.78 and 0.84 times lower odds of edentulousness, respectively. In addition, compared to men, women living in communities with higher average incomes had a significantly lower risk of edentulousness (p-value for interaction < 0.001). Conclusions: Individual- and community-level social inequalities in dental health were observed. Public health policies should account for social determinants of oral health when reducing oral health inequalities.
KW - Dental public health
KW - Edentulous/edentulism
KW - Gender differences
KW - Income inequality
KW - Multilevel analysis
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U2 - 10.1186/s12903-015-0020-z
DO - 10.1186/s12903-015-0020-z
M3 - Article
C2 - 25884467
AN - SCOPUS:85019170840
VL - 15
JO - BMC Oral Health
JF - BMC Oral Health
SN - 1472-6831
IS - 1
M1 - 34
ER -