Socioeconomic position indicators and periodontitis: examining the evidence

Abstract

Disparities in the prevalence and severity of periodontal disease are associated with socioeconomic factors, such as education and income, and have been recognized since the1960s. Epidemiologic reports have consistently shown that i) periodontal disease is inversely related to education and income after controlling for age and gender, and ii) differences in education and income explain mode if not all of the observed disparities in periodontal disease between blacks and whites. Although race/ethnicity has been the main focus of differences in periodontal diseases in the U.S., disparities in socioeconomic position (SEP) indicators (i.e., education, income, poverty-income ratio) have remained pervasive in the U.S. over the years. SEP indicators, as used in the epidemiologic literature, allocate assignment of socioeconomic measures as a proxy for one's place, position and power in society. Thus, understanding these disparities in periodontal health status may provide insight and context more generally into why racial/ethnic disparities persist. In this paper, we review recent prevalence estimates of periodontitis, according to SEP indicators, and critically assess the importance of SEP factors in periodontal epidemiolgy. The majority of the data available for review comes from the U.S. However, data from other countries is included where available. Specifically, we aim to identify the advantages and disadvantages of the most commonly used SEP indicators in studying periodontal disease; summarize existing evidence on the association between SEP indicators and periodontitis; discuss the analytical issues associated with SEP indicators; and finally, discuss and present, future and alternative research directions on examining the association between SEP indicators and periodontitis.