The Intersections of Ethnicity, Nativity Status and Socioeconomic Position in Relation to Periodontal Status: A Cross-Sectional Study in London, England

Abstract

The role of migration as a social determinant of periodontitis has been overlooked. Intersectionality theory could help understand how immigration status interacts with other social determinants of health to engender inequalities in periodontitis. The objective of the present study was to evaluate whether ethnicity, nativity status and socioeconomic position intersect to structure social inequalities in periodontal status. Data from 1936 adults in a deprived and multi-ethnic area of London were analysed. The numbers of teeth with probing depth and clinical attachment loss were determined from clinical examinations. A matrix with 51 intersectional strata, defined according to ethnicity, nativity status and education, was created. A cross-classified multilevel analysis, with participants clustered within intersectional social strata, was performed to assess the extent to which individual differences in periodontal measures were at the intersectional strata level. A complex pattern of social inequalities in periodontal status was found, which was characterised by high heterogeneity between strata and outcome-specificity. The variance partition coefficient of the simple intersectional model, which conflated additive and interaction effects, indicated that 3-5% of the observed variation in periodontal measures was due to between-stratum differences. Moreover, the percentual change in variance from the simple intersectional to the intersectional interaction model indicated that 73-74% of the stratum-level variance in periodontal measures was attributed to the additive effects of ethnicity, nativity status and education. This study found modest evidence of intersectionality among ethnicity, nativity status and education in relation to periodontal status.

Keywords: ethnic groups; migration status; periodontal disease; socioeconomic position.

Figure 1

Predicted numbers of teeth with PD (top plot) and CAL (bottom plot), by intersectional strata defined by ethnicity (AB: Asian Bangladeshi, AI: Asian Indian, AO: Asian Other, AP: Asian Pakistani, BA: Black African, BC: Black Caribbean, BO: Black Other, WB: White British, and WO: White Other), nativity status (N: Native; F: Foreign) and education (E1: low, E2: medium, and E3: high). Predictions were based on the simple intersectional model. Markers indicate estimated effects, and whiskers indicate 95% credible intervals.

Figure 2

Intersectional interaction effects of ethnicity, nativity status and education on the numbers of teeth with PD (top plot) and CAL (bottom plot). Stratum residuals are the remaining difference between total predicted values for each stratum and stratum-level predictions based on additive effects only. Markers indicate estimated effects, and whiskers indicate 95% credible intervals. Intersectional strata were ordered according to their interaction effect. Negative and positive values indicate the number of teeth affected was below and above predicted scores for a given stratum, respectively.