Social Gradients in Oral Health at Older Ages in England

The very few studies on socioeconomic inequalities in oral health at older ages are cross-sectional and have not comprehensively assessed socioeconomic position (SEP). Objectives: This study examined the prospective associations between a wide range of SEP markers and different oral health outcomes in a nationally representative sample of older adults in England. Methods: We used data from the English Longitudinal Study of Ageing (ELSA), a national prospective cohort study of community-dwelling people aged 50 and over. All different SEP markers (education, occupation, household income, household wealth, subjective social status, and childhood SEP) and sociodemographic confounders (age, sex, marital status) were measured at the ELSA baseline wave. Oral health data were collected on wave 3 and consisted of three outcomes: presence of natural teeth (dentate vs. edentate), self-rated oral health (excellent /good vs. fair/poor), and experience of oral impacts (yes/no) assessed through five performances from the OIDP index. We estimated multivariate logistic regression models for the associations of each of the three oral health outcomes with each of the six SEP indicators, adjusted for confounders, on 6634 older adults. Results: Irrespective of the SEP marker used, there were clear socioeconomic gradients in edentulousness, with higher proportion of edentate for each lower SEP level (p<0.001 in all cases). Lower SEP was also associated with worse self-rated oral health and oral impacts among dentate, but not among edentate. These gradients with self-rated oral health and oral impacts were evident for income, wealth, subjective social status, and to a lesser extent for occupation and education, while there were no clear linear patterns in the respective associations for childhood SEP. Conclusions: The overall consistent and clear social gradients, with oral health differences throughout the SEP hierarchy, provide strong support for the importance of relative rather than absolute deprivation for addressing oral health inequalities.