BackgroundThe impact of socioeconomic inequalities on health is well-documented. Despite the links of periodontal disease with cardiovascular diseases, adverse pregnancy outcomes and diabetes, no meta-analysis of socioeconomic variations in periodontal disease exists. This meta-analytic review was conducted to determine the extent to which education attainment influences risk of periodontitis in adults aged 35+ years in the general population.MethodsThe authors searched studies published until November 2010 using EMBASE and MEDLINE databases. References listed were then scrutinised, our own files were checked, and, finally, we contacted experts in the field. The authors included only general population-based studies conducted in adults aged 35 years and more. All articles were blind reviewed by two investigators. In the case of disagreement, a third investigator arbitrated. Using PRISMA statement, two reviewers independently extracted papers of interest.ResultsRelative to the higher education group, people with low education attainment experience a greater risk of periodontitis (OR: 1.86 [1.66–2.10]; p<0.00001). The association was partially attenuated after adjustment for covariates (OR: 1.55 [1.30–1.86]; p<0.00001). Sensitivity analyses showed that methods used to assess periodontitis, definition of cases, study country and categorization of education are largely responsible for the heterogeneity between studies. No significant bias of publication was shown using both the Egger (p = 0.16) and rank correlation tests (p = 0.35).ConclusionsIn the studies reviewed, low educational attainment was associated with an increased risk of periodontitis. Although this evidence should be cautiously interpreted due to methodological problems in selected studies, efforts to eliminate educational inequalities in periodontitis should focus on early life interventions.

Objective. Evidence from anti-inflammatory drug trials for the treatment of depression has been inconsistent. This may be ascribed to the differing symptom-specific effects of inflammation.Accordingly, we explored the associations between systemic inflammation and an array of individual symptoms of depression across multiple studies.Method. This random-effects pooled analysis included 15 population-based cohorts and 56,351 individuals aged 18 years and older. Serum or plasma concentrations of C-reactive protein and interleukin-6 were measured at baseline. Using validated self-report measures, 24 depression symptoms were ascertained in 15 cross-sectional studies, and, in 7 cohorts, also assessed at follow-up (mean 3.2 years).Results. Prevalence of depressive symptoms ranged between 1.1% ('suicidal ideation') and 21.5% ('sleep problems'). In cross-sectional analyses, higher concentrations of C-reactive protein were robustly associated with an increased risk of experiencing four physical symptoms ('changes in appetite', 'felt everything was an effort'; 'loss of energy', 'sleep problems') and one cognitive symptom ('little interest in doing things'). These associations remained after adjustment for sociodemographic variables, behavioural factors, and chronic conditions; in sex-and age-stratified analyses; in longitudinal analyses; when using interleukin-6 as the inflammatory marker of interest; in depressed individuals; and after excluding chronically ill individuals. For four exclusively emotional symptoms ('bothered by things', 'hopelessness about the future', 'felt fearful', 'life had been a failure'), the overall evidence was strongly against an association with inflammation.Conclusions. These findings suggest symptom-specific rather than generalised effects of systemic inflammation on depression. Future trials exploring anti-inflammatory treatment regimens for depression could target individuals presenting with symptom profiles characterised by distinct inflammation-related physical and cognitive symptoms.

Aims/hypothesis While there are plausible biological mechanisms linking oral health with cardiovascular disease (CVD) and mortality rates, no study, to our knowledge, has examined this association in a representative population of people with type 2 diabetes. Methods We used the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified-Release Controlled Evaluation (ADVANCE) study, a large, detailed, randomised controlled trial among a general population of individuals with type 2 diabetes. For the purposes of the present analyses, data from the trial are used within a prospective cohort study design. A total of 10,958 men and women, aged 55 to 88 years and with type 2 diabetes, participated in a baseline medical examination, during which they counted their number of natural teeth and reported the number of days that their gums had bled over the preceding year. Study members were followed up for mortality and morbidity over 5 years.Results After controlling for a range of potential confounding factors, the group with no teeth had a markedly increased risk of death due to all causes (HR 1.48, 95% CI 1.24-1.78), CVD (1.35, 1.05-1.74) and non-CVD (1.64, 1.26-2.13), relative to the group with the most teeth (≥22 teeth).

Background Observational studies have identified a link between unfavourable neighbourhood characteristics and increased risk of morbidity, but it is unclear whether changes in neighbourhoods affect future disease risk. We used a data-driven approach to assess the impact of neighbourhood modification on 79 health outcomes. MethodsIn this prospective cohort study, we used pooled, individual-level data from two Finnish cohort studies: the Health and Social Support study and the Finnish Public Sector study. Neighbourhood characteristics (mean educational level, median income, and employment rate of residents, and neighbourhood green space) and individual lifestyle factors of community-dwelling individuals were assessed at baseline (at different waves starting between 1998 and 2013). We repeated assessment of neighbourhood characteristics and lifestyle factors approximately 5 years from each baseline assessment, after which follow-up began for health conditions diagnosed according to the WHO International Classification of Diseases for 79 common health conditions using linkage to electronic health records. We used Cox proportional hazard regression models to compute adjusted hazard ratios (HRs) of incident disease associated with neighbourhood characteristics and changes in neighbourhood characteristics over time and logistic regression analysis to compute adjusted odds of association between changes in neighbourhood characteristics and individual lifestyle factors. Findings 114 786 individuals (87 012 [75•8%] women; mean age 44•4 years [SD 11•1]) had complete data and were included in this cohort study. During 1•17 million person-years at risk, we recorded 164 368 new-onset health conditions and 3438 deaths. Favourable changes in neighbourhood characteristics were associated with reduced risk of all-cause mortality and incidence of 19 specific health conditions. Unfavourable changes were correspondingly associated with increased risk of mortality and 27 specific health conditions. Among participants who did not move residence during the observation period, relative to individuals who continually lived in disadvantaged neighbourhoods, those who experienced favourable modifications in neighbourhood characteristics had a lower risk of future diabetes (HR 0•84, 95% CI 0•75-0•93), stroke (0•49, 0•29-0•83), skin disease (0•72, 0•53-0•97), and osteoarthritis (0•87, 0•77-0•99). Living in a neighbourhood with improving characteristics was also associated with improvements in individual-level health-related lifestyle factors. Among participants who lived in advantaged residential environments at baseline, unfavourable changes in neighbourhood characteristics were associated with an increased risk of diabetes, stroke, skin disease, and osteoarthritis compared with individuals who lived in advantaged neighbourhoods throughout the study period.Interpretation Favourable modifications to residential neighbourhoods showed robust, longitudinal associations with a range of improvements in health outcomes, including improved health be...

In the largest study to date to examine the relation, there was no evidence that diarrhoea in early life had an influence on measured blood pressure, hypertension or coronary heart disease in older adults.

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