Pathways of socioeconomic inequalities in self-perceived oral health

Abstract

Although there is a large body of evidence of the influence of social determinants on oral health, information on the mechanisms by which these determinants operate is poorly documented. Therefore, we aimed to investigate the pathways through which socioeconomic inequalities may influence self-perceived oral health (SPOH) in Brazilian adults. This cross-sectional study used data from the National Health Survey (NHS) of 2019, with a representative sample of adults aged 18 to 59 years (n = 65,803). The outcome was SPOH, assessed by a global self-item. Structural equation modeling was used to test direct and indirect pathways connecting a latent variable for socioeconomic position (SEP) to SPOH via psychosocial, behavioral, and biological factors. Higher SEP was directly associated with better SPOH [standardized coefficient (SC) = 0.069; p < 0.01)] fewer depressive symptoms (SC = -0.059; p < 0.01), fewer missing teeth (SC = 0.131; p < 0.01), and more healthy behaviors (SC = 0.643; p < 0.01). Fewer depressive symptoms (SC = -0.141; p < 0.01), more healthy behaviors (SC = 0.242; p < 0.01), and fewer missing teeth (SC = 0.058; p < 0.01) were directly associated with good SPOH. Among specific indirect effects of SEP on SPOH, the behavioral pathway was the one that best explained this association (SC = 0.155). Socioeconomic inequities in SPOH are mediate by psychosocial, behavioral, and biological factors. This has implications for positioning health strategies in the social context in which people live, to facilitate healthy choices and promote good oral health.

Social and economic capital as effect modifiers of the association between psychosocial stress and oral health

“…Psychosocial factors have been extensively investigated in relation to oral health and health inequalities [2][3][4][5]. Several studies have shown that the prolonged exposure to chronic psychosocial stress is associated with an increased risk of poor oral health in both children and adults [6].…”

Self-reported dental pain in Mexican schoolchildren: a national ecological study

“…Although this SEP concept is commonly used in oral epidemiological research, the multiple ways for measuring it reflect the complexity of its attributes. SEP is one of the variables that has consistently been associated with diverse oral conditions [14][15][16][17][18] and dental pain [5][6][7][8]. Diverse studies have pointed out, e.g., to the association between tooth loss and SEP variables in China, where low school attainment and living in a rural location were linked to tooth loss [14].…”

“…Diverse studies have pointed out, e.g., to the association between tooth loss and SEP variables in China, where low school attainment and living in a rural location were linked to tooth loss [14]. Data from Brazil identified an association between higher SEP and both better self-appraisal of oral Health and fewer missing teeth [15]. Just like in Chile, where severe poverty was associated with higher caries experience in primary and permanent dentitions [16], in Colombia individual and ecological SEP measures showed that low and very low SEP were associated with higher early tooth decay and untreated caries experiences [17].…”