A life course approach to total tooth loss: Testing the sensitive period, accumulation, and social mobility models in the Health and Retirement Study

Abstract

Objectives: Childhood socio-economic status (SES) has long been associated with later-life oral health, suggesting that childhood is a sensitive period for oral health.Far less attention has been given to the long-term impact of childhood trauma, abuse, and smoking on later-life oral health. This study fills the gap in the literature by examining how adverse childhood experiences-social, psychological, and behavioralshape total tooth loss over the life course, with an assessment of the sensitive period, accumulation, and social mobility models from life course research. Methods: Data are drawn from the 2012 Health and Retirement Study (HRS) mergedwith multiple HRS data sources to obtain childhood information (N = 6,427; age > 50).Adverse childhood experiences include childhood financial hardship, trauma, abuse, and smoking. Total tooth loss is measured to assess poor oral health in later life.Educational attainment and poverty status (since age 51) are measured as adult adversity. Current health conditions and health behaviors are assessed to reflect the correlates of oral health in later life. Results:The sensitive period model indicates that childhood trauma such as parental death or divorce (odds ratio [OR] = 1.37, 95% confidence interval [CI] = 1.04, 1.80), physical abuse (OR = 1.17, 95% CI = 1.03, 1.34), and low educational attainment (≤ high school; OR = 1.52, 95% CI = 1.04, 2.22) are associated with higher odds of total tooth loss in later life. Poverty status was not associated with the outcome. There was a clear graded relationship between accumulation of adverse experiences and oral health, which supports the accumulation model. In the social mobility model, older adults who occupied a stable disadvantageous position were more likely to be toothless (OR = 1.77, 95% CI = 1.08, 2.90) compared to those who did not face adversity in any case. Neither upward nor downward mobility mattered. Conclusions:Failing oral health in older adults, especially total tooth loss, may have its roots in adverse experiences such as childhood trauma, abuse, and low educational attainment. Findings also suggest that oral health in later life may be more influenced by accumulation of adversity rather than changes in social and economic position over the life course. | ME THODS | DataData are drawn from the 2012 Health and Retirement Study (HRS), merged with multiple HRS data sources including the 2015 Life History Mail Survey (LHMS) and the retrospective childhood variables from the HRS core surveys (1998-2010). The HRS is a nationally representative longitudinal study of older adults in the United States and their spouses aged 51 and older, which includes the core surveyed every two years, and off-year supplementary mail surveys administered in between waves of the HRS core. 23 The HRS was initiated in 1992 and has collected information on the changing social, financial, and health conditions of late adulthood in the core. Additionally, HRS has collected retrospective childhood information from 1998 onwards. Questions about ch...

Intragenerational social mobility and self-rated oral health in the british cohort study

“…They suggest that any form of social mobility (either upward or downward) might positively impact adult perceptions of oral health, probably because mobile individuals seek to maximise their status [9,38]. The positive effect of downward social mobility found in this study contrasts with previous dental studies that reported a negative association between downward mobility and good oral health [11][12][13][14][15][16][17][18][19][20][21]. The fact that downward mobility was inversely associated with poor oral health implies that there will be more people with good oral health in the lower social class.…”

“…The effect of social mobility on adult oral health has been investigated in several longitudinal studies, although most have focused on intergenerational mobility [11][12][13][14][15][16][17][18][19][20]. Only two previous studies have looked at intragenerational mobility in relation to oral health [12,21].…”

Social Mobility and Tooth Loss: A Systematic Review and Meta-analysis

“…1). Of the 21 articles, 18 provided sufficient data for meta-analysis after the authors were contacted for further information (Osler et al 2009; Pearce et al 2009; Bernabé et al 2011; Tsakos et al 2011; Yiengprugsawan et al 2011; Thomson 2012; Celeste et al 2013; Åström et al 2015; Peres et al 2016; Han and Khang 2017; Celeste and Fritzell 2018; Fantin et al 2018; Goettems et al 2018; Listl et al 2018; Ramsay et al 2018; Vendrame et al 2018; Lee 2019; Nascimento et al 2020), and 3 were included in the qualitative analysis (Brennan and Spencer 2015; de Andrade et al 2018; Zhang and Chen 2019). To increase homogeneity within studies, larger data sets were split by country (Listl et al 2018), age group (Yiengprugsawan et al 2011; Peres et al 2016; Celeste and Fritzell 2018), or specific group (e.g., twins; Osler et al 2009); therefore, the statistical analysis was performed with 40 analytic data sets.…”

Are Positive Childhood Experiences Linked to Better Cognitive Functioning in Later Life?: Examining the Role of Life Course Pathways

“…All models included demographic covariates including age in years, gender (1 = female), and race/ethnicity in four categories, non-Hispanic white (reference), non-Hispanic Black, Hispanic, and other. Following the previous work (Lee, 2019; Luo & Waite, 2005; Zhang et al, 2016), we also controlled for childhood health, as it is closely related to later cognition, using the question: “from age 6 to 16 years, would you say that your health during that time was excellent, very good, good, fair, or poor?” Respondents who reported that they had “fair” or “poor” health were compared to those whose health was “excellent,” “very good,” or “good.”…”