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...