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

Abstract

Objectives To assess the extent of the association of psychosocial stress with oral health in an Ontario population stratified by age groups, and whether any association is modified by indicators of social and economic capital. Methods We retrieved data of 21,320 Ontario adults, aged 30–74 years old, from the Canadian Community Health Survey (CCHS: 2017–2018), which is a Canada-wide, cross-sectional survey. Using binomial logistic regression models that adjusted for age, sex, education, and country of birth, we examined the association of psychosocial stress (indicated by perceived life stress) with inadequate oral health (indicated as having at least one of the following: bleeding gums, fair/poor self-perceived oral health, persistent oral pain). We assessed the effect measure modification of indicators of social (sense of belonging to the local community, living/family arrangements) and economic capital (household income, dental insurance, dwelling ownership) on the perceived life stress-oral health relationship, stratified by age (30–44, 45–59, 60–74 yrs). We then calculated the Relative Excess Risk due to Interaction (RERI) which indicates the risk that is above what would be expected if the combination of low capital (social or economic) and high psychosocial stress was entirely additive. Results Respondents with higher perceived life stress were at a significantly higher risk of having inadequate oral health (PR = 1.39; 95% CI: 1.34, 1.44). Adults with low social and economic capital were also at an increased risk of inadequate oral health. Effect measure modification showed an additive effect of indicators of social capital on the perceived life stress-oral health relationship. This effect was evident across all three age groups (30–44, 45–59, 60–74 yrs), with the highest attributable proportion of social and economic capital indicators in the psychosocial stress-oral health relationship in older adults (60–74 yrs). Conclusion Our findings suggest an exacerbating effect for low social and economic capital in the relationship of perceived life stress with inadequate oral health among older adults.

Associations between psychological stress, discrimination, and oral health-related quality of life: the buffering effects of social support networks

“…The lack of association between social support networks and OHRQoL in this sample differs from the current literature that reports that social support networks contributes to better oral health 3 , 12 , 24 and also differs from a study that showed that social capital can reduce the effect of psychological stress on oral health 35 . People who have extensive social networks were also found to be more likely to report psychological well-being and positive OHRQoL 15 .…”

“…Moreover, it has been postulated that when two or more factors (e.g., psychological stress and support from social networks) affect a health condition (e.g., OHRQoL) by the same mechanism (e.g., health behaviors and missing teeth), they can interact by antagonism or synergy 33 , 34 : one factor can modify the effect of another ( Figure 1 ). Although plausible, the hypothesis that social support networks interact with discrimination and stress by antagonism has not yet been well investigated; previous studies with adults and schoolchildren have shown that indicators of social capital reduced the effect of perceived stress on oral health 35 and that the sense of coherence reduced the effect of perceived discrimination on quality of life 36 .…”

Social Capital Associates with Cognitive Health, Oral Health and Epigenetic Age Deceleration: A Cross-sectional Analysis of the Canadian Longitudinal Study on Aging (CLSA)

“…These results align with recent findings in the Canadian adult population demonstrating the role of social capital and SES in oral health (Hensel & Gomaa, 2023).…”

“…Likewise, oral health has also been found to associate with social capital, as have oral health related behaviours and access to dental care services (Campagnol et al, 2022;do Amaral Júnior et al, 2022). Recently, we have shown social capital to buffer the association between psychosocial stress and oral health in a large Canadian sample (Hensel & Gomaa, 2023).…”

Biopsychosocial factors in oral and systemic diseases: a scoping review

“…Previous research has identified stress as a premorbid factor associated with many risk factors for chronic disease ( 82 , 83 ). Stress can stem from external events, such as major stressful life events or minor daily stressors, or from one's own perception of those experiences ( 84 ).…”