摘要：Objectives. We sought to determine the extent to which early life conditions and adverse life events impact chewing ability in middle and later adulthood. Methods. Secondary analyses were conducted based on data from waves 2 and 3 of the Survey of Health, Ageing, and Retirement in Europe (SHARE), collected in the years 2006 to 2009 and encompassing information on current chewing ability and the life history of persons aged 50 years or older from 13 European countries. Logistic regression models were estimated with sequential inclusion of explanatory variables representing living conditions in childhood and adverse life events. Results. After controlling for current determinants of chewing ability at age 50 years or older, certain childhood and later life course socioeconomic, behavioral, and cognitive factors became evident as correlates of chewing ability at age 50 years or older. Specifically, childhood financial hardship was identified as an early life predictor of chewing ability at age 50 years or older (odds ratio = 1.58; 95% confidence interval = 1.22, 2.06). Conclusions. Findings suggest a potential enduring impact of early life conditions and adverse life events on oral health in middle and later adulthood and are relevant for public health decision-makers who design strategies for optimal oral health. Oral diseases remain a major public health issue globally. 1 Not only do they affect nearly 4 billion people worldwide, 2 but they are also one of the most expensive diseases to treat. 1 Oral health is also recognized as an important component of general health and well-being. 3–8 Chronic diseases are increasingly studied within a life course framework that considers health impairments as a consequence of risk exposure in critical periods of life or accumulated exposure over time. Multiple events can occur throughout early- and later-life stages and pathways may link childhood conditions with health impairments in later life through intermediary adverse events. Models incorporating the entire life course have primarily been used to assess chronic conditions such as coronary heart disease and diabetes 9–11 but their application to oral health remains limited. Like other chronic diseases, oral diseases result from exposure to various risk factors throughout life. 12 Evidence from birth-cohort studies on life course determinants of oral health suggests that socioeconomic background, 13–16 dental-attendance patterns in early life years, 17,18 and parental oral health 19,20 play an important role in terms of tooth decay, periodontal health, tooth loss, and self-rated oral health at early adulthood. Moreover, it has been shown that caries experience in early life predicts caries occurrence later in life. 21 Despite robust methodological value and relevant findings, a limitation of birth-cohort studies containing oral health information is that they are age restricted. As these were not initiated before the early 1970s, 22,23 there has not yet been sufficient time to follow up individuals into middle and later adulthood. Consequently, they are not suitable to address research questions in terms of life course influences on oral health at older adulthood. This area of research could be served by longitudinal studies of older adults that contain current oral health-related outcomes and have also collected information on the major life course events and experiences of their participants. A significant consequence of oral diseases is deteriorating chewing ability. This represents serious functional impairment, interrelates with numerous oral health problems which determine oral health-related quality of life, and impacts on general health through influencing nutritional choices; chewing ability is thus often considered a meaningful marker of oral health, particularly in middle and late life years. 24–29 The study’s objective was to determine the extent to which childhood conditions and adverse life events impact on the chewing ability in middle and late adulthood populations from 13 European countries.
