摘要：Objectives. We evaluated the relationship between financial hardship and self-reported oral health for older men and women. Methods. We focused on adults in the 2008 Health and Retirement Study (n = 1359). The predictor variables were 4 financial hardship indicators. We used Poisson regression models to estimate the prevalence ratio of poor self-reported oral health. Results. In the non–gender-stratified model, number of financial hardships was not significantly associated with self-reported oral health. Food insecurity was associated with a 12% greater prevalence of poor self-reported oral health (95% confidence interval [CI] = 1.04, 1.21). In the gender-stratified models, women with 3 or more financial hardships had a 24% greater prevalence of poor self-reported oral health than women with zero (95% CI = 1.09, 1.40). Number of hardships was not associated with self-reported oral health for men. For men, skipping medications was associated with 50% lower prevalence of poor self-reported oral health (95% CI = 0.32, 0.76). Conclusions. Number of financial hardships was differentially associated with self-reported oral health for older men and women. Most financial hardship indicators affected both genders similarly. Future interventions to improve vulnerable older adults’ oral health should account for gender-based heterogeneity in financial hardship experiences. The Institute of Medicine’s 1998 publication Gender Differences in Susceptibility of Environmental Factors called attention to how socioeconomic factors differentially affect health outcomes for men and women. 1 Gender-based health disparities are pronounced among older adults. 2,3 In 2010, 25% of the US population was aged 55 years or older, a 15% increase from 2000. 4 Advances in chronic disease management have improved adult life expectancy, 5–12 making older adults the fastest growing subgroup in the United States. The close relationship between oral and systemic health 13–15 has motivated interest in addressing oral health disparities in older adults, particularly among those who are financially vulnerable. 16 Poverty and low socioeconomic status (SES) are associated with tooth decay, gum diseases, and oral cancers—all of which are indicators of poor oral health. 17–28 Older men and women are at differential risk for dental diseases and conditions. 29,30 For instance, older men are more likely to have untreated tooth decay, 31,32 gum disease, 33 and oropharyngeal cancer 34 whereas older women are more likely to have missing teeth and to be edentulous. 29 Dental care use by women partially explains this heterogeneity in disease risk 35 although the mechanisms underlying gender-based differences have not been elucidated. Differential risk for dental disease may translate to differences in self-reported oral health. Based on 1999–2004 US National Health and Nutrition Examination Survey data, a larger proportion of men aged 65 years and older reported fair or poor oral health compared with women (40.1% and 36.9%, respectively). 29 Although 2 studies suggest that self-reported oral health measures are weakly associated with dental disease status as assessed by a dentist, 36,37 most studies have concluded that self-reported oral health is a valid and reliable measure of clinical oral health. 38–41 There is a growing body of literature on gender, socioeconomic inequality, and health disparities. 42–45 Most studies have focused on traditional measures of SES such as education, income, or occupation. 46–48 However, these measures do not adequately capture the multiple pathways by which socioeconomic and financial circumstances influence health. 49–53 For example, focusing on income alone may not fully capture an individual’s ability to garner resources to meet financial obligations. 54 Alternative SES measures such as financial hardship have been shown to have an impact on health over and above traditional measures of SES. 55,56 Furthermore, recent studies suggest that alternative SES measures, which account for economic resources, assets, and household material conditions, are moderated by gender on outcomes such as self-rated health, psychological distress, musculoskeletal disorders, and mortality. 55–58 This interaction is particularly relevant for older adults, many of whom are retired or are preparing to exit the workforce. 59 Currently, there is little understanding of how gender and financial hardship interact on oral health outcome measures. In addition, the studies relevant to adult oral health have 2 limitations: (1) the inclusion of both younger and older adults in the same models, which assumes that the relationship between socioeconomic indicators and oral health is homogeneous across the adult life span 20,22,27,47 ; and (2) the lack of gender-stratified models, 28 which treats gender as a confounder rather than as an effect modifier. The aim of the present study was to test the hypothesis that the association between financial hardship and self-reported oral health is different for women and men. This research continues the line of work aimed at identifying ways to improve the oral health of vulnerable older adults, and has important implications in the development of interventions and policies that address gender-based disparities in adult oral health. 60,61
