摘要：Objectives. We examined prospective associations between socioeconomic position (SEP) markers and oral health outcomes in a national sample of older adults in England. Methods. Data were from the English Longitudinal Survey of Aging, a national cohort study of community-dwelling people aged 50 years and older. SEP markers (education, occupation, household income, household wealth, subjective social status, and childhood SEP) and sociodemographic confounders (age, gender, and marital status) were from wave 1. We collected 3 self-reported oral health outcomes at wave 3: having natural teeth (dentate vs edentate), self-rated oral health, and oral impacts on daily life. Using multivariate logistic regression models, we estimated associations between each SEP indicator and each oral health outcome, adjusted for confounders. Results. Irrespective of SEP marker, there were inverse graded associations between SEP and edentulousness, with proportionately more edentate participants at each lower SEP level. Lower SEP was also associated with worse self-rated oral health and oral impacts among dentate, but not among edentate, participants. Conclusions. There are consistent and clear social gradients in the oral health of older adults in England, with disparities evident throughout the SEP hierarchy. The inverse linear relationship between socioeconomic position (SEP) and health is well established. 1 – 4 The uneven distribution of health across socioeconomic strata has been observed in both industrialized and less developed countries and for most common diseases and causes of death. 1 , 5 – 8 In most cases, the association between SEP and health is characterized by a linear graded pattern, with people in each lower SEP category having successively worse levels of health and dying earlier than those that are better off, a characteristic known as the social gradient in health. 9 Although there is clear and consistent evidence about the existence of the social gradient in working-age adults, 10 , 11 studies in older adults are less consistent, with some showing attenuation of the gradient 12 , 13 and others reporting that it persisted 14 , 15 or even increased 16 in magnitude. Oral health is particularly important at older ages with tooth loss shown to be independently associated with disability and mortality. 17 – 20 Oral health status in older people is also an important determinant of nutritional status. 21 Socioeconomic disparities in oral health have been consistently demonstrated for various indicators, mostly clinical and disease related 22 – 31 but also subjective measures of oral health and quality of life. 30 , 32 – 38 Some of these studies have explicitly assessed the existence of an oral health gradient, 23 , 25 – 31 , 34 – 37 but almost all were carried out on adolescents and adults, with very few focusing on older people. 33 , 36 These few relevant studies are cross-sectional and inconclusive and have used a limited number of SEP indicators (typically, education and occupational class), thereby hindering any comprehensive analysis on the relationship between SEP and oral health. We addressed the gap in the literature about the existence of an oral health gradient at older ages by examining the prospective associations between a wide range of SEP indicators (education, occupation, household income, household wealth, subjective social status [SSS], and childhood SEP) and various oral health outcomes (presence of natural teeth, self-rated oral health, and oral impacts) in a national sample of older adults from the English Longitudinal Survey of Aging (ELSA). We explored whether there are any significant socioeconomic inequalities in oral health among older people in England and, if so, whether these take the form of a gradient.
