摘要：Objectives. We used data from the Dental Atherosclerosis Risk in Communities study to examine whether individual- and neighborhood-level socioeconomic characteristics were associated with periodontal disease. Methods. We assessed severe periodontitis with a combination of clinical attachment loss and pocket depth measures. Marginal logistic regression modeling was used to estimate the association between individual and neighborhood socioeconomic indicators and prevalence of severe periodontitis before and after control for selected covariates. Residual intraneighborhood correlations in outcomes were taken into account in the analyses. Results. Individual-level income and education were associated with severe periodontitis among Whites and African Americans, and these associations remained significant after adjustment for age, gender, recruitment center, and neighborhood socioeconomic score. Low-income Whites residing in disadvantaged neighborhoods had 1.8-fold (95% confidence interval=1.2, 2.7) higher odds of having severe periodontitis than high-income Whites residing in advantaged neighborhoods. Conclusions . Individual income and education were associated with severe periodontitis independently of neighborhood socioeconomic circumstances. Although the association between neighborhood socioeconomic status and severe periodontitis was not statistically significant, poverty and residence in a disadvantaged neighborhood were associated with higher odds of severe periodontitis among Whites. It has long been reported that periodontal diseases are more frequent and more severe among individuals of low socioeconomic status (SES) than among their peers of higher SES. 1 – 12 However, the nature of the association between periodontal disease and the socioeconomic indicators assessed (i.e., income, education) has rarely been the focus of investigations. In fact, socioeconomic indicators are usually included as covariates in analyses of factors associated with periodontal disease. Although an association between area-based socioeconomic indicators and health outcomes has been documented, 13 – 15 the mechanisms by which area-based SES affects health are not well understood. Research has suggested that neighborhood-specific socioeconomic conditions can influence patterns of health behaviors and health-related beliefs independent of individual levels of SES. 14 , 16 In the case of periodontal diseases, higher neighborhood SES might be associated with healthy behaviors among community members (e.g., reductions in smoking prevalence) and dissemination of health-related information to these individuals, which in turn could prevent periodontal diseases independent of individual SES. Also, the SES of a geographic area can influence the available supply of health professionals. 17 However, studies have shown that manpower and access to dental services do not correlate well with improved health status. 18 The dental ancillary component of the Atherosclerosis Risk in Communities (ARIC) cohort study (“Dental ARIC”) afforded us the opportunity to investigate whether individual-and neighborhood-level socioeconomic characteristics are independently associated with periodontal disease before and after control for selected individual characteristics. We hypothesized that (1) individual and neighborhood SES characteristics would be independently associated with a higher probability of periodontal disease and (2) neighborhood socioeconomic characteristics would have different effects on residents according to their individual SES (e.g., poor individuals living in poor neighborhoods would have worse outcomes than their high-income peers living in more affluent neighborhoods).
