摘要：Objectives . Profound and growing disparities exist in oral health among certain US populations. We sought here to determine the prevalence of oral health complaints among Harlem adults by measures of social class, as well as their access to oral health care. Methods . A population-based survey of adults in Central Harlem was conducted from 1992 to 1994. Two questions on oral health were included: whether participants had experienced problems with their teeth or gums during the past 12 months and, if so, whether they had seen a dentist. Results . Of 50 health conditions queried about, problems with teeth or gums were the chief complaint among participants (30%). Those more likely to report oral health problems than other participants had annual household incomes of less than $9000 (36%), were unemployed (34%), and lacked health insurance (34%). The privately insured were almost twice as likely to have seen a dentist for oral health problems (87%) than were the uninsured (48%). Conclusions . There is an urgent need to provide oral health services for adults in Harlem. Integrating oral health into comprehensive primary care is one promising mechanism. Although the oral health status of the US population has greatly improved over the last 30 years, profound and growing disparities exist among certain populations. 1– 4 The most disadvantaged include people of color, the working-class poor, and people with chronic illnesses and disabilities. National, state, and local data to accurately quantify the nature and magnitude of these disparities in oral health are notably lacking. 5 The surgeon general's report Oral Health in America calls for new efforts to eliminate disparities in oral health status and rates of oral disease. In particular, it uncovers the hidden epidemic of dental and oral diseases that largely affects poor people of color and those with chronic illnesses and disabilities. 1 The report also stresses the serious consequences that poor oral health has on overall health and well-being. Adults in Harlem suffer from high excess morbidity and mortality 6 , yet very little is known about the prevalence or impact of oral diseases in the population. Oral health disparities have been attributed in part to differences in the utilization of oral health services and access to primary oral health care. 7– 10 A better understanding of the underlying reasons for underutilization in poor populations of color is urgently needed. The Harlem Health Promotion Center, a joint project of Harlem Hospital Center, the Mailman School of Public Health of Columbia University, and the Centers for Disease Control and Prevention, conducted the Harlem Household Survey (HHS) to better understand and address the determinants of excess morbidity and mortality among adult residents of Harlem. This report presents the results of the survey's oral health assessment. In particular, we characterized the burden of oral health complaints among Central Harlem adults, determined whether or not they received dental care for their self-reported problems, and identified factors that facilitated their utilization of dental care services.
