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The Relationship between Income and Oral Health: A Critical Review

Singh, A; Peres, MA; Watt, RG; (2019) The Relationship between Income and Oral Health: A Critical Review. Journal of Dental Research , 98 (8) pp. 853-860. 10.1177/0022034519849557. Green open access

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Abstract

In this critical review, we summarized the evidence on associations between individual/household income and oral health, between income inequality and oral health, and income-related inequalities in oral health. Meta-analyses of mainly cross-sectional studies confirm that low individual/household income is associated with oral cancer (odds ratio, 2.41; 95% confidence interval [CI], 1.59–3.65), dental caries prevalence (prevalence ratio, 1.29; 95% CI, 1.18–1.41), any caries experience (odds ratio, 1.40; 95% CI, 1.19–1.65), tooth loss (odds ratio, 1.66; 95% CI, 1.48–1.86), and traumatic dental injuries (odds ratio, 0.76; 95% CI, 0.65–0.89). Reviews also confirm qualitatively that low income is associated with periodontal disease and poor oral health–related quality of life. Limited evidence from the United States shows that psychosocial and behavioral explanations only partially explain associations between low individual/household income and oral health. Few country-level studies and a handful of subnational studies from the United States, Japan, and Brazil show associations between area-level income inequality and poor oral health. However, this evidence is conflicting given that the association between area-level income inequality and oral health outcomes varies considerably by contexts and by oral health outcomes. Evidence also shows cross-national variations in income-related inequalities in oral health outcomes of self-rated oral health, dental care, oral health–related quality of life, outcomes of dental caries, and outcomes of tooth loss. There is a lack of discussion in oral health literature about limitations of using income as a measure of social position. Future studies on the relationship between income and oral health can benefit substantially from recent theoretical and methodological advancements in social epidemiology that include application of an intersectionality framework, improvements in reporting of inequality, and causal modeling approaches. Theoretically well-informed studies that apply robust epidemiological methods are required to address knowledge gaps for designing relevant policy interventions to reduce income-related inequalities in oral health.

Type: Article
Title: The Relationship between Income and Oral Health: A Critical Review
Open access status: An open access version is available from UCL Discovery
DOI: 10.1177/0022034519849557
Publisher version: https://doi.org/10.1177/0022034519849557
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Social determinants, Health inequalities, Epidemiology, Review, Dental, Theory
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health > Epidemiology and Public Health
URI: https://discovery.ucl.ac.uk/id/eprint/10079509
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