Sabbah, W.; (2007) Exploring pathways towards social gradients in oral and general health. Doctoral thesis , University of London.

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Abstract

There are social gradients in general and oral health. Few studies have examined the pathways towards the gradients in oral health and compared them to the pathways suggested for general health gradients. The objectives of this thesis are: (1) to examine and compare the social gradients in selected indicators of oral and general health, (2) to examine the gradients in selected indicators of health-related behaviours, (3) to examine and compare some of the potential pathways towards the gradients in oral and general health. Data were from the Third National Health and Nutrition Examination Survey, pertaining to adults aged 17 years and over in the United States. Oral health indicators were perceived oral health, tooth loss, edentulousness, and four variables indicating periodontal disease. General health indicators were perceived general health, and ischaemic heart disease. Health-related behaviours were smoking, visits to a dentist, frequency of eating fresh fruits and vegetables, and frequency of exercise. Socioeconomic position was measured by years of education and poverty-income ratio. Regression models were conducted to assess education and income gradients in all the health outcomes and all the behaviours, and to examine the effects of certain pathways and factors on health and on the social gradients. These factors included sex, ethnicity, cognitive ability, health-related behaviours and stress (allostatic load). Changes in the social gradients in oral and general health were assessed after adjusting for these factors. There were consistent and similar social gradients in oral and general health (objective 1), consistent social gradients in some but not all health-related behaviours (objective 2), and similar pathways towards the gradients in oral and general health (objective 3). Health behaviours, tooth cleanliness, and stress appeared to be the important pathways affecting the gradients in oral and general health. In conclusion, relative poverty is an important factor that affects the social gradients in oral and general health similar pathways appear to exist for the oral and general health outcomes explored in this thesis.

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