Hong, Jialan; (2023) Exploring associations between socioeconomic position across the life course, oral health, and all-cause mortality: evidence from the Chinese Longitudinal Healthy Longevity Survey. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Background Oral health inequality among older adult populations poses a major public health challenge globally, including in China, where the population is rapidly ageing. A large volume of evidence shows that socioeconomic position (SEP) is closed linked to healthy ageing. Objectives The study objectives were to examine: 1) whether, and to what extent, life course models explain the associations between SEP across the life course and number of teeth among Chinese older adults; 2) the effects of mediators on the association between SEP across the life course and number of teeth; and 3) the role of socioeconomic factors over the life course and oral health conditions at the baseline wave on all-cause mortality among Chinese older adults. Methods Secondary data of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) were analysed. Cross-sectional analyses used wave 8 (2018) data on a sample of 15,316 older adults aged 65 to 105 years, while longitudinal analyses employed a dataset merging waves 4-8 (2005-18) on a sample of 26,665 older adults. First, using cross-sectional data from wave 8 of the survey, SEP life course models on number of teeth were tested employing ordinal logistic regression with partial proportional odds models and structural equation modelling (SEM). SEM was subsequently performed to investigate behavioural, material, and health pathways between SEP in childhood, adulthood, and older age, and number of teeth in older age. Finally, survival analyses were conducted on the longitudinal dataset using Cox proportional hazards regression models to assess the associations between SEP, oral health status and all-cause mortality. Results Adulthood and older age were the most important sensitive periods in predicting the effects of SEP on number of teeth and all-cause mortality. The effect of childhood SEP was fully explained by SEP at subsequent life stages. There was strong evidence that cumulative disadvantages and social mobility trajectories were associated with number of teeth, supporting the accumulative risks and social mobility models. Also, there was statistical evidence of the mediating effects of life course behavioural, material, and general health conditions. Additionally, number of teeth and denture use were highly associated with all-cause mortality. The mortality risks were higher for those with fewer teeth and those who did not use dentures. Conclusion This thesis has demonstrated that SEP is a determinant of health among older Chinese adults. The life course influences of SEP on oral health appear to be mediated through health behaviours, material conditions, and general health status. Meanwhile, oral health status is associated with all-cause mortality. Public health interventions should, therefore, focus on social determinants of health to reduce health inequalities and promote healthy ageing.

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