November 25, 2008
Periodontitis can redden anyone’s gums. But years ago, researchers noticed that some Americans seemed to be more prone than others to this chronic and often destructive oral inflammation. This led the organizers of the National Health and Examination Nutrition Surveys, or NHANES, to collect data on periodontal health in the 1960s and in subsequent decades. The NHANES surveys, in turn, provided the raw material from which researchers mined data to develop hypotheses about who is at risk and why. Typically, the analyses lumped together two broad variables: race/ethnicity and socioeconomic position, or SEP, which accounts for a person’s education and income. The idea being, race/ethnicity and SEP are inextricably linked in American society. But some have questioned this assumption. Differences in education and income, for example, may reflect the impact of discriminatory social policies, not necessarily factors intrinsic to race and ethnicity.
In the October 2008 issue of the journal Community Dentistry Oral Epidemiology, an NIDCR grantee and colleague revisit the issue with a fresh and timely perspective. Using data from the latest NHANES survey (1999-2004), they examined whether race/ethnicity, income, and education are independently associated with periodontitis before and after adjusting for selected characteristics, such as smoking and diabetes, two risk factors for the condition. They then investigated the effects of adjusting for income and education on the association between race/ethnicity and periodontitis. The researchers found that the overall prevalence of periodontal disease was 3.6 percent. The prevalence data broke down along racial/ethnic lines: Black people - 7.2 percent, Mexican Americans - 4.4 percent, and White people - 3.0 percent. According to the authors, race/ethnicity, education, and income were independently associated with periodontal disease. For instance, Black adults are 2.66 times more likely than White adults to have periodontitis. When education and income were factored into the model, the association remained. Regardless of their education and income, Black adults remained 1.94 times more likely to have periodontitis than White adults from the same demographic categories.
“This study indicates that social constructs, race/ethnicity, education, and income are associated with periodontal health,” the researchers concluded. “These findings have been consistently reported in the U.S. over the years. Thus, the pathways by which race/ethnicity and socioeconomic indicators, separately or combined, lead to health or disease should be investigated.”