Social capital and self-reported oral health at baseline of the brazilian longitudinal study of aging

Association between frailty and oral health services use in Brazilian older adults

OBJECTIVES

To assess the association between frailty and oral health services use in Brazilian older adults.

METHODS

This cross-sectional study analysed the baseline data from the Longitudinal Study on Brazilian Ageing (ELSI-Brazil) representative of Brazilians aged 50 or over. The outcome was oral health services used in the year prior to the interview. The main exposure variable was Frailty defined by the frailty phenotype. Age, skin colour, wealth, sex, education, type of service, health insurance, number of teeth and self-perceived oral health were included as covariates. Prevalence ratios (PR) with their respective 95% confidence intervals (CI) were estimated using Poisson regression with robust variance.

RESULTS

8405 individuals were included in this study. The prevalence of frailty was 7.5%. Regarding frailty status, the prevalence of dental service use was 47.0%, 48.5% and 4.5% for robust, pre-frail and frail individuals, respectively. Frail individuals had a 7% higher prevalence of not using dental (PR: 1.07; 95% CI: 1.01-1.13) than robust individuals. Frailty was independently associated with not using oral health services.

CONCLUSION

Given the complexity of the determinants of dental service use, frailty adds another dimension to be examined in older adults. Public health strategies considering a common risk factor approach should be endorsed.

Psychosocial aspects associated with self-reported oral health in Brazilians older adults

OBJECTIVES

Oral health conditions can be determined by a series of factors that include psychosocial aspects. Therefore, this study aimed to investigate the association between psychosocial aspects and self-reported oral health in Brazilian older adults.

METHODS

The Brazilian Longitudinal Study of Ageing (ELSI-Brazil) baseline data was analysed to develop this cross-sectional study. The outcome was self-reported oral health, and the psychosocial aspects included neighbourhood trust, life satisfaction and depressive symptoms. The associations were determined through Poisson regression models, controlling for socioeconomic, demographic and behavioural characteristics.

RESULTS

A total of 9365 individuals with aged 50 years or over were included in this study. Individuals with good life satisfaction had 16% (PR: 0.84; 95% CI: 0.78-0.90) lower prevalence of having poor self-reported oral health. Individuals who have depressive symptoms and do not trust in the neighbourhood presented 17% (PR: 1.17; 95% CI: 1.09-1.25) and 12% (PR: 1.12; 95% CI: 1.04-1.21) higher prevalence of poor self-report oral health compared to those who did not show depressive symptoms and trust the neighbourhood.

CONCLUSION

Our findings suggest that positive psychosocial aspects are moderately associated with better self-reported oral health. Therefore, we suggest that psychological health and social interaction should be present in public health policy actions.

The mediating role of social capital in socioeconomic inequalities of oral health behaviours among Brazilian older adults

OBJECTIVES

Knowledge of the possible pathways linking socioeconomic status (SES) to oral health-related behaviours can improve the understanding of inequalities in oral health. Therefore, in this study, it was investigated whether social capital mediates the relationship between SES and oral health behaviours.

METHODS

Through a cross-sectional study, data were analysed from participants aged ≥60 years from the Brazilian National Health Survey 2019 (n = 21 575). Structural equation modelling was used to test the direct and indirect pathways from a latent variable for SES to a latent variable for oral health behaviours: daily flossing, toothbrushing frequency and the use of dental care services.

RESULTS

The maximum likelihood estimator was used for complex samples with robust standard errors, and the final model demonstrated an adequate fit. The findings demonstrated that a higher SES was directly associated with better oral health-related behaviours (standardized coefficient [SC]: 0.82; [90% CI: 0.78-0.85]) and indirectly via structural social capital (SC: 0.05; [90% CI: 0.02-0.07]). The total effect of SES on oral health-related behaviours was (SC: 0.87, [90% CI: 0.85-0.89]).

CONCLUSION

The findings demonstrate that structural social capital in older Brazilian adults might partly mediate the pathways to socioeconomic inequalities in oral health behaviours. However, there is a direct effect on oral health behaviours, reinforcing the hypothesis that SES is associated with oral health, based on paths that link income inequality to oral health.

Frailty index and ten oral conditions in the Coyoacan cohort study: A cross-sectional analysis

OBJECTIVES

To analyse the relationship between the Frailty Index and 10 oral conditions controlling for nutritional status among Mexican community-dwelling older people.

BACKGROUND

Studies suggest that the association between frailty and oral conditions are mediated by nutrition.

MATERIALS AND METHODS

This cross-sectional analysis includes 487 community-dwelling men and women aged ≥70 years old. Interview and clinical examinations were performed at participants' homes. Objective (number of natural teeth, root remnants, dental condition, utilisation and functionality of removable dental prostheses and periodontitis) and subjective (utilisation of dental services, self-rated oral health, chewing difficulties and xerostomia) oral variables were collected by trained personnel. The Frailty Index was calculated considering 35 deficits. Nutritional status measured with the Mini-Nutritional assessment (MNA), age, sex, education, and marital status were included as covariates. We fitted 11 multivariate generalised linear models (one for each oral condition), assuming gamma distribution for Frailty Index as the outcome.

RESULTS

Participants average age was 78.1 years, 52.1% were women. We observed a higher Frailty Index among those rating their oral health as worse than others their age (5.1%), reporting chewing difficulties often (4.9%) and fairly and very often (7.0%), and xerostomia (4.8%). Age, gender and MNA were consistently associated with the Frailty Index.

CONCLUSION

Subjective oral conditions are compatible with the Frailty Index after controlling for older people's nutritional status and covariates.

Social capital and dental service use in older Brazilians

OBJECTIVES

To estimate the prevalence of dental services use and its association with social capital among Brazilian older adults.

BACKGROUND

Health inequities can be explained by the social determinants of health, which are the social, environmental, cultural and behavioural factors that directly or indirectly affect people's health. Among these determinants is social capital, that seem to affect health behaviours, such as use of dental services among older adults.

MATERIALS AND METHODS

This was a cross-sectional study using baseline data from the Longitudinal Study of the Health of the Brazilian Elderly, nationally representative of people aged 50 years or older. The baseline survey was carried out between 2015 and 2016, using structured questionnaires. The dependent variable was use of dental services in the last year. The main exposure variable was social capital, assessed through two dimensions: structural and cognitive. The covariates used were sex, skin colour, age, education, wealth, need for dental treatment, self-perception of oral health, tooth loss, type of dental services used, reason for dental care, smoking and alcohol consumption. Descriptive analyses and Poisson regression modelling were used.

RESULTS

The sample consisted of 9323 individuals. The prevalence of dental services use was 32.6% (95% CI: 30.7-34.5). No associations were found between social capital and the use of dental services.

CONCLUSION

This study did not find an association between structural and cognitive social capital and dental services use in Brazilian older adults. Further researches using instruments with different assessments of social capital are needed.

Wealth index association with self-reported oral health between white and non-white older Brazilians

This cross-sectional study aimed to identify the association between self-reported oral health status and a wealth index among white and non-white older adults in Brazil. Data from individual assessments of 9,365 Brazilians aged 50 years or older were analyzed. Poisson regression models were performed to estimate the prevalence ratio between wealth index and self-reported oral health among whites and non-whites adjusted for intermediate and proximal determinants. The total prevalence of poor self-reported oral health on white and non-white individuals was 41.6% (95%CI: 40.0-43.4) and 48% (95%CI: 47.1-49.8) respectively. The adjusted analysis showed that, for whites, the wealth index is associated with self-reported oral health since individuals in the 3rd, 4th, and 5th quintiles have 25% (PR = 0.75; 95%CI: 0.65-0.88), 20% (PR = 0.80; 95%CI: 0.67-0.95), and 39% (PR = 0.61; 95%CI: 0.50-0.75) lower prevalence of poor self-reported oral health than those in the poorest quintile. For non-white individuals, the wealth index is associated with self-reported oral health only for those in the 5th quintile, with 25% (PR = 0.85; 95%CI: 0.72-0.99) lower prevalence of poor self-reported oral health than those in the poorest quintile. The wealth index showed different effects on self-reported oral health among whites and non-whites. Socioeconomic status indicators may reflect racial inequalities due to the historical legacy of institutional discrimination. This study highlights the importance of developing policies to combat racial inequities and how these can contribute to better oral health conditions for the older Brazilian population.

The Different Roles of Structural and Cognitive Social Capital on Oral Health-Related Quality of Life among Adolescents

This study evaluated the relationship of structural and cognitive dimensions of social capital with oral health-related quality of life (OHRQoL) among adolescents. This was a cross-sectional study nested in a cohort of adolescents from southern Brazil. OHRQoL was evaluated using the short version of the Child Perceptions Questionnaire 11-14 (CPQ11-14). Structural social capital was measured by attendance of religious meetings and social networks from friends and neighbours. Cognitive social capital was evaluated through trust in friends and neighbours, perception of relationships in the neighbourhood, and social support during hard times. Multilevel Poisson regression analysis was performed to estimate the association between social capital dimensions and overall CPQ11-14 scores; higher scores corresponded to worse OHRQoL. The sample comprised 429 adolescents with a mean age of 12 years. Adolescents who attended religious meetings less than once a month or never presented higher overall CPQ11-14 scores. Adolescents who did not trust their friends and neighbours, those who believe that their neighbours did not have good relationships, and those reporting no support during hard times also presented higher overall CPQ11-14 scores. OHRQoL was poorer in individuals who presented lower structural and cognitive social capital, with the greatest impact related to the cognitive dimension.

Pathways between Social Capital and Oral Health from Childhood to Adolescence

This study aimed to evaluate the theoretical pathways by which social capital can influence dental caries and oral health-related quality of life (OHRQoL) of children over time. This 10-y prospective cohort started in 2010 with a sample of 639 preschoolers aged 1 to 5 y from the southern Brazil. Community and individual social capital were assessed at baseline through the presence of formal institutions in the neighborhood and social networks, respectively. In the 10-y follow-up, the individual social capital was evaluated by social trust and social networks. Dental caries was measured by the International Caries Detection and Assessment System (ICDAS), and the short version of the Child Perception Questionnaire (CPQ11-14) was used to assess OHRQoL. Demographic, socioeconomic, behavioral (frequency of toothbrushing and use of dental services), and psychosocial (sense of coherence) characteristics were also assessed. Structural equation modeling was used to evaluate the associations between variables over time. About 429 children were reassessed at 10-y follow-up (67.1% cohort retention rate). High community social capital at baseline directly predicted lower occurrence of dental caries and better OHRQoL after 10 y. Social capital at community level also indirectly predicted lower occurrence of dental caries through sense of coherence, frequency of toothbrushing, and use of dental services. Individual social capital at follow-up was indirectly linked to OHRQoL via the psychosocial pathway (sense of coherence). Community-level social capital was associated with dental caries and OHRQoL over time. The relationship between individual social capital and oral health was mediated through the psychosocial pathway.

Association between social capital and oral health among adults aged 50 years and over in China: a cross-sectional study

Background

Social capital has a potential effect in protecting oral health among population. However, no study has explored the association between social capital and oral health in the Chinese context. Due to the unique culture, political, social context in China, it is important to understand their association in the Chinese context. The study aims to investigate the association between cognitive and structural dimensions of social capital with edentulism among adults aged 50 years and over in China.

Method

The study used data from the WHO SAGE (Study on Global AGEing and Adult Health) wave 1 China component. Structural social capital was operationalized as social participation. Cognitive social capital was operationalized as perceived community trust and perceived community safety. Community-level social capital was measured by aggregating individual-level social capital into community level. Oral health was measured using a final marker of oral health status, self-reported edentulism. A 2-level multilevel logistic regression was used to evaluate the association between different dimensions of social capital and oral health.

Results

In total, 12,856 individuals were included in the study, the overall prevalence of edentulism was 9.1% (95% CI 8.3–10.0). Multilevel logistic analysis revealed that individual-level social capital and community-level social capital are independently associated with edentulism. Individuals with low structural social capital and living in areas with low structural social capital have, respectively, 1.54 (95% CI 1.18–2.01) and 2.14 (95% CI 1.47–3.12) times higher odds for edentulism, after adjustment for potential confounders (age, sex, marital status, residence locality, wealth, education level, chronic conditions) and a potential mediator(smoking).

Conclusions

Living in a community with lower structural social capital and individual with low structural social capital is associated with higher risk for edentulism among adults aged 50 years and over in China.

Individual social capital and dental pain in older adults

OBJECTIVES

To investigate the association between the structural and cognitive dimensions of social capital and dental pain in Brazilian adults aged 50 years and over.

METHODS

This cross-sectional study conducted individual assessments of 6154 Brazilians aged 50 years or older. Four individual variables based on structural and cognitive dimensions of social capital were assessed. We used hierarchical logistic regression models to estimate the odds ratio for dental pain with individual structural and cognitive social capital variables adjusted for associated factors. The model followed hypothetical pathways linking social capital to oral health.

RESULTS

Cognitive social capital was associated with dental pain. Participants who did not trust their neighbourhood had a 28% greater chance (OR, 1.28; 95% CI, 1.02-1.60) of dental pain than those who did.

CONCLUSION

Elements of cognitive dimension of social capital, particularly trust, reciprocity and support, as part of a common risk factor approach, should be considered when planning oral health promotion and preventive activities for older people.