title: Social disparities in periodontitis among US adults: the effect of allostatic load.
abstract: BACKGROUND
  Periodontitis has been shown to be associated with allostatic load, a measure of physiological instability across biological systems from cumulative or repeated adaptation to stressors. Minority racial/ethnic and low socioeconomic groups tend to have higher prevalence of periodontitis and are more likely to be exposed to stress. The association between periodontitis and allostatic load and whether this association differed by race/ethnicity, education, income and age among US adults were examined.
  
  
  METHODS
  Using data from the National Health and Nutrition Examination Survey 1999-2004, prevalence ratios were calculated using logistic regression to estimate the strength of the association between allostatic load and the prevalence of periodontitis before and after adjusting for selected characteristics.
  
  
  RESULTS
  After adjustment for selected characteristics, including race/ethnicity, income and education, US adults with a high allostatic load were 55% (95% CI 1.05 to 2.29) more likely to have periodontitis than their counterparts with low allostatic load. This association varied by race/ethnicity where Mexican Americans with a high allostatic load were almost five (PR 4.62; 95% CI 2.52 to 8.50) times more likely to have periodontitis than their counterparts with low allostatic load.
  
  
  CONCLUSIONS
  These data suggest that stress may be associated with periodontitis in the USA, with Mexican Americans exhibiting the strongest association. Furthermore, this group may lack appropriate coping responses to process chronic stressors that other groups may have historically been conditioned to handle. More research is needed to understand allostatic load in Mexican Americans and its influence on periodontitis.
authors.affiliation: Graduate Program in Public Health, Department of Health Sciences, Lehman College, City University of New York, Bronx, NY 10468, USA. luisa.borrell@lehman.cuny.edu
authors.forename: L N
authors.initials: LN
authors.lastname: Borrell
authors.forename: N D
authors.initials: ND
authors.lastname: Crawford
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D052636:Allostasis / Q000502:physiology*; D005006:Ethnicity / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D010518:Periodontitis / Q000175:diagnosis / Q000453:epidemiology* / Q000208:ethnology; D017678:Sex Distribution; D012923:Social Class; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000175:diagnosis / Q000453:epidemiology / Q000208:ethnology; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology