title: Education as a predictor of chronic periodontitis: a systematic review with meta-analysis population-based studies.
abstract: BACKGROUND
  The impact of socioeconomic inequalities on health is well-documented. Despite the links of periodontal disease with cardiovascular diseases, adverse pregnancy outcomes and diabetes, no meta-analysis of socioeconomic variations in periodontal disease exists. This meta-analytic review was conducted to determine the extent to which education attainment influences risk of periodontitis in adults aged 35+ years in the general population.
  
  
  METHODS
  The authors searched studies published until November 2010 using EMBASE and MEDLINE databases. References listed were then scrutinised, our own files were checked, and, finally, we contacted experts in the field. The authors included only general population-based studies conducted in adults aged 35 years and more. All articles were blind reviewed by two investigators. In the case of disagreement, a third investigator arbitrated. Using PRISMA statement, two reviewers independently extracted papers of interest.
  
  
  RESULTS
  Relative to the higher education group, people with low education attainment experience a greater risk of periodontitis (OR: 1.86 [1.66-2.10]; p<0.00001). The association was partially attenuated after adjustment for covariates (OR: 1.55 [1.30-1.86]; p<0.00001). Sensitivity analyses showed that methods used to assess periodontitis, definition of cases, study country and categorization of education are largely responsible for the heterogeneity between studies. No significant bias of publication was shown using both the Egger (p = 0.16) and rank correlation tests (p = 0.35).
  
  
  CONCLUSIONS
  In the studies reviewed, low educational attainment was associated with an increased risk of periodontitis. Although this evidence should be cautiously interpreted due to methodological problems in selected studies, efforts to eliminate educational inequalities in periodontitis should focus on early life interventions.
authors.affiliation: Department of Periodontology, Service of Odontology, Rothschild Hospital, AP-HP, Paris 7-Denis Diderot University, U.F.R. of Odontology, Paris, France.
authors.forename: Adrien
authors.initials: A
authors.lastname: Boillot
authors.forename: Bechara
authors.initials: B
authors.lastname: El Halabi
authors.forename: George David
authors.initials: GD
authors.lastname: Batty
authors.forename: Hélène
authors.initials: H
authors.lastname: Rangé
authors.forename: Sébastien
authors.initials: S
authors.lastname: Czernichow
authors.forename: Philippe
authors.initials: P
authors.lastname: Bouchard
mesh_terms: D055113:Chronic Periodontitis / Q000150:complications* / Q000453:epidemiology* / Q000517:prevention & control; D004522:Educational Status; D006801:Humans; D012196:Review Literature as Topic; D012307:Risk Factors; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology