title: The role of potential mediators in racial inequalities in tooth loss: the Pró-Saúde study.
abstract: OBJECTIVE
  To assess the relation between race and tooth loss, as well as the influence of socioeconomic factors, health behaviours, routine dental care and self-reported discrimination on this association.
  
  
  METHODS
  This is a cross-sectional study with data collected from the baseline of the Pró-Saúde Study (Rio de Janeiro/Brazil), among 3253 civil servants in 1999-2001. Race was measured as self-reported skin colour (Black/Brown/White). The outcome was self-reported tooth loss, measured in four ordered categories (none/one or few/many/all or almost all). Three mediating pathways were explored between race and tooth loss. The first included self-reported discrimination assessed with a five-item scale. The second pathway included behavioural factors: routine dental care, marital status, smoking and alcohol consumption. The third considered socioeconomic factors: income, education, maternal education and early life poverty. Confounding factors were age and sex. Statistical analyses were carried out with ordinal logistic regression.
  
  
  RESULTS
  Absence of all or almost all teeth was reported by 8% of respondents. White individuals comprised 53% of the population, followed by Browns (26%) and Blacks (22%). After adjustment, Blacks had an odds ratio of being in a higher category of missing teeth equal to 1.39 (95% CI 1.12-1.72), and Browns, 1.33 (95% CI 1.10-1.60), when compared to Whites. Age, sex and socioeconomic variables explained most of racial inequalities in tooth loss, while behavioural and discrimination variables contributed very little. Behavioural and socioeconomic variables were associated with tooth loss, while discrimination was not. No statistically significant interactions were found.
  
  
  CONCLUSIONS
  There is an association between race and tooth loss that is mainly explained by current and early life socioeconomic variables, but not by behavioural factors and self-reported discrimination.
authors: Department of Preventive and Social Dentistry, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
authors: Roger Keller
authors: RK
authors: Celeste
authors: Letícia Gomes
authors: LG
authors: Gonçalves
authors: Eduardo
authors: E
authors: Faerstein
authors: João Luiz
authors: JL
authors: Bastos
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044383:Black People / Q000706:statistics & numerical data; D001938:Brazil / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003729:Dental Care / Q000706:statistics & numerical data; D004522:Educational Status; D015438:Health Behavior; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D044469:Racial Groups / Q000706:statistics & numerical data*; D063505:Racism / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D016388:Tooth Loss / Q000453:epidemiology*; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult
keywords: discrimination; mediation; race; socioeconomic factors; tooth loss