title: Tooth loss in the United Kingdom--trends in social inequalities: an age-period-and-cohort analysis.
abstract: This study assessed trends in social inequalities in tooth loss in the United Kingdom between 1988 and 2009. Data from 20,126 adults who participated in the latest three national Adult Dental Health Surveys in England, Wales and Northern Ireland were used. Social class was determined using the 6-point Registrar General's Social Class. Three indicators of tooth loss were analysed; the proportion of edentate people among all adults and the number of teeth and the proportion with functional dentition (defined as having 20+ teeth) among dentate adults. Trends were modelled within an age, period and cohort framework using partial least squares regression (PLSR). Confidence intervals for PLSR estimates were obtained using non-parametric bootstrapping. The Slope and Relative Index of Inequality (SII and RII) were used to quantify social inequalities in tooth loss. Between 1988 and 2009, absolute inequalities in total tooth loss narrowed (SII changed from -28.4% to -15.3%) while relative inequalities widened (RII from 6.21 to 20.9) in the whole population. On the other hand, absolute and relative social inequality in tooth loss remained fairly stable over time among dentate adults. There was an absolute difference of 2.5-2.9 in number of teeth and 22-26% in the proportion with functional dentition between the lowest and highest social classes. In relative terms, the highest social class had 10-11% more teeth and 25-28% higher probability of having functional dentition than the lowest social class. The findings show pervasive inequalities in tooth loss by social class among British adults despite marked improvements in tooth retention in recent years and generations. In the whole adult population, absolute inequalities in tooth loss have narrowed while relative inequalities have increased steadily. Among dentate adults, absolute and relative inequalities in number of teeth and proportion of people with functional dentition have remained significant but unchanged over time.
authors.affiliation: King's College London Dental Institute at Guy's, King's College and St. Thomas' Hospitals, Division of Population and Patient Health, London, United Kingdom.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bernabé
authors.affiliation: Department of Epidemiology and Public Health, University College London, London, United Kingdom.
authors.forename: Aubrey
authors.initials: A
authors.lastname: Sheiham
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003753:Dental Health Surveys; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D012923:Social Class; D012959:Socioeconomic Factors; D016388:Tooth Loss / Q000453:epidemiology*; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
references.citation: Soc Sci Med. 1997 Mar;44(6):757-71
references.pmid: 9080560
references.citation: J Epidemiol Community Health. 2002 Oct;56(10):762-5
references.pmid: 12239202
references.citation: Demography. 2003 May;40(2):309-31
references.pmid: 12846134
references.citation: Br Dent J. 2012 Nov;213(10):523-7
references.pmid: 23175081
references.citation: Public Health Rep. 2010 Nov-Dec;125(6):817-30
references.pmid: 21121227
references.citation: J Oral Rehabil. 2007 Dec;34(12):872-906; discussion 940
references.pmid: 18034671
references.citation: Epidemiology. 2012 Jul;23(4):583-93
references.pmid: 22407139
references.citation: J Epidemiol Community Health. 2006 Feb;60(2):95-101
references.pmid: 16415256
references.citation: J Dent Res. 2007 Feb;86(2):131-6
references.pmid: 17251511
references.citation: Soc Sci Med. 2014 Mar;104:163-77
references.pmid: 24581075
references.citation: Community Dent Oral Epidemiol. 2011 Jun;39(3):204-12
references.pmid: 21070319
references.citation: Community Dent Oral Epidemiol. 2013 Dec;41(6):481-9
references.pmid: 23992442
references.citation: J Oral Rehabil. 2013 Sep;40(9):707-22
references.pmid: 23855597
references.citation: Am J Epidemiol. 2008 Oct 15;168(8):906-14
references.pmid: 18779387
references.citation: J Epidemiol Community Health. 2013 Sep;67(9):728-35
references.pmid: 23814268
references.citation: J Dent Res. 2014 Jul;93(7 Suppl):20S-28S
references.pmid: 24947899
references.citation: Community Dent Oral Epidemiol. 2006 Aug;34(4):310-9
references.pmid: 16856951
references.citation: Milbank Q. 2010 Mar;88(1):4-29
references.pmid: 20377756
references.citation: Br Dent J. 2006 Mar 25;200(6):313-20
references.pmid: 16568054
references.citation: J Dent Res. 2012 Sep;91(9):865-70
references.pmid: 22837551
references.citation: Community Dent Oral Epidemiol. 2012 Oct;40 Suppl 2:28-32
references.pmid: 22998301
references.citation: Community Dent Oral Epidemiol. 2008 Aug;36(4):326-34
references.pmid: 18422707
references.citation: Soc Sci Med. 1991;33(5):545-57
references.pmid: 1962226
references.citation: Annu Rev Public Health. 1997;18:341-78
references.pmid: 9143723
references.citation: Am J Public Health. 2011 Oct;101(10):1892-9
references.pmid: 21852627
references.citation: J Epidemiol Community Health. 2004 Nov;58(11):900-3
references.pmid: 15483304
references.citation: Am Sociol Rev. 2010 Feb 1;75(1):126-150
references.pmid: 20379373