The relationship between income and oral health among people with intellectual disabilities: a global perspective.
BACKGROUND
The scientific literature cites wide health disparities for people with intellectual disabilities compared to the general population. This study seeks to gain an understanding of the effects of income status on oral health in a global population of people with intellectual disabilities.


METHODS
Eighty-two thousand five hundred and seventy Special Olympics athletes were screened and eligible for inclusion in this study. The main exposure (income status) and selected oral health signs and symptoms (missing teeth, untreated decay, injury, gingivitis, and mouth pain) were used to conduct a cross-sectional analysis. Prevalence odds ratios were obtained through logistic regression.


RESULTS
Study participants from low-income countries experienced adverse health outcomes at a lower rate than expected. Study participants from upper middle, lower middle, and low-income countries had higher odds of mouth pain and untreated decay, yet lower odds of missing teeth, injury, and gingivitis, than participants from high-income countries. Overall, a great number of individuals from every income group required maintenance or urgent care.


CONCLUSIONS
Oral health problems are not exclusive to low-income study participants. Unexpectedly high odds of missing teeth, injury, and gingivitis in high-income countries may be attributed to the high proportion of participants from the United States, which is considered a high-income country but has large income disparities. Health-determining circumstances in low-income countries provide some protection from the hypothesized gradient of oral health for all measured outcomes.
Graduate Student, Emory University Rollins School of Public Health, Atlanta, Georgia.
Michael J
MJ
Hughes
Associate Professor, Emory University Rollins School of Public Health, Atlanta, Georgia.
Julie A
JA
Gazmararian
epidemiology; global health; income; oral health