title: Austin Powers bites back: a cross sectional comparison of US and English national oral health surveys.
abstract: OBJECTIVE
  To compare oral health in the US and England and to assess levels of educational and income related oral health inequalities between both countries.
  
  
  METHODS
  Cross sectional analysis of US and English national surveys.
  
  
  METHODS
  Non-institutionalised adults living in their own homes.
  
  
  METHODS
  Oral health measures and socioeconomic indicators were assessed in nationally representative samples: the Adult Dental Health Survey 2009 for England, and the US National Health and Nutrition Examination Survey 2005-08. Adults aged ≥25 years were included in analyses with samples of 8719 (England) and 9786 (US) for analyses by education, and 7184 (England) and 9094 (US) for analyses by income.
  
  
  METHODS
  Number of missing teeth, self rated oral health, and oral impacts on daily life were outcomes. Educational attainment and household income were used as socioeconomic indicators. Age standardised estimates of oral health were compared between countries and across educational and income groups. Regression models were fitted, and relative and absolute inequalities were measured using the relative index of inequality (RII) and the slope index of inequality (SII).
  
  
  RESULTS
  The mean number of missing teeth was significantly higher in the US (7.31 (standard error 0.15)) than in England (6.97 (0.09)), while oral impacts were higher in England. There was evidence of significant social gradients in oral health in both countries, although differences in oral health by socioeconomic position varied according to the oral health measure used. Consistently higher RII and SII values were found in the US than in England, particularly for self rated oral health. RII estimates for self rated oral health by education were 3.67 (95% confidence interval 3.23 to 4.17) in the US and 1.83 (1.59 to 2.11) in England. In turn, SII values were 42.55 (38.14 to 46.96) in the US and 18.43 (14.01 to 22.85) in England.
  
  
  CONCLUSIONS
  The oral health of US citizens is not better than the English, and there are consistently wider educational and income oral health inequalities in the US compared with England.
authors.affiliation: Department of Epidemiology and Public Health, University College London, London WC1E 7HB, UK Departamento de Salud Colectiva, Facultad de Odontología, Universidad Nacional de Colombia, Bogotá, Colombia c.guarnizo-herreno.11@ucl.ac.uk.
authors.forename: Carol C
authors.initials: CC
authors.lastname: Guarnizo-Herreño
authors.affiliation: Department of Epidemiology and Public Health, University College London, London WC1E 7HB, UK.
authors.forename: Georgios
authors.initials: G
authors.lastname: Tsakos
authors.affiliation: Department of Epidemiology and Public Health, University College London, London WC1E 7HB, UK.
authors.forename: Aubrey
authors.initials: A
authors.lastname: Sheiham
authors.affiliation: Department of Epidemiology and Public Health, University College London, London WC1E 7HB, UK.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Marmot
authors.affiliation: Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts 02115, USA.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kawachi
authors.affiliation: Department of Epidemiology and Public Health, University College London, London WC1E 7HB, UK.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Watt
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D004522:Educational Status; D004739:England; D005260:Female; D054624:Health Status Disparities; D006306:Health Surveys; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009909:Oral Health / Q000706:statistics & numerical data*; D012044:Regression Analysis; D012923:Social Class; D012959:Socioeconomic Factors; D014481:United States