title: Common risk factors and edentulism in adults, aged 50 years and over, in China, Ghana, India and South Africa: results from the WHO Study on global AGEing and adult health (SAGE).
abstract: BACKGROUND
  Edentulism (loss of all teeth) is a final marker of disease burden for oral health common among older adults and poorer populations. Yet most evidence is from high-income countries. Oral health has many of the same social and behavioural risk factors as other non-communicable diseases (NCDs) which are increasing rapidly in low- and middle-income countries with ageing populations. The "common risk factor approach" (CRFA) for oral health addresses risk factors shared with NCDs within the broader social and economic environment.
  
  
  METHODS
  The aim is to improve understanding of edentulism prevalence, and association between common risk factors and edentulism in adults aged 50 years and above using nationally representative samples from China (N = 11,692), Ghana (N = 4093), India (N = 6409) and South Africa (N = 2985). The data source is the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) Wave 1 (2007-2010). Multivariable logistic regression describes association between edentulism and common risk factors reported in the literature.
  
  
  RESULTS
  Prevalence of edentulism: in China 8.9 %, Ghana 2.9 %, India 15.3 %, and South Africa 8.7 %. Multivariable analysis: in China, rural residents were more likely to be edentulous (OR 1.36; 95 % CI 1.09-1.69) but less likely to be edentulous in Ghana (OR 0.53; 95 % CI 0.31-0.91) and South Africa (OR 0.52; 95 % CI 0.30-0.90). Respondents with university education (OR 0.31; 95 % CI 0.18-0.53) and in the highest wealth quintile (OR 0.68; 95 % CI 0.52-0.90) in China were less likely to be edentulous. In South Africa respondents with secondary education were more likely to be edentulous (OR 2.82; 95 % CI 1.52-5.21) as were those in the highest wealth quintile (OR 2.78; 95 % CI 1.16-6.70). Edentulism was associated with former smokers in China (OR 1.57; 95 % CI 1.10-2.25) non-drinkers in India (OR 1.65; 95 % CI 1.11-2.46), angina in Ghana (OR 2.86; 95 % CI 1.19-6.84) and hypertension in South Africa (OR 2.75; 95 % CI 1.72-4.38). Edentulism was less likely in respondents with adequate nutrition in China (OR 0.68; 95 % CI 0.53-0.87). Adjusting for all other factors, compared with China, respondents in India were 50 % more likely to be edentulous.
  
  
  CONCLUSIONS
  Strengthening the CRFA should include addressing common determinants of health to reduce health inequalities and improve both oral and overall health.
authors.affiliation: Elite Dental Clinic, 6th Floor, Oasis Office Complex, Plot No. 14/15, Haile Selassie Road, P.O Box 38394, Masaki, Dar es salaam, Tanzania. alexkailembo@gmail.com.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kailembo
authors.affiliation: Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Faculty of Medicine, Umeå University, Umeå, Sweden.
authors.forename: Raman
authors.initials: R
authors.lastname: Preet
authors.affiliation: Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Faculty of Medicine, Umeå University, Umeå, Sweden.|Research Centre for Generational Health and Ageing, Faculty of Health, University of Newcastle, Newcastle, Australia.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Stewart Williams
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D002681:China / Q000453:epidemiology; D002908:Chronic Disease; D005869:Ghana / Q000453:epidemiology; D006801:Humans; D007194:India / Q000453:epidemiology; D008875:Middle Aged; D009066:Mouth, Edentulous / Q000453:epidemiology*; D015995:Prevalence; D012307:Risk Factors; D012959:Socioeconomic Factors; D013019:South Africa / Q000453:epidemiology; D014944:World Health Organization
keywords: CRFA; Caries; Common risk factor approach; Low- and middle-income countries, LMICs; NCDs; Non-communicable diseases; Oral health; Periodontal; Tooth loss