The Alcohol Harm Paradox in Periodontitis

Area of Science:

• Public Health
• Dental Research
• Socioeconomic Determinants of Health

Background:

• Lower socioeconomic position (SEP) individuals face higher alcohol-related harms despite similar or lower consumption.
• The alcohol harm paradox (AHP) describes this disparity, with limited understanding of underlying mechanisms.
• Both SEP and alcohol consumption are linked to periodontitis risk.

Purpose of the Study:

• To investigate if socioeconomic position modifies the association between alcohol consumption and periodontitis.
• To determine the extent to which alcohol consumption mediates or interacts with SEP inequalities in periodontitis.

Main Methods:

• Secondary analysis of National Health and Nutrition Examination Survey (NHANES) 2011-2014 data.
• Educational attainment as the primary SEP proxy; poverty-income ratio used in sensitivity analyses.
• Effect measure modification and causal mediation analyses using logistic regression, adjusted for multiple covariates.

Main Results:

• Less educated heavy drinkers showed significantly higher odds of periodontitis (OR 2.75).
• Super-additive associations indicated a significant interaction between heavy drinking and lower education on periodontitis.
• Interaction, not mediation, explained a substantial portion (-69.5%) of the effect of education on periodontitis, supporting the AHP.

Conclusions:

• Heavy alcohol consumption disproportionately exacerbates periodontitis risk among lower socioeconomic position individuals.
• The alcohol harm paradox in periodontitis is driven by a significant interaction effect between heavy drinking and lower SEP.
• Findings underscore the need for targeted public health interventions addressing socioeconomic disparities in alcohol-related oral health outcomes.