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Social Adversity Is Causally Linked to Multimorbidity Including Oral Conditions
A O Esemezie1,2, D J Lizotte2,3, G Tsakos4
1Dentistry, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.
Journal of Dental Research
|September 6, 2025
Summary
Social adversity, including low economic and social capital, causally increases the risk of developing oral conditions (OC) and multimorbidity including oral conditions (MIOC) in older adults. These effects were most pronounced in middle-aged individuals.
Area of Science:
- Social Determinants of Health
- Oral Health Epidemiology
- Gerontology and Aging Research
Background:
- Fundamental cause theory suggests social factors influence disease, but direct causality for oral health remains unclear.
- Social adversity, encompassing low economic and social capital, is linked to various diseases, including oral and systemic conditions.
- Understanding the causal pathways from social adversity to oral conditions and multimorbidity is crucial for public health interventions.
Purpose of the Study:
- To estimate the causal effect of social adversity on the development of oral conditions (OC).
- To assess the causal effect of social adversity on multimorbidity including oral conditions (MIOC).
- To examine if these causal effects vary by age or gender in middle-aged and older adults.
Main Methods:
- Analysis of two waves (2011, 2018) from the Canadian Longitudinal Study on Aging (CLSA) cohort.
- Social adversity defined by low income and social capital (community participation, social relationships).
- Logistic marginal structural models with inverse probability weighting used to estimate causal odds ratios (OR) for OC and MIOC development.
Main Results:
- Social adversity significantly increased the odds of developing OC (OR=1.9) and MIOC (OR=1.7) over a 7-year period.
- The causal effects of social adversity were strongest in the middle-aged subgroup.
- Similar increased odds for OC and MIOC were observed in both men and women experiencing social adversity.
Conclusions:
- Social and economic capital are causally linked to the development of oral conditions and multimorbidity in aging populations.
- Interventions targeting social and living conditions are essential for promoting healthy aging and reducing health disparities.
- Findings underscore the importance of addressing socioeconomic factors in oral health and overall systemic health strategies.
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