Neighborhood environmental burden and the elderly's complete edentulism prevalence in the US

Complete edentulism affects the quality of life and overall health. Identifying environmental factors linked to teeth lost may help address the global public health burden of oral health. This study aimed to estimate the association between neighborhood-level cumulative environmental burden and the prevalence of complete edentulism among the elderly across the US.

This cross-sectional study of 72 333 US neighborhoods using US Census tract-level data on environmental burden index (EBI) from the US CDC. Mixed-effects linear regression was applied to assess the relationship between neighborhood EBI and the prevalence of edentulism among the elderly, overall and by levels of neighborhood characteristics. The associations between 5 environmental burden domains and complete edentulism prevalence were further investigated. In addition, age proportion score-based matching and geospatially-based matching analyses were conducted to verify the robustness of the findings.

Across the US, compared to neighborhoods with the low-EBI, neighborhoods with the high-EBI were more likely to be located in the urban, to be more social vulnerable, have a lower percentage of males and the elderly (P < 0.001). After fully adjustment, the beta[95%CI] of the EBI was 1.759[1.620, 1.899] (P < 0.001). Among all 5 environmental burden domains, the built environment showed the strongest association (β = 2.735, 95% CI: 2.581-2.891). These associations were more pronounced in neighborhoods with male-percentage < = 50% and higher SVI scores, as well as in the urban and the south neighborhoods in (P < 0.001). Results were consistent after age proportion score-based matching and geospatially-based matching analyses among the high-EBI and low-EBI neighborhoods.

This national study across US neighborhoods indicated a modest but statistically significant association between the cumulative environmental burden and the prevalence of complete edentulism among the elderly. Interventions targeting adverse environmental conditions may hold potential for promoting oral health in aging populations.