Trends in Oral Health Inequalities among Older Adults in England

Healthy aging is a global public health priority, and good oral health is essential for this. While studies in the United Kingdom documented social gradients in oral health measures among adults, they were mostly cross-sectional and conducted before major policy and economic changes. One study examined trends over time in inequalities in tooth loss but used only 1 socioeconomic position (SEP) measure and did not focus on older adults. Our study aimed to examine trends in oral health inequalities by a comprehensive range of SEP indicators among older adults in England from 2006-2007 to 2018-2019. Secondary data analyses used both baseline and refreshment samples from waves 3, 5, 7, and 9 of the English Longitudinal Study of Ageing (ELSA). Oral health outcomes were edentulousness (waves 3-7; 8-y follow-up), self-rated oral health (SROH), and Oral Impacts on Daily Performances (OIDP) (waves 3-9 for both; 12-y follow-up). SEP indicators consisted of education, occupation, household income, and household wealth. Logistic regression with robust standard errors accounting for clustering was used to measure socioeconomic inequalities in oral health over time, controlling for age, sex, and marital status. Odds ratios and predicted probabilities were compared to assess changes in relative and absolute oral health inequalities over 12 y. The prevalence of edentulousness decreased from waves 3 to 7 (data not available for wave 9), while the prevalence of reporting at least 1 oral impact and fair/poor SROH increased from waves 3 to 9. Social gradients were evident across oral health outcomes and for different SEP markers. For all 3 outcomes, relative inequalities remained largely unchanged over the study period. Absolute inequalities slightly narrowed for edentulousness but increased for both SROH and oral impacts. Overall, oral health inequalities among older adults in England have persisted and, in some aspects, widened over these 12 y, highlighting the need for upstream public health strategies to reduce inequalities.