Socioeconomic position indicators and periodontitis: examining the evidence

Socioeconomic factors, such as education and income, are associated with disparities in the prevalence and severity of periodontal disease, and this has been recognized since the 1960s. Epidemiological reports have consistently shown that periodontal disease is inversely related to education and income after controlling for age and gender, and that differences in education and income explain most if not all of the observed disparities in periodontal disease between blacks and whites. Although race/ethnicity has been the main focus of studies on differences in periodontal diseases in the USA, periodontal disease disparities according to socioeconomic position (SEP) indicators (i.e. education, income, povertyincome ratio) remain pervasive in the USA. SEP indicators, as used in the epidemiological literature, involve use of socioeconomic measures as a proxy measure for an individuals place, position and power in society. Thus, understanding disparities according to SEP indicators in periodontal health status may provide insight into why racial/ethnic disparities in periodontal health status persist. Here we review recent prevalence estimates of periodontitis according to SEP indicators, and critically assess the importance of SEP factors in periodontal epidemiolgy. The majority of the data available for review come from the USA. However, data from other countries are included where available. Specifically, we identify the advantages and disadvantages of the most commonly used SEP indicators in studying periodontal disease, summarize existing evidence on the association between SEP indicators and periodontitis, discuss the analytical issues associated with SEP indicators, and suggest future and alternative research directions for examining the association between SEP indicators and periodontitis.