The role of individual and neighborhood social factors on periodontitis: The Third National Health and Nutrition Examination Survey

Background: This study investigates whether race/ethnicity, individual income, education, and neighborhood socioeconomic characteristics are independently associated with periodontitis in adults >= 18 years of age who participated in the third National Health and Nutrition Examination Survey (NHANES 111). Methods: Analyses were limited to participants in NHANES III who self-identified as non-Hispanic black, non-Hispanic white, or Mexican American, received a periodontal examination, and whose records were linked to the 1990 U.S. Census data (N = 13,090). Periodontitis was investigated using a combination of clinical attachment loss and probing depth. Marginal logistic regression models were used to assess the association of race/ethnicity, individual income, education, and neighborhood socioeconomic characteristics with periodontitis before and after adjusting for selected covariates. A survey program was used to account for the survey sampling design and for the intraneighborhood correlation of outcomes of participants selected from the same neighborhood. Results: Race/ethnicity, education, and neighborhood socioeconomic conditions were associated with periodontitis before and after controlling for selected covariates. After adjustment, blacks were twice (1.58 to 2.53) as likely to have periodontitis as whites. Compared to those with more than a high school education, those with less than a high school diploma were twice (1.48 to 2.89) as likely to have periodontitis. Individuals living in a neighborhood in the lowest tertile of the socioeconomic score were 1.81 times (1.36 to 2.41) more likely to have periodontitis than those living in a neighborhood in the highest tertile of the socioeconomic score. Conclusion: This study indicates that race/ethnicity, individual education, and neighborhood socioeconomic circumstances are important for periodontal health.