The independent contribution of neighborhood disadvantage and individual-level socioeconomic position to self-reported oral health: a multilevel analysis.

OBJECTIVES: To examine the association between neighborhood disadvantage and individual-level socioeconomic position (SEP) and self-reported oral health.
METHODS: A population-based cross-sectional study conducted in 2003 among males and females aged 43-57 years. The sample comprised 2915 individuals and 60 neighborhoods and was selected using a stratified two-stage cluster design. Data were collected using a mail survey (69.4% response rate). Neighborhood disadvantage was measured using a census-based composite index, and individual-level SEP was measured using education and household income. Oral health was indicated by self-reports of the impact of oral conditions on quality of life (0 = none or minor, 1 = severe), self-rated oral health (0 = excellent-good, 1 = fair/poor) and missing teeth (measured as a quantitative outcome). Data were analyzed using multilevel modeling.
RESULTS: After adjusting for age, sex, education, and household income, residents of socioeconomically disadvantaged neighborhoods were significantly more likely than those in more advantaged neighborhoods to indicate negative impacts of oral conditions on quality of life, to assess their oral health as fair or poor, and to report greater tooth loss. In addition, respondents with low levels of education and those from a low income household reported poorer oral health for each outcome independent of neighborhood disadvantage.
CONCLUSIONS: The socioeconomic characteristics of neighborhoods are important for oral health over and above the socioeconomic characteristics of the people living in those neighborhoods. Policies and interventions to improve population oral health should be directed at the social, physical and infrastructural characteristics of places as well as individuals (i.e. the traditional target of intervention efforts).