The Intersections of Ethnicity, Nativity Status and Socioeconomic Position in Relation to Periodontal Status: A Cross-Sectional Study in London, England

Abstract

The role of migration as a social determinant of periodontitis has been overlooked. Intersectionality theory could help understand how immigration status interacts with other social determinants of health to engender inequalities in periodontitis. The objective of the present study was to evaluate whether ethnicity, nativity status and socioeconomic position intersect to structure social inequalities in periodontal status. Data from 1936 adults in a deprived and multi-ethnic area of London were analysed. The numbers of teeth with probing depth and clinical attachment loss were determined from clinical examinations. A matrix with 51 intersectional strata, defined according to ethnicity, nativity status and education, was created. A cross-classified multilevel analysis, with participants clustered within intersectional social strata, was performed to assess the extent to which individual differences in periodontal measures were at the intersectional strata level. A complex pattern of social inequalities in periodontal status was found, which was characterised by high heterogeneity between strata and outcome-specificity. The variance partition coefficient of the simple intersectional model, which conflated additive and interaction effects, indicated that 3–5% of the observed variation in periodontal measures was due to between-stratum differences. Moreover, the percentual change in variance from the simple intersectional to the intersectional interaction model indicated that 73–74% of the stratum-level variance in periodontal measures was attributed to the additive effects of ethnicity, nativity status and education. This study found modest evidence of intersectionality among ethnicity, nativity status and education in relation to periodontal status.

Racial and ethnic disparities in periodontal health among adults seeking dental care in rural North Carolina communities: A retrospective study

“…A subsequent metanalysis that included seven longitudinal studies with sample sizes ranging from 167 to 2806 subjects found that lower life‐long socioeconomic position increased the risk of periodontitis in adulthood 37 . A recent cross‐sectional study involving 1936 adults in London demonstrated that periodontitis was associated with individual and intersectional social characteristics, especially ethnicity and education 38 . Another cross‐sectional study of Indian adults also identified ethnicity as a risk indicator for periodontitis 39 .…”

“…37 A recent cross-sectional study involving 1936 adults in London demonstrated that periodontitis was associated with individual and intersectional social characteristics, especially ethnicity and education. 38 Another cross-sectional study of Indian adults also identified ethnicity as a risk indicator for periodontitis. 39 While the present study did not examine educational status, the results affirm that periodontitis is significantly associated with both race and ethnicity for adults seeking dental care in rural communities in North Carolina.…”

Socioeconomic determinants of periodontitis

“…On the other hand, in the Celeste et al 43 study on the Brazilian population, the moderate to severe periodontitis weighted prevalence was not significantly different between ethnicity in both low‑ and high‐income groups. The Shaharyar et al 44 studyon the multi‐ethnic population of East London did not find a significant interaction between ethnicity, nativity, and socioeconomic status. Ethnic diversity is an advantage for studies in which interactions between socioeconomic status and race/ethnicity is of interest.…”

“…The results of this study showed that income and education might affect periodontitis via independent pathways. 43 Shaharyar et al 44 Mendelian randomization is a method of using observational data to measure the causal exposure effects on a particular outcome. In recent years genome-wide association studies were used to obtain large-scale genetic association data for Mendelian randomization analysis.…”

“…Shaharyar et al 44 tested the hypothesis of the intersectionality of periodontitis among an immigrant population of London. Based on this theory, race, gender, ethnicity, and nativity together with various aspects of socioeconomic status may overlap and intersect with each other to create a disadvantage or privilege ingredient for the social achievements of individuals.…”