Oral health disparities among geriatric population according to sexual difference in South Korea: A Nationwide population- based study

doi:10.21203/rs.3.rs-1961070/v1

Download PDF

Article

Oral health disparities among geriatric population according to sexual difference in South Korea: A Nationwide population- based study

https://doi.org/10.21203/rs.3.rs-1961070/v1

This work is licensed under a CC BY 4.0 License

Journal Publication

published 15 May, 2023

Read the published version in Scientific Reports →

You are reading this latest preprint version

The proportion aged 60 years or older in the world's population is expected to double by 2050. In general, they have many complex diseases and poor oral health status. Oral health is one of the important health indicators of elderly people and it is affected by diverse factors, such as socioeconomic status. In this study, gender was considered as an associated factor that is closely related to edentulism. The sexual difference might be more influential within the geriatric population because of lower economic and educational backgrounds in that stage. Edentulism was significantly higher among elderly females than males, when combined with the education level. The lower the level of education, the higher the prevalence of edentulism as much as 24~28 times, especially in female (P=0.002). These findings suggest a more complex relationship between oral health, socioeconomic status, and gender.

According to the United Nation’s World Population Prospects 2019, the geriatric population aged 65 years or older is rapidly increasing and is expected to account for 16% of the world's population by 2050¹. These population experience problems with vision, hearing, and tooth loss with increasing age² and has at least one restriction in activities of daily living (ADL), such as walking, eating, and washing^3–5. According to the Health and Retirement Study (HRS) in the United States, almost one-fifth of the elderly with these restrictions answered that their health status was poor⁶. Older females have less access to health care and experience discrimination within the health care system⁷. In particular, the population from lower socioeconomic backgrounds was more likely to report limitations in daily living⁸. This makes the geriatric population more dependent on care. Because many complex diseases already existed, they got less attention for their lower priority, and it makes their oral health condition worse⁹. A decrease in the number of natural teeth makes usual life difficult and health status worse. Intaking of fibrous foods, fruits, and vegetables is decreasing and the risk of gastrointestinal disorders is increasing^10,11. Tooth loss usually starts from the age of 40s and rapidly increases when in they were 60s or 70s¹². According to the US National Health and Nutrition Examination Survey, edentulism was prevalent in 0.7% of the population aged 20–44 years but increased to 20.2% in the geriatric population aged over 65 years¹³. In South Korea, the population with no natural teeth was 0.2% when they were in their 40s and reached 13.6% at the age of 70s¹⁴.

Tooth loss is affected by various demographic and sociological factors. Studies suggest that the risk factors for edentulism included increasing age^15,16, poor oral health practices, disability in function^17,18, low socioeconomic status¹⁹, and living alone²⁰. Elderly people suffer from health and oral health difficulties and the oral health gap to demographic social factors increasingly added and affects their overall life²¹. There are differences by sex in tooth loss as well, more frequently happening in females²². Supa et al mentioned that among males the major factor affecting edentulism was smoking; however, among females, it was lower socioeconomic status²³. The elderly female showed a fifteen times higher economic dependence than males²⁴ and these exacerbate oral health conditions and increase dissatisfaction, depression²⁵, or inconvenience in their daily life of them²⁶. Sexual differences in health among the elderly have been widely reported^27–29 but they are not normally considered to be related to disparities, especially in oral health. There is a limited number of studies available to establish the relationship between the diverse variables related to these differences.

This study aimed to understand oral health disparities in the geriatric population, considering sexual difference as a related factor, through analysis of data obtained from the Korean National Health and Nutrition Survey (KNHANES Ⅶ, 2016 to 2018); our findings will aid in the proper planning and implementation of oral health policies.

1. General characteristics of the study population:

The total number of participants aged 65 years and older in the 7th National Health and Nutrition Survey (2016–2018) was 3,426. Among these elderly participants, 57.6% were female, which was 15% higher than the proportion of than male (Table 1). Most participants had only elementary school education or none (57.6%). Female had a graduation rate for elementary school, that was 1.5 times the graduation rate of male; however, the number of females graduating high school was only 0.5 times the number of male graduating high school. Twenty-one percent of the participants lived alone; twice as many females lived alone than male. With respect to morbidities, the proportion of the elderly population with hypertension and diabetes was 62.3% and 25.7%, respectively. Female showed a 5% higher rate of hypertension than male, but there was no significant difference in the prevalence of diabetes. The rate of drinking more than once a month was 34.4% and male were a three times higher rate than female. With respect to smoking, 15 times as many males reported a history of smoking than female. Almost 70% of subjects were involved in physical activity on a weekly basis with male reporting a higher likelihood of engaging in physical activity than female. Most people brushed more than twice a day (76.0%); 10% more female brushed more than twice a day than male. Only a quarter of the participants did an annual oral examination; more male received the examination than female.

2. Prevalence of edentulism in elderly individuals

The proportion of the geriatric population without teeth was 9.5%. This increased with age, with 18.1% of participants aged 80 years being edentulous; female showed a higher rate of edentulism than male (Table 2). With respect to educational level, the prevalence of edentulism was 11.1% in people finished elementary school, which was twice as high as that among high school graduates and those with a higher education. The difference of prevalence of edentulism by education level was 10 times higher in female than in male. The higher the income, the lower the prevalence of edentulism, especially in female; the gap between the first and fifth quartiles was almost double compared to male. The participants who lived alone had a slightly higher prevalence of edentulism than participants who lived with someone else. There was no statistical difference among participants with hypertension in general. However, female with this metabolic disease had a higher prevalence of edentulism. The participants who did not have a history of drinking monthly had a higher prevalence of edentulism, but there was no difference according to gender. The percent of the people with no teeth was 11.4% in smokers, which was higher than that in non-smokers, as much as twice in both male and female. In the case of physical activity, male who were not engaged in physical activity had a higher rate of edentulism. Participants, both male and female, who brushed lesser than twice a day had a five times higher likelihood of edentulism than those who brushed more. The rate of edentulism was almost five times higher in participants who did not receive oral examinations once a year; the gap was bigger in male, as ten times more likely to be edentulous.

3. Logistic regressions by risk factors associated with edentulism in elderly individuals

The logistic regression analysis for the factors affecting the prevalence of edentulism among elderly individuals is presented in Table 3. Age, educational level, income, living alone, and lifetime smoking were significantly associated with edentulism among elderly individuals. Participants who brushed fewer than twice a day were five times more likely to be edentulous than participants who did, and participants who did not receive yearly oral examinations were six times more likely to be edentulous than participants who did. After adjustment for all risk factors, the geriatric population who did not receive yearly oral examinations showed a lower odds ratio: almost four times that before. The coefficient of determination of NagelKerke R2 in this model was 0.185. In the third model considering the interaction between gender and education level, the odds ratio of edentulism decreased for females with the opposite results of those from the second model. Compared to the group of elderly female participants who graduated high school, people who finished middle school showed 29 times higher risk of being edentulous, and people who graduated elementary school were at a 24-fold higher risk of being edentulous. The lower the level of education, the higher the prevalence of edentulism, especially in females. The coefficient of determination of NagelKerke R2 in the final model was 0.198.

Table 1

Characteristics of the study population of elderly between 2016 to 2018
	Variables		Total		Male		Female		p
	Variables		N	%	n	%	n	%	p
Total			3,426	100.0	1,465	42.4	1,961	57.6
		Age
	65–69		1,059	31.5	482	33.0	577	30.4	0.483
	70–74		916	27.4	387	27.4	529	27.4
	75–79		830	23.7	350	22.5	480	24.6
	≥ 80		621	17.4	246	17.1	375	17.6
		Educational level
	High school and more		834	27.1	557	41.6	277	16.6	< 0.001
	Middle school		476	15.3	248	18.6	228	12.8
	Elementary school		1,906	57.6	570	39.8	1,336	70.6
	Missing value		210		90		120
		Household income quintile
	1st		700	21.1	300	20.9	400	21.3	0.944
	2nd		692	19.3	297	19.9	395	18.8
	3rd		697	19.7	296	19.6	401	19.8
	4th		673	20.4	286	20.4	387	20.4
	5th		644	19.5	277	19.2	367	19.8
	Missing value		20		9		11
		Living status
	Alone		853	21.0	201	11.7	652	27.8	< 0.001
	With family		2,573	79.0	1,264	88.3	1,309	72.2	< 0.001
		Location of residence
	Province		1,852	53.8	762	52.5	1,090	54.7	0.203
	Metropolitan		1,574	46.2	703	47.5	871	45.3	0.203
		Hypertension
	Yes		2,172	62.3	879	59.4	1,293	64.5	0.010
	No		1,248	37.7	585	40.6	663	35.5
	Missing value		6		1		5
		Diabetes
	Yes		824	25.7	377	26.8	447	24.8	0.288
	No		2,239	74.3	955	73.2	1,284	75.2
	Missing value		363		133		230
		Drinking per month
	Once and more		1,144	34.4	813	56.6	331	17.8	< 0.001
	Never		2,222	65.6	636	43.4	1,586	82.2
	Missing value		60		16		44
		Lifetime smoking
	Experienced		1,216	35.8	1,116	77.0	100	5.1	< 0.001
	Never		2,146	64.2	330	23.0	1,816	94.9
	Missing value		64		19		45
		Aerobic physical activity^*
	No		2,268	69.0	904	64.1	1,364	72.7	< 0.001
	Yes		942	31.0	472	35.9	470	27.3
	Missing value		216		89		127
		Tooth brushing per day
	Less than twice		840	24.0	449	30.3	391	19.4	< 0.001
	Twice and more		2,586	76.0	1,016	69.7	1,570	80.6	< 0.001
		Oral exam in last year
	No		2,567	75.5	1,053	72.1	1,514	78.1	< 0.001
	Yes		795	24.5	393	27.9	402	21.9
	Missing value		64		19		45
^*Medium-intensity physical activity for more than 2 hours and 30 minutes, high-intensity physical activity for more than 1 hour and 15 minutes, or mixed intensity per week (1 minute of high-intensity physical activity is equal for 2 minutes of medium-intensity).

Table 2

Prevalence of edentulism according to characteristics of the study population of elderly between 2016 to 2018
Variables		Total				Male				Female
Variables		N	n	%	p	N	n	%	p	N	n	%	p
Total		3,426	328	9.5	0.597	1,465	138	9.1		1,961	190	9.8
Age
	65–69	1,059	40	3.9	< 0.001	482	23	4.7	< 0.001	577	17	3.2	< 0.001
	70–74	916	64	7.4		387	36	8.8		529	28	6.3
	75–79	830	110	13.1		350	43	12.7		480	67	13.3
	≥ 80	621	114	18.1		246	36	13.5		375	78	21.4
Educational level
	High school and more	834	49	5.1	< 0.001	557	44	7.2	0.126	277	5	1.2	< 0.001
	Middle school	476	33	6.8		248	21	8.2		228	12	5.2
	Elementary school	1,906	208	11.1		570	64	11.2		1,336	144	11.0
Household income quintile
	1st	700	84	11.1	0.007	300	34	9.4	0.417	400	50	12.3	0.008
	2nd	692	77	11.8		297	33	11.7		395	44	11.9
	3rd	697	71	11.0		396	28	9.6		401	43	12.0
	4th	673	51	7.5		286	25	8.7		387	26	6.6
	5th	644	42	6.1		277	18	6.4		367	24	5.9
Living status
	Alone	853	117	13.9	< 0.001	201	31	16.2	0.001	652	86	13.2	0.009
	With family	2,573	211	8.3	< 0.001	1,264	107	8.2	0.001	1,309	106	8.4	0.009
Location of residence
	Province	1,852	190	10.5	0.111	762	80	10.3	0.110	1,090	110	10.7	0.328
	Metropolitan	1,574	138	8.3	0.111	703	58	7.8	0.110	871	80	8.7	0.328
High blood pressure
	Yes	2,172	212	9.8	0.324	879	75	7.8	0.065	1,293	137	11.1	0.004
	No	1,248	113	8.8	0.324	585	63	11	0.065	663	50	6.9	0.004
Diabetes
	Yes	824	85	9.9	0.171	377	38	8.9	0.751	447	47	10.6	0.153
	No	2,239	183	8.0	0.171	955	82	8.3	0.751	1,294	101	7.7	0.153
Drinking per month
	Once and more	1,144	89	7.7	0.044	813	64	8.0	0.106	331	25	7.0	0.124
	Never	2,222	224	10.0	0.044	636	73	10.7	0.106	1,586	151	9.7	0.124
Lifetime smoking
	Experienced	1,216	139	11.4	0.008	1,116	123	10.7	< 0.001	100	16	19.5	0.008
	Never	2,146	174	8.0	0.008	330	14	4.1	< 0.001	1,816	160	8.7	0.008
Aerobic physical activity^*
	No	2,268	224	9.8	0.105	904	89	10.4	0.011	1,364	135	9.4	0.479
	Yes	942	68	6.8	0.105	472	39	6.1	0.011	470	29	7.4	0.479
Tooth brushing per day
	Less than twice	840	181	21.7	< 0.001	449	85	19.2	< 0.001	391	96	24.6	< 0.001
	Twice and more	2,586	147	5.6	< 0.001	1,016	53	4.7	< 0.001	1,570	64	6.2	< 0.001
Oral exam last year
	No	2,567	295	11.6	< 0.001	1,053	130	12.2	< 0.001	1,514	165	11.1	< 0.001
	Yes	795	18	2.1	< 0.001	393	7	1.3	< 0.001	402	11	2.7	< 0.001
^*Medium-intensity physical activity for more than 2 hours and 30 minutes, high-intensity physical activity for more than 1 hour and 15 minutes, or mixed intensity per week (1 minute of high-intensity physical activity is equal for 2 minutes of medium-intensity).

Table 3

Odds ratio (OR) and 95% confidence interval (CI) estimated from logistic regression model for edentulism of elderly between 2016 to 2018
Variables		No-interaction						Interaction (Sex*Educational Level)
		Unadjusted			Model 1			Model 2
		OR	95% CI	p	OR	95% CI	p	OR	95% CI	p
Sex (= Male)
	Female	1.079	0.813–1.433	0.597	1.507	0.740–3.071	0.258	0.074	0.010–0.576	0.013
Age (= 65–69)
	70–74	1.977	1.211–3.229	0.007	2.049	1.225–3.428	0.006	2.130	1.269–3.576	0.004
	75–79	3.745	2.300-5.393	< 0.001	3.571	2.053–6.210	< 0.001	3.486	1.999–6.080	< 0.001
	≥ 80	5.507	3.619–8.378	< 0.001	3.382	1.967–5.816	< 0.001	3.325	1.935–5.713	< 0.001
Educational level (= High school and more)
	Middle school	1.364	0.817–2.276	0.234	1.440	0.809–2.563	0.215	0.908	0.465–1.773	0.777
	Elementary school	2.337	1.592–3.430	< 0.001	1.453	0.901–2.342	0.125	0.936	0.524–1.673	0.824
Household income (= 5th)
	4th	1.249	0.766–2.037	0.371	1.168	0.660–2.065	0.594	1.121	0.634–1.981	0.694
	3rd	1.914	1.148–3.191	0.013	1.247	0.631–2.462	0.525	1.198	0.613–2.342	0.598
	2nd	2.074	1.310–3.283	0.002	1.036	0.561–1.914	0.909	1.015	0.554–1.859	0.961
	1st	1.935	1.222–3.064	0.005	0.880	0.437–1.711	0.719	0.852	0.428–1.697	0.649
Living status (= With family)
	Alone	1.791	1.332–2.407	< 0.001	1.502	0.936–2.409	0.092	1.508	0.936–2.432	0.091
Location of residence (= Metropolitan )
	Province	1.304	0.940–1.808	0.111	1.202	0.825–1.751	0.336	1.227	0.841–1.790	0.288
High blood pressure (= No)
	Yes	1.133	0.884–1.453	0.324	0.858	0.638–1.153	0.310	0.875	0.651–1.175	0.373
Diabetes (= No)
	Yes	1.259	0.905–1.751	0.172	1.008	0.705–1.441	0.966	1.006	0.706–1.433	0.976
Drinking per month (= Never)
	Once and more	0.749	0.565–0.992	0.749	0.854	0.526–1.081	0.124	0.748	0.523–1.071	0.113
Lifetime smoking (= Never)
	Experienced	1.481	1.139–1.927	0.003	2.403	1.295–4.460	0.006	2.346	1.268–4.341	0.007
Aerobic physical activity^* (= Yes)
	No	1.483	0.919–2.393	0.107	0.922	0.563–1.509	0.746	0.920	0.562–1.506	0.739
Tooth brushing per day (= Twice and more)
	Less than twice	4.672	3.501–6.235	< 0.001	3.471	2.502–4.815	< 0.001	3.548	2.559–4.919	< 0.001
Oral exam in last year (= Yes)
	No	6.222	3.657–10.586	< 0.001	3.807	2.071–6.995	< 0.001	3.743	2.040–6.868	< 0.001
Gendereducational level (= Femalehigh school and more)
	Female*middle school							28.877	3.488–238.080	0.002
	Female*elementary school							24.422	3.272-182.275	0.002
NagelKerke R2					0.185			0.198
*Model 1: fully adjusted for gender, age group, educational level, household income quintile, living status with family, location of residence, existence of high blood pressure or diabetes, drinking, smoking, physical activity, frequency of tooth brushing, and oral exam experience in last year, Model 2: Model 1 plus interaction between gender and educational level

The proportion of the world's population aged 60 years or older is expected to double by 2050. As a result, population aging is recognized as an important problem worldwide³⁰. Oral health is an essential health indicator among elderly people^9,10. A gap is reported in the oral health of geriatrics for various factors including socioeconomic and behavioral factors. In this study, gender was considered the main factor that affected the prevalence of edentulism among those aged 65 years or above.

There was no difference in the prevalence of edentulism according to gender until the interaction between gender and education level was considered, which was significant. Edentulism among elderly females was significantly higher than that among males when categorized by education level. The prevalence of edentulism among middle school or elementary school graduates and participants with lower education levels was 24–28 times that of high school graduates or participants with higher education in an elderly female. The prevalence of edentulism among elderly individuals in South Korea was 9.5%, which was lower than the prevalence of 12.9% observed in the United States³¹, but higher than the prevalence of 8.1% observed in Japan³². The proportion of elderly individuals is expected to reach 46.5% in 2067³³, of which the proportion of female elderly individuals is expected to be about 55%, higher than that of male elderly individuals in Korea. Gender may be an important factor associated with edentulism among the geriatric population, especially for economic and educational backgrounds. Some studies have reported that the lower the education or income, the higher the prevalence of edentulism^34–37. This population is also reported to have lower subjective oral health, which might affect care for oral health³⁸. Most of them showed a lower tendency to visit dental clinics³⁹, which might have worsened oral health conditions. There was a significant difference in edentulism by socioeconomic level in an elderly female. This is the reason that the interaction between gender and socioeconomic factors is assumed to exist. There might be a more complex relationship between oral health, socioeconomic status, and gender. Among the geriatric Korean population, a female had a significantly less chance than a male of being educated. They also lived longer than males and many of them lived alone⁴⁰. Elderly females were found to be more sensitive to socio-economic factors as well. The gap in economic poverty appeared in poorer elderly females, which worsened oral health⁴¹. Paola et al reported that elderly females did more preventive oral care than males, but complex mechanisms working in oral health make necessary careful management⁴². The oral health gender gap should be considered not just gender itself but also the contextual mechanism around it.

Regular tooth brushing twice a day and yearly oral examination was found to have effects on edentulism. Healthy behaviors were reported as closely related to oral health⁴³. The prevalence of edentulism was higher in participants with a history of smoking, brushing fewer than twice a day, and not taking yearly oral examinations^44,45. These oral health behaviors showed different patterns depending on gender, and females are known to visit the dentist more frequently, perform better oral care⁴⁶, and have better knowledge, attitude, and behavior about oral health than male^47,48. The elderly female showed about a 10% higher rate of brushing their teeth twice or more a day than males in this study. Likewise, each gender in elderly individuals had significant associations with different oral health behavior factors, such as physical activity for males and hypertension for females. The type of residence also showed a significant association. Elderly individuals living alone were at an almost two times higher risk of edentulism. Kim et al reported that elderly people who lived alone had a higher possibility of needing dentures and experiencing difficulty in mastication than geriatric people living with their families⁴⁹. Elderly males living without families showed a higher level of edentulism. Elderly individuals living alone might have fewer opportunities to acquire and exchange information about oral health and more difficulties in practicing healthy oral behavior⁵⁰.

There are several limitations of this study. First, social relationships and support might influence physical, mental, and oral health and behavior, especially in geriatric people^51,52. The data used in this study did not include social capital variables such as the number of friends and meetings. It is necessary to understand the social relationship of elderly individuals with oral health in depth in the future. Second, it is difficult to identify the causal relationship because the data as this was a cross-sectional study. The present education or income levels were surveyed but the past socioeconomic status or oral health behavior of the participant could not be included in this survey. The causal relationship from previous conditions would be important in the study of the geriatric population. Future studies must design a longitudinal data set such as a cohort framework to identify the influential relationship after identifying the related factors. Even with these limitations, this study established the fundamentally important health characteristics of an aging society according to gender with oral health status using national representative data.

This study revealed the association between gender and socioeconomic factors related to the oral health of elderly individuals. In edentulism in elderly individuals, there was no difference according to gender, initially. After considering the interaction between gender and education, an elderly female had a lower possibility of being edentulous than a male. The prevalence of edentulism in the elderly female who graduated middle school or elementary school was 24 ~ 28 times that of high school graduates. Each gender of the geriatric population had significant associations with different oral health behavior factors, such as physical activity for males and hypertension for females. In conclusion, in the plan for oral health improvement in elderly individuals, gender characteristics must be identified, such as socioeconomic factors for females and health behavior factors for males.

Study Subjects. This study analyzed oral health conditions by gender in the geriatric population aged 65 years or older using the Korean National Health and Nutrition Survey (KNHANES Ⅶ, 2016-2018) data. The sampling frame was layered based on the size of the area (cities, provinces, and districts) and housing types (general housing, apartments). The ratio of residential area and educational background of household owners was used as the intrinsic stratification criteria. Finally, 576 districts were surveyed over 3 years, with 10,611 households participating in the study. A cohort of 24,269 participants was recruited with a response rate of 76.6%. Among them, 3,426 people were elderly, which was 21.0% of all subjects.

Study Variable. The general characteristics of the study sample were gender, age, education or income level, household type, region, comorbidities such as hypertension or diabetes, health-related behavior such as drinking, smoking, aerobic physical activity, brushing teeth, or visiting a dental clinic for oral examination per year. The independent variables are classified as shown in Table 1. The type of household was categorized by the number of family members - one as living alone and two or more as family living together. A person involved in as much as medium intensity physical activity for 2 h and 30 min, high-intensity physical activity for 1 h and 15 min, or medium and high-intensity physical activity per week (1-min-high intensity for 2 min) was defined as properly engaging in physical activity.

Statistical Analysis: A complex sample analysis was used because the KNHANES was a two-stage stratified cluster sampling. It was conducted by generating an integrated weight based on the prepared analysis plan file. The plan file adapted analysis weight with “oral examination weight”, design of the strata with “variance estimation” and “group aged 65 years or above, and cluster as primary sampling unit with the district. Complex sample frequency and chi-square tests were conducted to find out the difference in the prevalence of edentulism according to socioeconomic factors, chronic diseases, and health-related behaviors. A complex sample logistical regressions were performed with an unadjusted model with univariate variables, a fully adjusted model including all variables (Model 1), and an advanced model with interaction by gender and education (Model 2). All analyses used SPSS (Statistical Packages for Social Science 26.0. SPSS Inc., USA) and statistical significance was set to α=0.05.

Ethical approval and informed consent

This study used the dataset obtained from the KNHANES Ⅶ, 2016 to 2018. All KNHANES were conducted with participants’ informed consent after approval by the Research Ethics Review Committee of the Korea Disease Control and Prevention Agency (KDCA) (IRB No. 2018-03-P-A for the KNHANES VII). This analytical study was approved again by the institutional review board (IRB) of Kyung Hee University (IRB No. KHSIRB-21-337(EA)) as exemption of the review because this retrospective analysis included the dataset of national surveillance and did not contain personally identifiable information. All methods were carried out following the KNHANES analytic guidelines and regulations.

Data availability

The data that supports the findings of this study is available from the KDCA, but restrictions apply to the availability of data, which was used with permission for the current study and therefore not publicly available. Data is however available upon reasonable request and with permission of KDCA.

Acknowledgements:

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No. 2021R1F1A1063105).

Author Contributions

H.A.P. and J.I.R contributed for the conception and design of the work and wrote the main manuscript text; S.H.S has substantial contributions to the acquisition, analysis, and interpretation of data. All authors reviewed the manuscript.

Competing Interests:

The authors declare no competing interests.

Additional information

Correspondence and requests for materials should be addressed to J.I.R

United Nations. Department of economic and social affairs, population division. World Population Ageing 2019 Highlights. (United Nations Department of economic and social affairs, population division, 2019).
Yamada, M. et al. Prevalence of visual impairment in the adult Japanese population by cause and severity and future projections. Ophthalmic Epidemiol 17, 50–57, doi:10.3109/09286580903450346 (2010).
Kim, N. et al. Health Status and Integrated Care for Elderly People: Focused on Healthcare. (Korea Institute for Health and Social Affairs 2019).
Korean Statistical Information System. 2019 Senior Citizen Statistics, http://kostat.go.kr/portal/korea/kor_nw/1/1/index.board?bmode=read&aSeq=385322 (2019).
The Mexican health and aging study. Aging in Mexico: Disability, http://www.mhasweb.org/ (2020).
Ankuda, C. K., Levine, D. A., Langa, K. M., Ornstein, K. A. & Kelley, A. S. Caregiving, Recovery, and Death After Incident ADL/IADL Disability Among Older Adults in the United States. J Appl Gerontol 39, 393–397, doi:10.1177/0733464819826842 (2020).
World Health Organization. Women, Ageing and Health: A Framework for Action: Focus on gender. (World Health Organization, 2007).
Park, G. R. & Choi, B. H. A Gender analysis of the association between Self-rated Health and Disability of daily living among Korean Elderly. Korean Public Health Research 44, 25–34 (2018).
Panchbhai, A. S. Oral health care needs in the dependant elderly in India. Indian J Palliat Care 18, 19–26, doi:10.4103/0973-1075.97344 (2012).
Osterberg, T. et al. Edentulism associated with obesity: A study of four national surveys of 16,416 Swedes aged 55–84 years. Acta Odontol Scand 68, 360–367, doi:10.3109/00016357.2010.514721 (2010).
Hung, H. C., Colditz, G. & Joshipura, K. J. The association between tooth loss and the self-reported intake of selected CVD-related nutrients and foods among US women. Community Dent Oral Epidemiol 33, 167–173, doi:10.1111/j.1600-0528.2005.00200.x (2005).
Kim, J. S., Kim, S. Y., Jun, E. J., Jeong, S. H. & Kim, J. B. The number of existing permanent teeth and the denture status of elderly adults aged 65 years and above living in metropolitan cities using data from the Korean National Health and Nutrition Examination Survey. Journal of Korean Society of Dental Hygiene 18, 921–932, doi:10.13065/jksdh.20180079 (2018).
Lee, H., Kim, D., Jung, A. & Chae, W. Ethnicity, Social, and Clinical Risk Factors to Tooth Loss among Older Adults in the U.S., NHANES 2011–2018. Int J Environ Res Public Health 19, doi:10.3390/ijerph19042382 (2022).
Korea Centers for Disease Control and Prevention. 2020 National Health Statistics. (Korea Centers for Disease Control and Prevention, 2020).
Esan, T. A., Olusile, A. O., Akeredolu, P. A. & Esan, A. O. Socio-demographic factors and edentulism: the Nigerian experience. BMC oral health 4, 3, doi:10.1186/1472-6831-4-3 (2004).
Hugo, F. N., Hilgert, J. B., de Sousa Mda, L., da Silva, D. D. & Pucca, G. A., Jr. Correlates of partial tooth loss and edentulism in the Brazilian elderly. Community Dent Oral Epidemiol 35, 224–232, doi:10.1111/j.0301-5661.2007.00346.x (2007).
Peltzer, K. et al. Prevalence of loss of all teeth (edentulism) and associated factors in older adults in China, Ghana, India, Mexico, Russia and South Africa. Int J Environ Res Public Health 11, 11308–11324, doi:10.3390/ijerph111111308 (2014).
Mendes, D. C. et al. Analysis of socio-demographic and systemic health factors and the normative conditions of oral health care in a population of the Brazilian elderly. Gerodontology 29, e206-214, doi:10.1111/j.1741-2358.2010.00446.x (2012).
Kailembo, A., Preet, R. & Stewart Williams, J. Common risk factors and edentulism in adults, aged 50 years and over, in China, Ghana, India and South Africa: results from the WHO Study on global AGEing and adult health (SAGE). BMC oral health 17, 29, doi:10.1186/s12903-016-0256-2 (2016).
Musacchio, E. et al. Tooth loss in the elderly and its association with nutritional status, socio-economic and lifestyle factors. Acta Odontol Scand 65, 78–86, doi:10.1080/00016350601058069 (2007).
Petersen, P. E. & Yamamoto, T. Improving the oral health of older people: the approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol 33, 81–92, doi:10.1111/j.1600-0528.2004.00219.x (2005).
Gaio, E. J. et al. Oral health status in elders from South Brazil: a population-based study. Gerodontology 29, 214–223, doi:10.1111/j.1741-2358.2011.00617.x (2012).
Pengpid, S. & Peltzer, K. The prevalence of edentulism and their related factors in Indonesia, 2014/15. BMC oral health 18, 118, doi:10.1186/s12903-018-0582-7 (2018).
Shah, N. Gender issues and oral health in elderly Indians. Int Dent J 53, 475–484, doi:10.1002/j.1875-595x.2003.tb00890.x (2003).
Skoskiewicz-Malinowska, K., Kaczmarek, U. & Malicka, B. Gender-wise comparison of oral health quality of life and its relationship with oral health parameters among elderly from Wroclaw, south-west Poland. PloS one 16, e0259286, doi:10.1371/journal.pone.0259286 (2021).
Choi, J. O. & Nam, S. H. The Convergence Effect of Oral Health Level on Daily Life of Elderly Women. Journal of the Korea Convergence Society 8, 209–214, doi:10.15207/JKCS.2017.8.12.209 (2017).
Andersson, P., Hallberg, I. R., Lorefalt, B., Unosson, M. & Renvert, S. Oral health problems in elderly rehabilitation patients. International journal of dental hygiene 2, 70–77, doi:10.1111/j.1601-5029.2004.00073.x (2004).
Bakker, M. H. et al. Are Edentulousness, Oral Health Problems and Poor Health-Related Quality of Life Associated with Malnutrition in Community-Dwelling Elderly (Aged 75 Years and Over)? A Cross-Sectional Study. Nutrients 10, doi:10.3390/nu10121965 (2018).
Bakker, M. H., Vissink, A., Spoorenberg, S. L. W., Wynia, K. & Visser, A. Self-reported oral health problems and the ability to organize dental care of community-dwelling elderly aged >/=75 years. BMC oral health 20, 185, doi:10.1186/s12903-020-01175-7 (2020).
World Health Organization. Ageing and health, https://www.who.int/news-room/fact-sheets/detail/ageing-and-health (2021).
Fleming, E., Afful, J. & Griffin, S. O. Prevalence of Tooth Loss Among Older Adults: United States, 2015–2018. NCHS Data Brief, 1–8 (2020).
Hoshi-Harada, M. et al. Difference of income inequalities of denture use by co-payment rates: A JAGES cross-sectional study. Community Dent Oral Epidemiol, doi:10.1111/cdoe.12749 (2022).
Korean Statistical Information System. 2020 Population status and forecast of the world and Korea, http://kostat.go.kr/understand/info/info_lge/1/detail_lang.action?bmode=detail_lang&cd=SL3970 (2020).
Klein, B. E., Klein, R. & Knudtson, M. D. Life-style correlates of tooth loss in an adult Midwestern population. J Public Health Dent 64, 145–150, doi:10.1111/j.1752-7325.2004.tb02744.x (2004).
Roberto, L. L. et al. Sociodemographic determinants of edentulism in the elderly population: A systematic review and meta-analysis. Gerodontology 36, 325–337, doi:10.1111/ger.12430 (2019).
Eustaquio-Raga, M. V., Montiel-Company, J. M. & Almerich-Silla, J. M. Factors associated with edentulousness in an elderly population in Valencia (Spain). Gac Sanit 27, 123–127, doi:10.1016/j.gaceta.2012.02.009 (2013).
Muller, F., Naharro, M. & Carlsson, G. E. What are the prevalence and incidence of tooth loss in the adult and elderly population in Europe? Clin Oral Implants Res 18 Suppl 3, 2–14, doi:10.1111/j.1600-0501.2007.01459.x (2007).
Hernandez-Palacios, R. D., Ramirez-Amador, V., Jarillo-Soto, E. C., Irigoyen-Camacho, M. E. & Mendoza-Nunez, V. M. Relationship between gender, income and education and self-perceived oral health among elderly Mexicans. An exploratory study. Cien Saude Colet 20, 997–1004, doi:10.1590/1413-81232015204.00702014 (2015).
Matthews, R. A healthy market. The European dental market: braced for change. (Stockholm network, 2006).
Lee, M. R. A Study on the Elderly Woman and Welfare in Aging Society. Korean J Human Ecology 8, 57–69 (2005).
Chi, D. L. & Tucker-Seeley, R. Gender-stratified models to examine the relationship between financial hardship and self-reported oral health for older US men and women. Am J Public Health 103, 1507–1515, doi:10.2105/AJPH.2012.301145 (2013).
Coda Bertea, P., Staehelin, K., Dratva, J. & Zemp Stutz, E. Female gender is associated with dental care and dental hygiene, but not with complete dentition in the Swiss adult population. J Public Health-Uk 15, 361–367, doi:10.1007/s10389-007-0126-0 (2007).
Attin, T. & Hornecker, E. Tooth brushing and oral health: how frequently and when should tooth brushing be performed? Oral Health Prev Dent 3, 135–140 (2005).
Northridge, M. E. et al. Tooth loss and dental caries in community-dwelling older adults in northern Manhattan. Gerodontology 29, e464-473, doi:10.1111/j.1741-2358.2011.00502.x (2012).
Arora, M., Schwarz, E., Sivaneswaran, S. & Banks, E. Cigarette smoking and tooth loss in a cohort of older Australians: the 45 and up study. J Am Dent Assoc 141, 1242–1249, doi:10.14219/jada.archive.2010.0052 (2010).
Fukai, K., Takaesu, Y. & Maki, Y. Gender differences in oral health behavior and general health habits in an adult population. Bull Tokyo Dent Coll 40, 187–193, doi:10.2209/tdcpublication.40.187 (1999).
Bashiru, B. O., Ernest, A. & Egodotaire, O. J. Gender and Age Related Disparity in Oral Health Knowledge, Attitude and Practice Among Elderly Pensioners in Port Harcourt, Rivers State. Central African Journal of Public Health 3, 34–39, doi:10.11648/j.cajph.20170303.12 (2017).
Al-Ansari, J. M. & Honkala, S. Gender differences in oral health knowledge and behavior of the health science college students in Kuwait. J Allied Health 36, 41–46 (2007).
Kim, N. H., Kim, H. D., Han, D. H., Jin, B. H. & Baek, D. I. Relationship between perceived oral symptoms and preceived oral health status among the elderly in welfare institutions in Seoul. J Korean Acad Oral Health 30, 141–150 (2006).
Park, H. R., Ku, I. Y. & Moon, S. J. A Study on Social Efficacy of Senior Citizens in Welfare Centers in Some Areas according to Their Subjective Oral Health and Their Quality of Life related to Oral Health. Journal of the Korea Academia-Industrial cooperation Society 15, 1000–1009 (2014).
Im, S. Y., Kang, M. A. & Cho, S. I. Social network and health status among Korean elders Social network and health status among Korean elders. Gerontological Social Welfare, 281–308 (2013).
Tsakos, G. et al. Social relationships and oral health among adults aged 60 years or older. Psychosomatic medicine 75, 178–186, doi:10.1097/PSY.0b013e31827d221b (2013).

No competing interests reported.

Download PDF

Journal Publication

published 15 May, 2023

Read the published version in Scientific Reports →

Editorial decision: Major revision
01 Mar, 2023
Reviews received at journal
06 Feb, 2023
Reviewers agreed at journal
24 Jan, 2023
Reviews received at journal
22 Jan, 2023
Reviewers agreed at journal
30 Dec, 2022
Reviewers agreed at journal
22 Sep, 2022
Reviewers invited by journal
22 Aug, 2022
Editor assigned by journal
22 Aug, 2022
Editor invited by journal
22 Aug, 2022
Submission checks completed at journal
22 Aug, 2022
First submitted to journal
14 Aug, 2022

You are reading this latest preprint version

Oral health disparities among geriatric population according to sexual difference in South Korea: A Nationwide population- based study

Status:

Journal Publication

Version 1

Abstract

Introduction

Results

Discussion

Conclusion

Methods

Declarations

References

Additional Declarations

Status:

Journal Publication

Version 1