Can Tobacco consumption explain the association between SEP and chronic periodontitis in adults living in a deprived area of the UK? A secondary analysis of the ELOHI study data.

Abstract

Aim: To assess whether there are social inequalities on periodontitis at the population level in a deprived area of the United Kingdom (UK) and further elucidate the relationship between socio-economic position, plaque accumulation, tobacco smoking, and chronic periodontitis in a representative sample of adults living in a multicultural and socially deprived area. Methods: The present sub study used the cross-sectional data previously collected in the East London Oral Health Inequality (ELOHI) study, conducted in the outer northeast boroughs of London, UK. A stratified two-staged sampling was performed which consisted of a sample of 2149 adults (16-65 years of age). Participants underwent an oral examination and answered a supervised questionnaire in their own homes. Data regarding information on the explanatory variables: socio-economic position (SEP), oral health behaviour and indicators were obtained from the ELOHI study. The main outcome variable for the present sub study was chronic periodontitis (presence of at least one site of a tooth with a pocket depth (PD) ≥4mm). Statistical analysis included conceptual hierarchical modelling and mediation analysis. The level of statistical significance was set at 0.05. Results: The prevalence of periodontitis in this area of East London was very high, 80.5% among males and 82% among females although these differences were not statistically significant. Hierarchical conceptual modelling analysis demonstrated that those in the manual/routine occupations category were 2.21 (95% CI 1.64-2.989) more likely to have chronic periodontitis than those in the professional category. The difference between those in the intermediate and the professional and managerial occupations category were not statistically significant after adjusting for demographic and behavioural variables. The results of mediation analysis, using the four steps proposed by Baron and Kenny demonstrated that the association between socio-economic position and periodontitis was partially mediated through smoking. Conclusion: A social gradient in periodontal diseases in part mediated by tobacco consumption may exist even in areas where there are highly socially deprived communities was identified. SEP as measured by NS-SEC was found to be associated with the chronic periodontitis experience (PD ≥ 4mm) with individuals placed higher in the NS-SEC ranking demonstrating a lesser risk of disease as compared to a lower NS-SEC ranking.