Impact of Poverty Reduction on Oral Health Outcomes among US Adults

Abstract

Poor oral health is a public health issue in the United States, disproportionately affecting people in poverty. This cross-sectional study investigates the impact of reducing absolute and relative poverty on the prevalence of periodontitis, caries, and dental pain among US adults. Data from 13,139 adults aged 30 to 70 y who completed dental examinations in the 2011–2018 National Health and Nutrition Examination Surveys were used. Periodontitis and dental caries outcomes were assessed with the 2011–2014 surveys (n = 6,563). Assessment of absolute and relative poverty was based on the poverty income ratio established by the US Census Bureau. Hypothetical counterfactual scenarios were emulated to assess the impact of poverty reductions (10%, 25%, and 50%) on periodontitis, dental caries, and dental pain. A targeted minimum loss–based estimator was used to estimate the outcomes under each scenario adjusted for age, sex, race, comorbidity, and marital status. Reductions in absolute and relative poverty were associated with a lower prevalence of oral disease. A 50% reduction in absolute poverty would avert 1.1 million cases of periodontitis, 0.4 million individuals with dental caries, and 0.6 million dental pain cases. A similar reduction in relative poverty would avert 5.4 million cases of periodontitis, 3.8 million individuals with caries, and 2 million cases of dental pain. The greatest impact was seen with a 50% relative poverty reduction: 12% reduction in periodontitis (prevalence ratio [PR], 0.88; 95% CI, 0.85 to 0.92), 13% reduction in caries (PR, 0.87; 95% CI, 0.81 to 0.92), and 18% reduction in frequent dental pain (PR, 0.82; 95% CI, 0.73 to 0.91). These findings highlight the potential of poverty reduction, especially relative poverty, to significantly lower the US oral disease burden and emphasize policy importance for reducing income inequality to achieve equitable oral health.