Socioeconomic and Ethnic Inequalities in the Progress of Multimorbidity and the Role of Health Behaviors.

OBJECTIVES: To assess socioeconomic and ethnic inequalities in the progress of multimorbidity and whether behavioral factors explain these inequalities among older Americans. DESIGN: Health and Retirement Study, a longitudinal survey of older American adults. SETTING AND PARTICIPANTS: Data pooled from 2006 to 2018 (waves 8-14), which include 38,061 participants. METHODS: We used 7 waves of the survey from 2006 to 2018. Socioeconomic factors were indicated by education, total wealth, poverty-income ratio (income), and race/ethnicity. Multimorbidity was indicated by self-reported diagnoses of 5 chronic conditions: diabetes, heart conditions, lung diseases, cancer, and stroke. Behavioral factors were smoking, excessive alcohol consumption, physical activity, and body mass index (BMI). Multilevel mixed effects generalized linear models were constructed to assess socioeconomic and ethnic inequalities in the progress of multimorbidity and the role of behavior. All variables included in the analysis were time-varying except gender, race/ethnicity, and education. RESULTS: African American individuals had higher rates of multimorbidity than White individuals; however, after adjusting for income and education, the association was reversed. There were clear income, wealth, and education gradients in the progress of multimorbidity. After adjusting for behavioral factors, the relationships were attenuated. The rate ratio (RR) of multimorbidity attenuated by 9% among participants with the lowest level of education after accounting for behavior (RR 1.21; 95% CI 1.18-1.23 and 1.11; 95% CI 1.17-1.14) in the models unadjusted and adjusted for behaviors, respectively. Similarly, RR for multimorbidity among those in the lowest wealth quartile attenuated from 1.47 (95% CI 1.44-1.51) and 1.31 (95% CI 1.26-1.36) after accounting for behaviors. CONCLUSION AND IMPLICATIONS: Ethnic inequalities in the progress of multimorbidity were explained by wealth, income, and education. Behavioral factors partially attenuated socioeconomic inequalities in multimorbidity. The findings are useful in identifying the behaviors that should be included in health promotion programs aiming at tackling inequalities in multimorbidity.

Inequalities in the progress of multiple chronic conditions: A systematic review of longitudinal studies.

The objective of this review is to assess the impact of socioeconomic factors on the progress of multiple chronic health conditions (MCC) in Adults. Two independent investigators searched three databases (MEDLINE, EMBASE and LILACS) up to August 2021 to identify longitudinal studies on inequalities in progress of MCC. Grey literature was searched using Open Grey and Google Scholar. Inclusion criteria were retrospective and prospective longitudinal studies; adult population; assessed socioeconomic inequalities in progress of MCC. Quality of included studies and risk of bias were assessed using the Newcastle Ottawa Quality Assessment Scale for longitudinal studies. Nine longitudinal studies reporting socioeconomic inequalities in progress of MCC were included. Two of the studies had poor quality. Studies varied in terms of follow-up time, sample size, included chronic conditions and socioeconomic indicators. Due to high heterogeneity meta-analysis was not possible. The studies showed positive association between lower education (five studies), lower income and wealth (two studies), area deprivation (one study), lower job categories (two studies) and belonging to ethnic minority (two study) and progress of MCC. The review demonstrated socioeconomic inequality in progress of multiple chronic conditions. trial registratiom: The review protocol was registered in the International Prospective Register of Systematic Reviews (CRD42021229564).

Cumulative socio-economic disadvantage and traumatic dental injuries during adolescence.

BACKGROUND/AIM: Studies on the association between socio-economic circumstances and traumatic dental injuries (TDIs) are cross-sectional and inconclusive. The aim of this study was to investigate the association between cumulative socio-economic disadvantage and TDIs among adolescents. METHOD: Data from 668 participants in the East London Adolescents Community Health Survey (RELACHS) were analysed. Family socio-economic indicators (parental employment, car ownership and eligibility for free school meals) were collected when participants were in grades 7 (11-12 years), 9 (13-14 years) and 11 (15-16 years). The number of periods (RELACHS waves) adolescents lived in socio-economic disadvantage was counted for each socio-economic measure, ranging from 0 (never in disadvantage) to 3 (always in disadvantage). Adolescents were dentally examined for TDIs at age 15-16 years. The association between each measure of cumulative socio-economic disadvantage and TDIs was tested in logistic regression models adjusting for demographic factors. RESULTS: Significant positive linear trends in the prevalence of TDIs were observed by the number of periods of parental unemployment and being without a family car, but not by eligibility for free school meals. Adolescents whose parents were always unemployed had 2.06 (95% CI: 1.12-3.80) greater odds of having TDIs than those whose parents were never unemployed. Similarly, adolescents from families that never owned a car had 2.17 (95% CI: 1.26-3.74) greater odds of having TDIs than those that always had a family car. CONCLUSION: Cumulative socio-economic disadvantage during adolescence was associated with greater odds of having TDIs.

Tolerability of a green tea-based mouth rinse: A pilot study.

INTRODUCTION: Mouth rinse containing essential oil is one of the most popular, over the counter dental products which has been promoted to have anti-inflammatory, anti-plaque and anti-microbial properties. An essential oil alcohol-free mouth rinse with green tea has been introduced recently and promoted for management of periodontitis and gingivitis. As the role of chlorhexidine gluconate (CHX) mouth rinse in management of periodontal disease has been evaluated previously, the aim of this study is to compare the tolerability of none-alcohol containing green tea-based (NAGT) mouth rinse with CHX mouth rinse. METHODS: Forty healthy subjects were enrolled in September 2018 at King Abdulaziz University and allocated randomly to two study arms: NAGT mouth rinse and chlorhexidine gluconate mouth rinse. Study subjects were instructed to follow the manufacturer instructions and rinse twice daily for two weeks. Collected data included age, gender, smoking history in addition to subjective assessment using a validated questionnaire. Intraoral clinical examination was completed at baseline and 2-weeks time point. RESULTS: The data of 36 patients were included in this study and analyzed. At 2 weeks, NAGT group reported higher burning sensation score compared to chlorhexidine group (mean: 4.33 and 0.6 respectively; P < 0.05). Reported mucosal dryness was more evident in NAGT group (mean: 1.9 Vs 1.7 for chlorhexidine group). Oral examination revealed significant mucosal desquamation (27.8%) in NAGT group. However, oral ulceration was reported equally in both groups (5.6%). CONCLUSION: The current data demonstrates an overall less tolerability of a non-alcohol containing green tea-based mouth rinse compared to chlorhexidine gluconate. Further long term randomized clinical trials are recommended to confirm our findings.