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T
he United States Surgeon Generals Report tionship between SES and the incidence and prevalence
on Oral Health in America describes improve- of disease: that is, as socioeconomic status increases,
ments in oral health that have taken place over disease, illness, and their impacts decrease.3 This is true
the past fifty years, although large disparities on oral of health conditions related to lifestyle factors and in-
health still exist between the wealthiest and poorest fectious diseases,4 as well as self-ratings of health sta-
Americans.1 Health disparities are generally recognized, tus, disability days, health practitioner ratings,3 and oral
but questions remain about the underlying mechanisms health status.2 How SES operates to influence health
that account for differences in oral health as related to outcomes is poorly understood.
socioeconomic status and the behavioral risk factors Defining SES is challenging, as it is an abstract
associated with the incidence and prevalence of dental and complex construct that represents how power and
caries.2 The purpose of this paper is to summarize a resources are distributed in society.5 SES generally is
systematic review evaluating the evidence for the asso- measured by indicators of human capital, such as in-
ciation between the incidence and prevalence of dental come, education, or occupational prestige that offer
caries and: 1) socioeconomic status; 2) tooth-brushing; advantages to individuals and families.5 Another ap-
and 3) the use of the baby bottle. The full systematic proach is to assign a social status position based on
review can be found at http://www.nidcr.nih.gov/news/ ecological measures6 derived from place of residence.7
consensus.asp. This measure is assigned to the individual. The poten-
tial ecological fallacy is that the social level evident
within the social environment where the individual re-
sides may not apply to every person. This may not only
Socioeconomic Status (SES) weaken the potential relationship between SES and
and Health health or other social outcomes, but could lead to con-
clusions about individuals that are valid only at an ag-
A substantial body of literature documents the gregate societal level.
relationship between socioeconomic status (SES) and
general health and consistently finds an inverse rela-
Table 2. Number of abstracts identified in the Medline and EmBase search, total number of abstracts reviewed,
number of papers reviewed, final number selected for the evidence tables, mean quality rating, and percent with
multivariate analysis by question
Number of Number of Total Number of Final Mean (sd) Percent with
Medline EmBase Number of Papers Number Quality Multivariate
Question Abstracts Abstracts of Abstracts Reviewed in Tables Rating Analysis
1. <Age 6 and SES 312 163 475 59 46 8.8 (2.7) 59%
2. Ages 6-11 and SES 338 7 345 59 45 9.2 (3.4) 60%
3. Ages 12-17 and SES 258 29 287 20 15 8.6 (2.5) 67%
4. Ages 18-64 and SES 269 58 327 29 24 9.5 (2.9) 55%
5. Ages 65+ and SES 151 39 190 23 14 8.9 (3.4) 40%
6. Ages <18 and brushing 777 33 810 93 72 8.6 (2.5) 69%
7. Ages 18+ and brushing 244 90 334 22 14 8.3 (1.7) 93%
8. Baby bottle use 352 18 370 53 42 8.3 (2.2) 26%
Total 2701 437 3138 358 272
*Mean quality rating for questions 1-7 can range from 1 to19 and question 8 can range from 1 to 22. See Table 3 for scoring
system.