Race and periodontitis among the United States adult population: Fifteen-year trends.

Abstract

Since the 1960's, disparities in health status have been evident between minority groups and the majority white population in the United States (US). Oral health conditions, including periodontitis, have been no exception. This dissertation had three specific aims: (1) to examine whether historically evident disparities in periodontal status between African-American and white populations in the US have diminished over time; (2) to evaluate the associations of risk indicators and periodontitis within and between these two racial groups over time; and finally, (3) to identify differences in the prevalence of periodontitis and its predictors among African-Americans, Mexican-Americans, and non-Hispanic whites. Data for the first two hypotheses came from NHANES I (1971--1974) and NHANES III (1988--1994), for hypothesis three data came from NHANES III only. Records of US African-American, Mexican-American, and non-Hispanic white adults 17 years and older who received a periodontal assessment during dental examinations were included in these analyses. This study independently compares results from cross-sectional cohort analyses in the three racial/ethnic groups. The prevalence of periodontitis in the US adult population in NHANES I was 31.6%, with African-Americans exhibiting a higher prevalence than whites (37% versus 30%). In NHANES III, a different case-definition for periodontitis led to an apparently sharp drop in overall prevalence from 31.6% to 4.3%, with African-Americans (7.5%) exhibiting twice the prevalence found among whites (3.7%). When ethnicity was taken into account, Mexican-Americans exhibited a prevalence similar to non-Hispanic whites and the African-American/white disparity persisted. Age, perception of oral health, and smoking were commonly associated with periodontitis among African-Americans and whites in both surveys. In addition, the same variables were associated with periodontitis among Mexican-Americans in NHANES III. However, the strength and direction of these associations were not the same among these racial/ethnic groups. The historically evident disparity between African-American and white populations did not diminish in the approximately 15 years between NHANES I and NHANES III. Mexican-Americans' periodontal status, which was only identified in NHANES III, was similar to non-Hispanics whites. The study also shows that the differential effect of risk factors could reflect social and cultural behaviors rather than inherent racial/ethnic differences.