# Impact of Adverse Socioeconomic Conditions on Physical and Oral Health Limitations Among American Older Adults

## TL;DR

This study shows that lower income and education are linked to worse physical and oral health in older Americans, with combined health issues being most affected.

## Contribution

The study reveals a steeper income gradient for combined physical and oral health limitations compared to physical limitations alone.

## Key findings

- 81.7% of older adults reported physical limitations, 66.9% reported oral limitations, and 90.0% had at least one limitation.
- Lower income and education were strongly associated with higher risks of physical, oral, and combined limitations.
- The income gradient was steeper for combined limitations than for physical limitations alone.

## Abstract

Aim

This study aims to investigate whether income and education are associated with physical, oral, and combined functional limitations among Americans aged 60 and older.

Methods

Data from the 2021-2023 National Health and Nutrition Examination Survey (NHANES) were used. Ethical approval was not required for this analysis. Physical and oral health limitations were assessed using items from the physical functioning and oral health impact questionnaires, respectively. Two binary physical and oral limitation variables were created. An additional binary combined limitation variable was also created to reflect the presence of at least one physical or oral limitation. Socioeconomic factors were indicated by income and education. Negative binomial regression was used to assess associations between socioeconomic indicators and each outcome, adjusting for age, gender, race/ethnicity, marital status, health insurance, and smoking status. NHANES sampling weights were applied to account for the complex survey design.

Results

The analysis included 2888 participants aged 60 and older. Physical, oral, and combined functional limitations were reported by 81.7% (n = 2360) (95% confidence interval {CI}: 79.0, 84.1), 66.9% (n = 1932) (95% CI: 64.0, 69.7), and 90.0% (n = 2599) (95% CI: 88.2, 91.6) of the participants, respectively. Socioeconomic disadvantage was associated with a higher risk of all types of functional limitation. Compared to the participants in the highest-income group, those in the lowest group had a greater risk of physical limitation (rate ratio {RR} = 1.35; 95% CI: 1.21, 1.51), oral limitation (RR = 1.60; 95% CI: 1.35, 1.90), and combined limitation (RR = 1.46; 95% CI: 1.29, 1.65). Similarly, those with a high school education or more had higher risks across all outcomes compared to those with a college education or more.

Conclusion

The analysis demonstrated greater inequality in physical limitations when combined with oral health limitations. There was a clear income and education gradient in physical, oral, and combined functional limitations among older adults. The income gradient was steeper for combined limitations than for physical limitations alone. Identifying those subjected to adverse economic conditions could help target vulnerable populations and inform public health interventions for oral and general health.