Perceived Racism Associated with Declines in Self-rated Oral Health among U.S. Black Women

Elsevier

Available online 25 May 2023

Annals of EpidemiologyAuthor links open overlay panel, , , , , , AbstractBackground

Racial disparities in oral health are well-documented. Stress has been associated with both perceived racism and oral health, yet little research has directly investigated the association between perceived racism and oral health.

Methods

We used data from the Black Women’s Health Study, a longitudinal cohort study that includes a geographically diverse sample of Black women across the US. Perceived exposure to racism was assessed via two scales, one assessing lifetime exposure and one everyday exposure. Self-rated oral health was subsequently assessed over multiple time points. We used Cox proportional hazard models to calculate adjusted incidence rate ratios (IRRs) estimating the association between higher levels of perceived racism and incident “fair” or “poor” oral health, and explored potential effect measure modification using stratified models.

Results

The adjusted IRRs (n=27,008) relating perceived racism to incident fair/poor oral health were 1.50 (95% confidence interval [CI] 1.35,1.66) comparing the highest quartile of everyday racism to the lowest and 1.45 (95% CI 1.31, 1.61) for the highest score of lifetime racism compared to the lowest. We did not see evidence of effect modification.

Conclusion

Higher levels of perceived racism documented in 2009 were associated with declines in self-rated oral health from 2011 to 2019.

Section snippetsINTRODUCTION

Racial disparities in oral health are widely documented in the United States [1], [2], [3], [4]; Blacks experience higher rates of tooth decay, root caries, tooth loss, edentulism [1], [4], and periodontal disease [2], [4] than Whites. These observed differences are only partially explained by differences in income, education [5], [6], [7], and dental insurance coverage [4]. Further, the inequitable distribution of poor oral health outcomes, including dental caries, periodontal disease,

METHODS

The BWHS is a longitudinal observational cohort study that began in 1995 when 59,000 Black women ages 21 to 69 years (median age, 38 years) from across the U.S. completed postal questionnaires mailed to Essence magazine subscribers, members of professional organizations, and friends and family of early enrollees. Over 80% of women resided in California, Georgia, Illinois, Indiana, Louisiana, Maryland, Massachusetts, Michigan, New Jersey, New York, South Carolina, Virginia, and the District of

RESULTS

Overall, study subjects had a mean age of 53.8 years (range: 36 – 86). Twenty-one percent and 11% of the sample reported experiencing the highest levels of everyday and lifetime racism, respectively, as shown in Table 1. Higher education, higher BMI, and ever-smoking were associated with more frequent experiences of racism. Independent of the level of racism experienced, a majority of women reported either “trying to do something” or “talking to other people” as coping strategies.

Between 2011

DISCUSSION

Using prospective, longitudinal data from a large cohort study, we observed a positive association between experiences of racism and worsening self-rated oral health. Our results are suggestive of a potential “dose response” type relationship, with greater exposure to everyday and lifetime racism having a stronger association with worsening oral health. The observed relationship between experiences of racism and oral health persisted after adjustment for many confounders and stratification by

Funding source

This work was supported by funding from the National Cancer Institute (NCI) (grant numbers R01 CA58420 and UM1 CA164974), the National Institute of Dental and Craniofacial Research (NIDCR) (grant numbers R03 DE026841, K99R00 DE025917, and F31 DE031969), and the National Center for Advancing Translational Sciences at the National Institutes of Health (through BU-CTSI grant number U54TR001012).

Competing interests

None

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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