Perception of general and oral health in White and African American adults: assessing the effect of neighborhood socioeconomic conditions.

OBJECTIVES This study investigates the independent and joint effects of family income and neighborhood socioeconomic status (SES) on general health and oral health before and after controlling for traditional risk factors in a representative sample of adults aged 18+ years residing in the Detroit tri-county area, Michigan. METHODS Individuals data were obtained through interviews, while neighborhood data came from the 1990 US Census. SUDAAN was used to accommodate the complex sampling design and correlation of outcomes within the same neighborhoods. RESULTS Whites in disadvantaged neighborhoods were four times more likely to rate their oral health as fair or poor [odds ratio (OR): 4.0; 95% confidence intervals (CI): 1.6-10.3] than their counterparts in advantaged neighborhoods. When evaluating the joint effects of family income and neighborhood SES, low-income Whites in disadvantaged neighborhoods were six times more likely to rate their oral health as fair or poor (OR: 6.4; 95% CI: 1.6-26.5) than their high-income counterparts in advantaged neighborhoods. The odds of rating general health as fair or poor was six times greater in low-income African Americans in disadvantaged neighborhoods (OR: 6.1; 95% CI: 1.6-23.8) than high-income African Americans in advantaged neighborhoods. Similarly, low-income African Americans in disadvantaged neighborhoods were almost three times (OR: 2.8; 95% CI: 1.0-8.1) more likely to rate their oral health as fair/poor than high-income African Americans in advantaged neighborhoods. CONCLUSIONS SES conditions at the neighborhood-level, independently or jointly with individual-level income, appear to be important in evaluating racial/ethnic differences in self-rated oral health. Neighborhood conditions could tap into constructs not captured by individual-level variables on self-rated oral health.