Non-Cochrane · aetiology · PM40597152
Association between oral health-related quality of life and structural determinants of health among elderly populations. a systematic review and meta-analysis.
Borg-Bartolo Roberta, Roccuzzo Andrea, Gambetta-Tessini Karla, et al. · International journal for equity in health · 2025 · PubMed · doi:10.1186/s12939-025-02557-5
Full textEvery question was extracted from the full text, figures and supplements by two independent LLM extractors, disagreements adjudicated. Rows cite where in the review the value comes from.
Questions
24
current version
GRADE rated
0
No studies
0
Included studies
6
linked below
No studies 0 · 0%Ungraded 24 · 100%Very low 0 · 0%Low 0 · 0%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Participants aged ≥60 years living in the community (60-year cut-off per United Nations) | Community-dwelling adults aged ≥60 years across 25 countries (n=45 studies) |
| Intervention | Structural determinants of health (country-level income, Gini index, unemployment rate, HDI, out-of-pocket health expenditure, health expenditure per capita) and dental status (dental caries, periodontal disease, edentulism prevalence) as exposures | Nine determinants meta-analyzed: country-level income, Gini index, unemployment rate, HDI, out-of-pocket expenditure, per-capita health expenditure, and dental caries, periodontal disease and edentulism prevalence |
| Comparison | Not applicable (PECO framework; no comparator group) | Not applicable (subgroup categories within each determinant compared) |
| Outcomes | OHRQoL measured by OHIP, GOHAI or OIDP | OHRQoL sum score transformed to 0-100 (GOHAI n=21, OHIP-14 n=19, OHIP-7 n=1, OIDP n=2 studies) |
| Study designs | Observational studies: cross-sectional, longitudinal, and national oral health surveys | 45 observational studies (39 cross-sectional, 6 longitudinal) |
| Timing | Cross-sectional associations (baseline OHRQoL for longitudinal studies); studies published 2014 onward | Cross-sectional / baseline OHRQoL |
Search date: 23 August 2024 (records from January 2014 onward). Databases: Embase; MEDLINE (via PubMed); Scopus; OpenGrey (grey literature) plus hand searching
Questions and results
Country-level income (World Bank income classification) vs Higher- vs lower-income country categories
Population: Community-dwelling elderly persons aged ≥60 years
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Oral health-related quality of life (OHRQoL sum score, transformed 0-100) High-middle to high income Community-dwelling older adults in higher-income countries had better OHRQoL than those in lower-income countries (77.9, 95% CI 70.2 to 85.6 vs 66.9, 95% CI 56.7 to 77.0); the difference by income was statistically significant (ungraded). Source: Abstract; Results, 'Structural determinants of health' para 1; Fig. 2a · same question in other reviews | MEAN 77.9 [70.2, 85.6] | NR | Ungraded |
Oral health-related quality of life (OHRQoL sum score, transformed 0-100) Low-middle income Community-dwelling older adults in higher-income countries had better OHRQoL than those in lower-income countries (77.9, 95% CI 70.2 to 85.6 vs 66.9, 95% CI 56.7 to 77.0); the difference by income was statistically significant (ungraded). Source: Results, 'Structural determinants of health' para 1; Fig. 2a · same question in other reviews | MEAN 66.9 [56.7, 77.0] | NR | Ungraded |
Country-level income inequality (Gini index) vs Lower vs higher income inequality categories
Population: Community-dwelling elderly persons aged ≥60 years
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Oral health-related quality of life (OHRQoL sum score, transformed 0-100) Relative equality (Gini index 0.21 to 0.30) Older adults in countries with relative income equality (low Gini index) had markedly higher OHRQoL (91.3, 95% CI 90.0 to 92.6) than those in less equal countries; the difference by Gini index was statistically significant (ungraded). Source: Results, 'Structural determinants of health' para 1; Fig. 2b · same question in other reviews | MEAN 91.3 [90.0, 92.6] | NR | Ungraded |
Oral health-related quality of life (OHRQoL sum score, transformed 0-100) High inequality Older adults in countries with relative income equality (low Gini index) had markedly higher OHRQoL (91.3, 95% CI 90.0 to 92.6) than those in less equal countries; the difference by Gini index was statistically significant (ungraded). Source: Results, 'Structural determinants of health' para 1; Fig. 2b · same question in other reviews | MEAN 75.3 [67.1, 83.6] | NR | Ungraded |
Oral health-related quality of life (OHRQoL sum score, transformed 0-100) Adequate equality Older adults in countries with relative income equality (low Gini index) had markedly higher OHRQoL (91.3, 95% CI 90.0 to 92.6) than those in less equal countries; the difference by Gini index was statistically significant (ungraded). Source: Results, 'Structural determinants of health' para 1; Fig. 2b · same question in other reviews | MEAN 75.4 [70.1, 82.7] | NR | Ungraded |
Oral health-related quality of life (OHRQoL sum score, transformed 0-100) Severe inequality Older adults in countries with relative income equality (low Gini index) had markedly higher OHRQoL (91.3, 95% CI 90.0 to 92.6) than those in less equal countries; the difference by Gini index was statistically significant (ungraded). Source: Results, 'Structural determinants of health' para 1; Fig. 2b · same question in other reviews | MEAN 81.2 [75.3, 88.3] | NR | Ungraded |
Country-level unemployment rate vs Higher vs lower unemployment-rate categories
Population: Community-dwelling elderly persons aged ≥60 years
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Oral health-related quality of life (OHRQoL sum score, transformed 0-100) Across unemployment-rate categories OHRQoL did not differ significantly across country-level unemployment-rate categories; no pooled estimate was reported in the text (ungraded). Source: Results, 'Structural determinants of health' para 1; Fig. 2c · same question in other reviews | No statistically significant difference in OHRQoL based on unemployment rate (Fig. 2c). | NR | Ungraded |
Human Development Index (HDI) vs Higher vs lower HDI categories
Population: Community-dwelling elderly persons aged ≥60 years
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Oral health-related quality of life (OHRQoL sum score, transformed 0-100) High HDI Older adults in higher-HDI countries had better OHRQoL (high 79.9, 95% CI 74.4 to 85.5; very high 78.4, 95% CI 71.1 to 85.8) than those in medium-HDI countries (63.5, 95% CI 54.3 to 72.7); the difference by HDI was statistically significant (ungraded). Source: Results, 'Structural determinants of health' para 1; Fig. 2d · same question in other reviews | MEAN 79.9 [74.4, 85.5] | NR | Ungraded |
Oral health-related quality of life (OHRQoL sum score, transformed 0-100) Medium HDI Older adults in higher-HDI countries had better OHRQoL (high 79.9, 95% CI 74.4 to 85.5; very high 78.4, 95% CI 71.1 to 85.8) than those in medium-HDI countries (63.5, 95% CI 54.3 to 72.7); the difference by HDI was statistically significant (ungraded). Source: Results, 'Structural determinants of health' para 1; Fig. 2d · same question in other reviews | MEAN 63.5 [54.3, 72.7] | NR | Ungraded |
Oral health-related quality of life (OHRQoL sum score, transformed 0-100) Very high HDI Older adults in higher-HDI countries had better OHRQoL (high 79.9, 95% CI 74.4 to 85.5; very high 78.4, 95% CI 71.1 to 85.8) than those in medium-HDI countries (63.5, 95% CI 54.3 to 72.7); the difference by HDI was statistically significant (ungraded). Source: Results, 'Structural determinants of health' para 1; Fig. 2d · same question in other reviews | MEAN 78.4 [71.1, 85.8] | NR | Ungraded |
Out-of-pocket health expenditure vs Lower vs higher out-of-pocket expenditure categories
Population: Community-dwelling elderly persons aged ≥60 years
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Oral health-related quality of life (OHRQoL sum score, transformed 0-100) Highest out-of-pocket expenditure Lower out-of-pocket health expenditure was associated with better OHRQoL (83.9, 95% CI 75.2 to 92.6 vs 67.5, 95% CI 58.5 to 76.5); the difference was statistically significant (ungraded). Source: Abstract; Results, 'Structural determinants of health' para 1; Fig. 3a · same question in other reviews | MEAN 67.5 [58.5, 76.5] | NR | Ungraded |
Oral health-related quality of life (OHRQoL sum score, transformed 0-100) Lowest out-of-pocket expenditure Lower out-of-pocket health expenditure was associated with better OHRQoL (83.9, 95% CI 75.2 to 92.6 vs 67.5, 95% CI 58.5 to 76.5); the difference was statistically significant (ungraded). Source: Abstract; Results, 'Structural determinants of health' para 1; Fig. 3a · same question in other reviews | MEAN 83.9 [75.2, 92.6] | NR | Ungraded |
Health expenditure per capita vs Higher vs lower per-capita health expenditure categories
Population: Community-dwelling elderly persons aged ≥60 years
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Oral health-related quality of life (OHRQoL sum score, transformed 0-100) Across per-capita health expenditure categories OHRQoL did not differ significantly across per-capita health-expenditure categories; no pooled estimate was reported in the text (ungraded). Source: Results, 'Structural determinants of health' para 1; Fig. 3a · same question in other reviews | No statistically significant difference in OHRQoL based on per-capita health expenditure (Fig. 3a). | NR | Ungraded |
Country-level dental caries prevalence (Global Burden of Disease) vs Low vs high dental caries prevalence
Population: Community-dwelling elderly persons aged ≥60 years
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Oral health-related quality of life (OHRQoL sum score, transformed 0-100) Low dental caries prevalence Lower country-level dental caries prevalence was associated with better OHRQoL (low-prevalence pooled mean 81.5, 95% CI 76.5 to 86.6, higher than high-prevalence countries); statistically significant (ungraded). Source: Abstract; Results, 'Dental status' para 1; Fig. 4a · same question in other reviews | MEAN 81.5 [76.5, 86.6] | NR | Ungraded |
Country-level periodontal disease prevalence (Global Burden of Disease) vs Low vs high periodontal disease prevalence
Population: Community-dwelling elderly persons aged ≥60 years
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Oral health-related quality of life (OHRQoL sum score, transformed 0-100) Across periodontal disease prevalence categories OHRQoL did not differ significantly by country-level periodontal disease prevalence; no pooled estimate was reported in the text (ungraded). Source: Results, 'Dental status' para 1; Fig. 4b · same question in other reviews | No statistically significant difference in OHRQoL based on periodontal disease prevalence (Fig. 4b). | NR | Ungraded |
Country-level edentulism prevalence (Global Burden of Disease) vs Low vs high edentulism prevalence
Population: Community-dwelling elderly persons aged ≥60 years
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Oral health-related quality of life (OHRQoL sum score, transformed 0-100) Across edentulism prevalence categories OHRQoL did not differ significantly by country-level edentulism prevalence; no pooled estimate was reported in the text (ungraded). Source: Results, 'Dental status' para 1; Fig. 4c · same question in other reviews | No statistically significant difference in OHRQoL based on edentulism prevalence (Fig. 4c). | NR | Ungraded |
High dental-caries prevalence vs Not applicable
Population: Community-dwelling adults aged 60 years or older
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
OHRQoL sum score transformed to 0-100 Baseline for longitudinal studies · High dental-caries prevalence The review reported higher OHRQoL in the low than high dental-caries-prevalence category. Source: Results, Fig. 4a · same question in other reviews | 71.40 [64.16, 78.63] | NR | Ungraded |
Unemployment rate vs Not applicable
Population: Community-dwelling adults aged 60 years or older
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
OHRQoL sum score transformed to 0-100 Baseline for longitudinal studies No statistically significant difference in OHRQoL was reported by unemployment rate. Source: Results, Fig. 2c · same question in other reviews | There was no statistically significant difference in OHRQoL based on unemployment rate. | NR | Ungraded |
Health expenditure per capita vs Not applicable
Population: Community-dwelling adults aged 60 years or older
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
OHRQoL sum score transformed to 0-100 Baseline for longitudinal studies No statistically significant difference in OHRQoL was reported by health expenditure per capita. Source: Results, Fig. 3a · same question in other reviews | There was no statistically significant difference in OHRQoL based on per capita expenditure on health care. | NR | Ungraded |
Low edentulism prevalence vs Not applicable
Population: Community-dwelling adults aged 60 years or older
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
OHRQoL sum score transformed to 0-100 Baseline for longitudinal studies · Low edentulism prevalence No statistically significant difference in OHRQoL was reported by edentulism prevalence. Source: Results, Dental status; Fig. 4c · same question in other reviews | There were no statistically significant differences reported in the OHRQoL sum scores based on prevalence of edentulism. | NR | Ungraded |
High edentulism prevalence vs Not applicable
Population: Community-dwelling adults aged 60 years or older
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
OHRQoL sum score transformed to 0-100 Baseline for longitudinal studies · High edentulism prevalence No statistically significant difference in OHRQoL was reported by edentulism prevalence. Source: Results, Dental status; Fig. 4c · same question in other reviews | There were no statistically significant differences reported in the OHRQoL sum scores based on prevalence of edentulism. | NR | Ungraded |
Low periodontal-disease prevalence vs Not applicable
Population: Community-dwelling adults aged 60 years or older
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
OHRQoL sum score transformed to 0-100 Baseline for longitudinal studies · Low periodontal-disease prevalence No statistically significant difference in OHRQoL was reported by periodontal-disease prevalence. Source: Results, Dental status; Fig. 4b · same question in other reviews | There were no statistically significant differences reported in the OHRQoL sum scores based on periodontal disease prevalence. | NR | Ungraded |
High periodontal-disease prevalence vs Not applicable
Population: Community-dwelling adults aged 60 years or older
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
OHRQoL sum score transformed to 0-100 Baseline for longitudinal studies · High periodontal-disease prevalence No statistically significant difference in OHRQoL was reported by periodontal-disease prevalence. Source: Results, Dental status; Fig. 4b · same question in other reviews | There were no statistically significant differences reported in the OHRQoL sum scores based on periodontal disease prevalence. | NR | Ungraded |
Comparison
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Oral health-related quality of life (OHRQoL sum score, transformed 0-100) Overall (pooled across all studies) | MEAN 77.0 | 45 studies | Ungraded |
Included primary studies 6
Open as a trial list| Study | Also included by | Outcomes it informs here | Trial PICO | Results |
|---|---|---|---|---|
| AlBaker 2017 Oral Health Status and Oral Health-related Quality of Life among Hospitalized and Nonhospitalized Geriatric Patients DOI:10.5005/jp-journals-10024-2022 | this review only | not stated | not extracted yet | not extracted yet |
| Chimi Chimi 2021 Implications of Climate Change on Agricultural Productivity: A Review DOI:10.47363/jftns/2021(3)130 | this review only | not stated | not extracted yet | not extracted yet |
| Masood 2017 The relationship between oral health and oral health related quality of life among elderly people in United Kingdom DOI:10.1016/j.jdent.2016.11.002 | this review only | not stated | not extracted yet | not extracted yet |
| Nanri 2017 Frequency of Fruit and Vegetable Consumption and the Oral Health-Related Quality of Life among Japanese Elderly: A Cross-Sectional Study… PMID:29244736 | this review only | not stated | not extracted yet | not extracted yet |
| Suphinwong 2022 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Tsakos 2017 Explaining time changes in oral health-related quality of life in England: a decomposition analysis DOI:10.1136/jech-2017-209696 | this review only | not stated | not extracted yet | not extracted yet |