Prevalence of Loss of All Teeth (Edentulism) and Associated Factors in Older Adults in China, Ghana, India, Mexico, Russia and South Africa †
Identifieur interne : 002E27 ( Pmc/Corpus ); précédent : 002E26; suivant : 002E28Prevalence of Loss of All Teeth (Edentulism) and Associated Factors in Older Adults in China, Ghana, India, Mexico, Russia and South Africa †
Auteurs : Karl Peltzer ; Sandra Hewlett ; Alfred E. Yawson ; Paula Moynihan ; Raman Preet ; Fan Wu ; Godfrey Guo ; Perianayagam Arokiasamy ; James J. Snodgrass ; Somnath Chatterji ; Mark E. Engelstad ; Paul KowalSource :
- International Journal of Environmental Research and Public Health [ 1661-7827 ] ; 2014.
Abstract
Little information exists about the loss of all one’s teeth (edentulism) among older adults in low- and middle-income countries. This study examines the prevalence of edentulism and associated factors among older adults in a cross-sectional study across six such countries. Data from the World Health Organization (WHO’s) Study on global AGEing and adult health (SAGE) Wave 1 was used for this study with adults aged 50-plus from China (
Url:
DOI: 10.3390/ijerph111111308
PubMed: 25361046
PubMed Central: 4245614
Links to Exploration step
PMC:4245614Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Prevalence of Loss of All Teeth (Edentulism) and Associated Factors in Older Adults in China, Ghana, India, Mexico, Russia and South Africa <xref ref-type="author-notes" rid="fn1-ijerph-11-11308">†</xref></title><author><name sortKey="Peltzer, Karl" sort="Peltzer, Karl" uniqKey="Peltzer K" first="Karl" last="Peltzer">Karl Peltzer</name><affiliation><nlm:aff id="af1-ijerph-11-11308">HIV/AIDS/STIs and TB (HAST), Human Sciences Research Council, Private Bag X41, Pretoria 0001, South Africa</nlm:aff></affiliation><affiliation><nlm:aff id="af2-ijerph-11-11308">Department of Psychology, University of the Free State, Bloemfontein 9300, South Africa</nlm:aff></affiliation><affiliation><nlm:aff id="af3-ijerph-11-11308">ASEAN Institute for Health Development, Madidol University, Salaya, Phutthamonthon, Nakhonpathom 73170, Thailand</nlm:aff></affiliation></author><author><name sortKey="Hewlett, Sandra" sort="Hewlett, Sandra" uniqKey="Hewlett S" first="Sandra" last="Hewlett">Sandra Hewlett</name><affiliation><nlm:aff id="af4-ijerph-11-11308">Department of Restorative Dentistry, University of Ghana Dental School, College of Health Sciences, Korle-Bu, Accra KB 460, Ghana; E-Mail:<email>sandrahewlett@yahoo.co.uk</email></nlm:aff></affiliation></author><author><name sortKey="Yawson, Alfred E" sort="Yawson, Alfred E" uniqKey="Yawson A" first="Alfred E." last="Yawson">Alfred E. Yawson</name><affiliation><nlm:aff id="af5-ijerph-11-11308">Department of Community Health, University of Ghana Medical School, College of Health Sciences, Korle-Bu, KB 4236, Accra, Ghana; E-Mail:<email>aeyawson@yahoo.com</email></nlm:aff></affiliation></author><author><name sortKey="Moynihan, Paula" sort="Moynihan, Paula" uniqKey="Moynihan P" first="Paula" last="Moynihan">Paula Moynihan</name><affiliation><nlm:aff id="af6-ijerph-11-11308">Institute of Health & Society, Centre for Oral Health Research, Newcastle University, Newcastle NE2 4BW, UK; E-Mail:<email>paula.moynihan@newcastle.ac.uk</email></nlm:aff></affiliation></author><author><name sortKey="Preet, Raman" sort="Preet, Raman" uniqKey="Preet R" first="Raman" last="Preet">Raman Preet</name><affiliation><nlm:aff id="af7-ijerph-11-11308">Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå SE-90187, Sweden; E-Mail:<email>raman.preet@epiph.umu.se</email></nlm:aff></affiliation></author><author><name sortKey="Wu, Fan" sort="Wu, Fan" uniqKey="Wu F" first="Fan" last="Wu">Fan Wu</name><affiliation><nlm:aff id="af8-ijerph-11-11308">Shanghai municipal Center for Disease Control and Prevention, No. 1380 West Zhongshan Rd, Changning District, Shanghai 200336, China; E-Mails:<email>fwu@scdc.sh.cn</email> (F.W.);<email>guoyanfei@scdc.sh.cn</email> (G.G.)</nlm:aff></affiliation></author><author><name sortKey="Guo, Godfrey" sort="Guo, Godfrey" uniqKey="Guo G" first="Godfrey" last="Guo">Godfrey Guo</name><affiliation><nlm:aff id="af8-ijerph-11-11308">Shanghai municipal Center for Disease Control and Prevention, No. 1380 West Zhongshan Rd, Changning District, Shanghai 200336, China; E-Mails:<email>fwu@scdc.sh.cn</email> (F.W.);<email>guoyanfei@scdc.sh.cn</email> (G.G.)</nlm:aff></affiliation></author><author><name sortKey="Arokiasamy, Perianayagam" sort="Arokiasamy, Perianayagam" uniqKey="Arokiasamy P" first="Perianayagam" last="Arokiasamy">Perianayagam Arokiasamy</name><affiliation><nlm:aff id="af9-ijerph-11-11308">International Institute for Population Studies, Mumbai, Maharashtra 400088, India; E-Mail:<email>parokiasamy@yahoo.co.uk</email></nlm:aff></affiliation></author><author><name sortKey="Snodgrass, James J" sort="Snodgrass, James J" uniqKey="Snodgrass J" first="James J." last="Snodgrass">James J. Snodgrass</name><affiliation><nlm:aff id="af10-ijerph-11-11308">Department of Anthropology, University of Oregon, Eugene, OR 97403, USA; E-Mail:<email>jjosh@uoregon.edu</email></nlm:aff></affiliation></author><author><name sortKey="Chatterji, Somnath" sort="Chatterji, Somnath" uniqKey="Chatterji S" first="Somnath" last="Chatterji">Somnath Chatterji</name><affiliation><nlm:aff id="af11-ijerph-11-11308">World Health Organization, SAGE, 1211 Geneva 27, Switzerland; E-Mails:<email>chatterjis@who.int</email> (S.C.);<email>kowalp@who.int</email> (P.K.)</nlm:aff></affiliation></author><author><name sortKey="Engelstad, Mark E" sort="Engelstad, Mark E" uniqKey="Engelstad M" first="Mark E." last="Engelstad">Mark E. Engelstad</name><affiliation><nlm:aff id="af12-ijerph-11-11308">Department of Oral and Maxillofacial Surgery, Oregon Health and Science University, Portland OR 97201, USA; E-Mail:<email>engelsta@ohsu.edu</email></nlm:aff></affiliation></author><author><name sortKey="Kowal, Paul" sort="Kowal, Paul" uniqKey="Kowal P" first="Paul" last="Kowal">Paul Kowal</name><affiliation><nlm:aff id="af11-ijerph-11-11308">World Health Organization, SAGE, 1211 Geneva 27, Switzerland; E-Mails:<email>chatterjis@who.int</email> (S.C.);<email>kowalp@who.int</email> (P.K.)</nlm:aff></affiliation><affiliation><nlm:aff id="af13-ijerph-11-11308">University of Newcastle Research Centre for Gender, Health and Ageing, Newcastle, NSW 2305, Australia</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">25361046</idno><idno type="pmc">4245614</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4245614</idno><idno type="RBID">PMC:4245614</idno><idno type="doi">10.3390/ijerph111111308</idno><date when="2014">2014</date><idno type="wicri:Area/Pmc/Corpus">002E27</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002E27</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Prevalence of Loss of All Teeth (Edentulism) and Associated Factors in Older Adults in China, Ghana, India, Mexico, Russia and South Africa <xref ref-type="author-notes" rid="fn1-ijerph-11-11308">†</xref></title><author><name sortKey="Peltzer, Karl" sort="Peltzer, Karl" uniqKey="Peltzer K" first="Karl" last="Peltzer">Karl Peltzer</name><affiliation><nlm:aff id="af1-ijerph-11-11308">HIV/AIDS/STIs and TB (HAST), Human Sciences Research Council, Private Bag X41, Pretoria 0001, South Africa</nlm:aff></affiliation><affiliation><nlm:aff id="af2-ijerph-11-11308">Department of Psychology, University of the Free State, Bloemfontein 9300, South Africa</nlm:aff></affiliation><affiliation><nlm:aff id="af3-ijerph-11-11308">ASEAN Institute for Health Development, Madidol University, Salaya, Phutthamonthon, Nakhonpathom 73170, Thailand</nlm:aff></affiliation></author><author><name sortKey="Hewlett, Sandra" sort="Hewlett, Sandra" uniqKey="Hewlett S" first="Sandra" last="Hewlett">Sandra Hewlett</name><affiliation><nlm:aff id="af4-ijerph-11-11308">Department of Restorative Dentistry, University of Ghana Dental School, College of Health Sciences, Korle-Bu, Accra KB 460, Ghana; E-Mail:<email>sandrahewlett@yahoo.co.uk</email></nlm:aff></affiliation></author><author><name sortKey="Yawson, Alfred E" sort="Yawson, Alfred E" uniqKey="Yawson A" first="Alfred E." last="Yawson">Alfred E. Yawson</name><affiliation><nlm:aff id="af5-ijerph-11-11308">Department of Community Health, University of Ghana Medical School, College of Health Sciences, Korle-Bu, KB 4236, Accra, Ghana; E-Mail:<email>aeyawson@yahoo.com</email></nlm:aff></affiliation></author><author><name sortKey="Moynihan, Paula" sort="Moynihan, Paula" uniqKey="Moynihan P" first="Paula" last="Moynihan">Paula Moynihan</name><affiliation><nlm:aff id="af6-ijerph-11-11308">Institute of Health & Society, Centre for Oral Health Research, Newcastle University, Newcastle NE2 4BW, UK; E-Mail:<email>paula.moynihan@newcastle.ac.uk</email></nlm:aff></affiliation></author><author><name sortKey="Preet, Raman" sort="Preet, Raman" uniqKey="Preet R" first="Raman" last="Preet">Raman Preet</name><affiliation><nlm:aff id="af7-ijerph-11-11308">Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå SE-90187, Sweden; E-Mail:<email>raman.preet@epiph.umu.se</email></nlm:aff></affiliation></author><author><name sortKey="Wu, Fan" sort="Wu, Fan" uniqKey="Wu F" first="Fan" last="Wu">Fan Wu</name><affiliation><nlm:aff id="af8-ijerph-11-11308">Shanghai municipal Center for Disease Control and Prevention, No. 1380 West Zhongshan Rd, Changning District, Shanghai 200336, China; E-Mails:<email>fwu@scdc.sh.cn</email> (F.W.);<email>guoyanfei@scdc.sh.cn</email> (G.G.)</nlm:aff></affiliation></author><author><name sortKey="Guo, Godfrey" sort="Guo, Godfrey" uniqKey="Guo G" first="Godfrey" last="Guo">Godfrey Guo</name><affiliation><nlm:aff id="af8-ijerph-11-11308">Shanghai municipal Center for Disease Control and Prevention, No. 1380 West Zhongshan Rd, Changning District, Shanghai 200336, China; E-Mails:<email>fwu@scdc.sh.cn</email> (F.W.);<email>guoyanfei@scdc.sh.cn</email> (G.G.)</nlm:aff></affiliation></author><author><name sortKey="Arokiasamy, Perianayagam" sort="Arokiasamy, Perianayagam" uniqKey="Arokiasamy P" first="Perianayagam" last="Arokiasamy">Perianayagam Arokiasamy</name><affiliation><nlm:aff id="af9-ijerph-11-11308">International Institute for Population Studies, Mumbai, Maharashtra 400088, India; E-Mail:<email>parokiasamy@yahoo.co.uk</email></nlm:aff></affiliation></author><author><name sortKey="Snodgrass, James J" sort="Snodgrass, James J" uniqKey="Snodgrass J" first="James J." last="Snodgrass">James J. Snodgrass</name><affiliation><nlm:aff id="af10-ijerph-11-11308">Department of Anthropology, University of Oregon, Eugene, OR 97403, USA; E-Mail:<email>jjosh@uoregon.edu</email></nlm:aff></affiliation></author><author><name sortKey="Chatterji, Somnath" sort="Chatterji, Somnath" uniqKey="Chatterji S" first="Somnath" last="Chatterji">Somnath Chatterji</name><affiliation><nlm:aff id="af11-ijerph-11-11308">World Health Organization, SAGE, 1211 Geneva 27, Switzerland; E-Mails:<email>chatterjis@who.int</email> (S.C.);<email>kowalp@who.int</email> (P.K.)</nlm:aff></affiliation></author><author><name sortKey="Engelstad, Mark E" sort="Engelstad, Mark E" uniqKey="Engelstad M" first="Mark E." last="Engelstad">Mark E. Engelstad</name><affiliation><nlm:aff id="af12-ijerph-11-11308">Department of Oral and Maxillofacial Surgery, Oregon Health and Science University, Portland OR 97201, USA; E-Mail:<email>engelsta@ohsu.edu</email></nlm:aff></affiliation></author><author><name sortKey="Kowal, Paul" sort="Kowal, Paul" uniqKey="Kowal P" first="Paul" last="Kowal">Paul Kowal</name><affiliation><nlm:aff id="af11-ijerph-11-11308">World Health Organization, SAGE, 1211 Geneva 27, Switzerland; E-Mails:<email>chatterjis@who.int</email> (S.C.);<email>kowalp@who.int</email> (P.K.)</nlm:aff></affiliation><affiliation><nlm:aff id="af13-ijerph-11-11308">University of Newcastle Research Centre for Gender, Health and Ageing, Newcastle, NSW 2305, Australia</nlm:aff></affiliation></author></analytic><series><title level="j">International Journal of Environmental Research and Public Health</title><idno type="ISSN">1661-7827</idno><idno type="eISSN">1660-4601</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Little information exists about the loss of all one’s teeth (edentulism) among older adults in low- and middle-income countries. This study examines the prevalence of edentulism and associated factors among older adults in a cross-sectional study across six such countries. Data from the World Health Organization (WHO’s) Study on global AGEing and adult health (SAGE) Wave 1 was used for this study with adults aged 50-plus from China (<italic>N</italic> = 13,367), Ghana (<italic>N</italic> = 4724), India (<italic>N</italic> = 7150), Mexico (<italic>N</italic> = 2315), Russian Federation (<italic>N</italic> = 3938) and South Africa (<italic>N</italic> = 3840). Multivariate regression was used to assess predictors of edentulism. The overall prevalence of edentulism was 11.7% in the six countries, with India, Mexico, and Russia has higher prevalence rates (16.3%–21.7%) than China, Ghana, and South Africa (3.0%–9.0%). In multivariate logistic analysis sociodemographic factors (older age, lower education), chronic conditions (arthritis, asthma), health risk behaviour (former daily tobacco use, inadequate fruits and vegetable consumption) and other health related variables (functional disability and low social cohesion) were associated with edentulism. The national estimates and identified factors associated with edentulism among older adults across the six countries helps to identify areas for further exploration and targets for intervention.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Sussex, P V" uniqKey="Sussex P">P.V. Sussex</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Thomson, W M" uniqKey="Thomson W">W.M. Thomson</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Kossioni, A E" uniqKey="Kossioni A">A.E. Kossioni</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wu, B" uniqKey="Wu B">B. Wu</name></author><author><name sortKey="Liang, J" uniqKey="Liang J">J. Liang</name></author><author><name sortKey="Plassman, B L" uniqKey="Plassman B">B.L. Plassman</name></author><author><name sortKey="Remle, C" uniqKey="Remle C">C. Remle</name></author><author><name sortKey="Luo, X" uniqKey="Luo X">X. Luo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Dolan, T A" uniqKey="Dolan T">T.A. Dolan</name></author><author><name sortKey="Gilbert, G H" uniqKey="Gilbert G">G.H. Gilbert</name></author><author><name sortKey="Duncan, R P" uniqKey="Duncan R">R.P. Duncan</name></author><author><name sortKey="Foerster, U" uniqKey="Foerster U">U. Foerster</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Medina Solis, C E" uniqKey="Medina Solis C">C.E. Medina-Solís</name></author><author><name sortKey="Perez Nu Ez, R" uniqKey="Perez Nu Ez R">R. Pérez-Núñez</name></author><author><name sortKey="Maupome, G" uniqKey="Maupome G">G. Maupomé</name></author><author><name sortKey="Avila Burgos, L" uniqKey="Avila Burgos L">L. Avila-Burgos</name></author><author><name sortKey="Pontigo Loyola, A P" uniqKey="Pontigo Loyola A">A.P. Pontigo-Loyola</name></author><author><name sortKey="Pati O Marin, N" uniqKey="Pati O Marin N">N. Patiño-Marín</name></author><author><name sortKey="Villalobos Rodelo, J J" uniqKey="Villalobos Rodelo J">J.J. Villalobos-Rodelo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Muller, F" uniqKey="Muller F">F. Müller</name></author><author><name sortKey="Naharro, M" uniqKey="Naharro M">M. Naharro</name></author><author><name sortKey="Carlsson, G E" uniqKey="Carlsson G">G.E. Carlsson</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mojon, P" uniqKey="Mojon P">P. Mojon</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Steele, J G" uniqKey="Steele J">J.G. Steele</name></author><author><name sortKey="Treasure, E T" uniqKey="Treasure E">E.T. Treasure</name></author><author><name sortKey="O Ullivan, I" uniqKey="O Ullivan I">I. O’Sullivan</name></author><author><name sortKey="Morris, J" uniqKey="Morris J">J. Morris</name></author><author><name sortKey="Murray, J J" uniqKey="Murray J">J.J. Murray</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Do An, B G" uniqKey="Do An B">B.G. Doğan</name></author><author><name sortKey="Gokalp, S" uniqKey="Gokalp S">S. Gökalp</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gaio, E J" uniqKey="Gaio E">E.J. Gaio</name></author><author><name sortKey="Haas, A N" uniqKey="Haas A">A.N. Haas</name></author><author><name sortKey="Carrard, V C" uniqKey="Carrard V">V.C. Carrard</name></author><author><name sortKey="Oppermann, R V" uniqKey="Oppermann R">R.V. Oppermann</name></author><author><name sortKey="Albandar, J" uniqKey="Albandar J">J. Albandar</name></author><author><name sortKey="Susin, C" uniqKey="Susin C">C. Susin.</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hugo, F N" uniqKey="Hugo F">F.N. Hugo</name></author><author><name sortKey="Hilgert, J B" uniqKey="Hilgert J">J.B. Hilgert</name></author><author><name sortKey="De Sousa Mda, L" uniqKey="De Sousa Mda L">L. de Sousa Mda</name></author><author><name sortKey="Da Silva, D D" uniqKey="Da Silva D">D.D. da Silva</name></author><author><name sortKey="Pucca, G A" uniqKey="Pucca G">G.A. Pucca</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mendes, D C" uniqKey="Mendes D">D.C. Mendes</name></author><author><name sortKey="Poswar Fde, O" uniqKey="Poswar Fde O">O. Poswar Fde</name></author><author><name sortKey="De Oliveira, M V" uniqKey="De Oliveira M">M.V. de Oliveira</name></author><author><name sortKey="Haikal, D S" uniqKey="Haikal D">D.S. Haikal</name></author><author><name sortKey="Da Silveira, M F" uniqKey="Da Silveira M">M.F. da Silveira</name></author><author><name sortKey="Martins, A M" uniqKey="Martins A">A.M. Martins</name></author><author><name sortKey="De Paula, A M" uniqKey="De Paula A">A.M. De Paula</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Northridge, M E" uniqKey="Northridge M">M.E. Northridge</name></author><author><name sortKey="Ue, F V" uniqKey="Ue F">F.V. Ue</name></author><author><name sortKey="Borrell, L N" uniqKey="Borrell L">L.N. Borrell</name></author><author><name sortKey="De La Cruz, L D" uniqKey="De La Cruz L">L.D. De La Cruz</name></author><author><name sortKey="Chakraborty, B" uniqKey="Chakraborty B">B. Chakraborty</name></author><author><name sortKey="Bodnar, S" uniqKey="Bodnar S">S. Bodnar</name></author><author><name sortKey="Marshall, S" uniqKey="Marshall S">S. Marshall</name></author><author><name sortKey="Lamster, I B" uniqKey="Lamster I">I.B. Lamster</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wennstrom, A" uniqKey="Wennstrom A">A. Wennström</name></author><author><name sortKey="Ahlqwist, M" uniqKey="Ahlqwist M">M. Ahlqwist</name></author><author><name sortKey="Stenman, U" uniqKey="Stenman U">U. Stenman</name></author><author><name sortKey="Bjorkelund, C" uniqKey="Bjorkelund C">C. Björkelund</name></author><author><name sortKey="Hakeberg, M" uniqKey="Hakeberg M">M. Hakeberg</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Moreira Rda, S" uniqKey="Moreira Rda S">S. Moreira Rda</name></author><author><name sortKey="Nico, L S" uniqKey="Nico L">L.S. Nico</name></author><author><name sortKey="Tomita, N E" uniqKey="Tomita N">N.E. Tomita</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Starr, J M" uniqKey="Starr J">J.M. Starr</name></author><author><name sortKey="Hall, R" uniqKey="Hall R">R. Hall</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Vargas, C M" uniqKey="Vargas C">C.M. Vargas</name></author><author><name sortKey="Yellowitz, J A" uniqKey="Yellowitz J">J.A. Yellowitz</name></author><author><name sortKey="Hayes, K L" uniqKey="Hayes K">K.L. Hayes</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Felton, D A" uniqKey="Felton D">D.A. Felton</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Patel, M H" uniqKey="Patel M">M.H. Patel</name></author><author><name sortKey="Kumar, J V" uniqKey="Kumar J">J.V. Kumar</name></author><author><name sortKey="Moss, M E" uniqKey="Moss M">M.E. Moss</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Medina Solis, C E" uniqKey="Medina Solis C">C.E. Medina-Solís</name></author><author><name sortKey="Pontigo Loyola, A P" uniqKey="Pontigo Loyola A">A.P. Pontigo-Loyola</name></author><author><name sortKey="Perez Campos, E" uniqKey="Perez Campos E">E. Pérez-Campos</name></author><author><name sortKey="Hernandez Cruz, P" uniqKey="Hernandez Cruz P">P. Hernández-Cruz</name></author><author><name sortKey="Avila Burgos, L" uniqKey="Avila Burgos L">L. Avila-Burgos</name></author><author><name sortKey="Kowolik, M J" uniqKey="Kowolik M">M.J. Kowolik</name></author><author><name sortKey="Maupome, G" uniqKey="Maupome G">G. Maupomé</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Elter, J R" uniqKey="Elter J">J.R. Elter</name></author><author><name sortKey="Offenbacher, S" uniqKey="Offenbacher S">S. Offenbacher</name></author><author><name sortKey="Toole, J F" uniqKey="Toole J">J.F. Toole</name></author><author><name sortKey="Beck, J D" uniqKey="Beck J">J.D. Beck</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ayo Yusuf, O A" uniqKey="Ayo Yusuf O">O.A. Ayo-Yusuf</name></author><author><name sortKey="Ayo Yusuf, I J" uniqKey="Ayo Yusuf I">I.J. Ayo-Yusuf</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Osterberg, T" uniqKey="Osterberg T">T. Österberg</name></author><author><name sortKey="Dey, D K" uniqKey="Dey D">D.K. Dey</name></author><author><name sortKey="Sundh, V" uniqKey="Sundh V">V. Sundh</name></author><author><name sortKey="Carlsson, G E" uniqKey="Carlsson G">G.E. Carlsson</name></author><author><name sortKey="Jansson, J O" uniqKey="Jansson J">J.O. Jansson</name></author><author><name sortKey="Mellstrom, D" uniqKey="Mellstrom D">D. Mellström</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Arora, M" uniqKey="Arora M">M. Arora</name></author><author><name sortKey="Schwarz, E" uniqKey="Schwarz E">E. Schwarz</name></author><author><name sortKey="Sivaneswaran, S" uniqKey="Sivaneswaran S">S. Sivaneswaran</name></author><author><name sortKey="Banks, E" uniqKey="Banks E">E. Banks</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hanioka, T" uniqKey="Hanioka T">T. Hanioka</name></author><author><name sortKey="Ojima, M" uniqKey="Ojima M">M. Ojima</name></author><author><name sortKey="Tanaka, K" uniqKey="Tanaka K">K. Tanaka</name></author><author><name sortKey="Aoyama, H" uniqKey="Aoyama H">H. Aoyama</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Islas Granillo, H" uniqKey="Islas Granillo H">H. Islas-Granillo</name></author><author><name sortKey="Borges Ya Ez, S A" uniqKey="Borges Ya Ez S">S.A. Borges-Yañez</name></author><author><name sortKey="Lucas Rinc N, S E" uniqKey="Lucas Rinc N S">S.E. Lucas-Rincón</name></author><author><name sortKey="Medina Solis, C E" uniqKey="Medina Solis C">C.E. Medina-Solís</name></author><author><name sortKey="Casanova Rosado, A J" uniqKey="Casanova Rosado A">A.J. Casanova-Rosado</name></author><author><name sortKey="Marquez Corona, M L" uniqKey="Marquez Corona M">M.L. Márquez-Corona</name></author><author><name sortKey="Maupome, G" uniqKey="Maupome G">G. Maupomé</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="De Marchi, R J" uniqKey="De Marchi R">R.J. De Marchi</name></author><author><name sortKey="Hugo, F N" uniqKey="Hugo F">F.N. Hugo</name></author><author><name sortKey="Padilha, D M" uniqKey="Padilha D">D.M. Padilha</name></author><author><name sortKey="Hilgert, J B" uniqKey="Hilgert J">J.B. Hilgert</name></author><author><name sortKey="Machado, D B" uniqKey="Machado D">D.B. Machado</name></author><author><name sortKey="Durgante, P C" uniqKey="Durgante P">P.C. Durgante</name></author><author><name sortKey="Antunes, M T" uniqKey="Antunes M">M.T. Antunes</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Tsakos, G" uniqKey="Tsakos G">G. Tsakos</name></author><author><name sortKey="Herrick, K" uniqKey="Herrick K">K. Herrick</name></author><author><name sortKey="Sheiham, A" uniqKey="Sheiham A">A. Sheiham</name></author><author><name sortKey="Watt, R G" uniqKey="Watt R">R.G. Watt</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Yu, Y H" uniqKey="Yu Y">Y.H. Yu</name></author><author><name sortKey="Lai, Y L" uniqKey="Lai Y">Y.L. Lai</name></author><author><name sortKey="Cheung, W S" uniqKey="Cheung W">W.S. Cheung</name></author><author><name sortKey="Kuo, H K" uniqKey="Kuo H">H.K. Kuo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Naorungroj, S" uniqKey="Naorungroj S">S. Naorungroj</name></author><author><name sortKey="Slade, G D" uniqKey="Slade G">G.D. Slade</name></author><author><name sortKey="Beck, J D" uniqKey="Beck J">J.D. Beck</name></author><author><name sortKey="Mosley, T H" uniqKey="Mosley T">T.H. Mosley</name></author><author><name sortKey="Gottesman, R F" uniqKey="Gottesman R">R.F. Gottesman</name></author><author><name sortKey="Alonso, A" uniqKey="Alonso A">A. Alonso</name></author><author><name sortKey="Heiss, G" uniqKey="Heiss G">G. Heiss</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Starr, J M" uniqKey="Starr J">J.M. Starr</name></author><author><name sortKey="Hall, R J" uniqKey="Hall R">R.J. Hall</name></author><author><name sortKey="Macintyre, S" uniqKey="Macintyre S">S. Macintyre</name></author><author><name sortKey="Deary, I J" uniqKey="Deary I">I.J. Deary</name></author><author><name sortKey="Whalley, L J" uniqKey="Whalley L">L.J. Whalley</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Tsakos, G" uniqKey="Tsakos G">G. Tsakos</name></author><author><name sortKey="Sabbah, W" uniqKey="Sabbah W">W. Sabbah</name></author><author><name sortKey="Chandola, T" uniqKey="Chandola T">T. Chandola</name></author><author><name sortKey="Newton, T" uniqKey="Newton T">T. Newton</name></author><author><name sortKey="Kawachi, I" uniqKey="Kawachi I">I. Kawachi</name></author><author><name sortKey="Aida, J" uniqKey="Aida J">J. Aida</name></author><author><name sortKey="Sheiham, A" uniqKey="Sheiham A">A. Sheiham</name></author><author><name sortKey="Marmot, M G" uniqKey="Marmot M">M.G. Marmot</name></author><author><name sortKey="Watt, R G" uniqKey="Watt R">R.G. Watt</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hugo, F N" uniqKey="Hugo F">F.N. Hugo</name></author><author><name sortKey="Hilgert, J B" uniqKey="Hilgert J">J.B. Hilgert</name></author><author><name sortKey="De Sousa Mda, L" uniqKey="De Sousa Mda L">L. de Sousa Mda</name></author><author><name sortKey="Cury, J A" uniqKey="Cury J">J.A. Cury</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rodrigues, S M" uniqKey="Rodrigues S">S.M. Rodrigues</name></author><author><name sortKey="Oliveira, A C" uniqKey="Oliveira A">A.C. Oliveira</name></author><author><name sortKey="Vargas, A M" uniqKey="Vargas A">A.M. Vargas</name></author><author><name sortKey="Moreira, A N E" uniqKey="Moreira A">A.N.E. Moreira</name></author><author><name sortKey="Ferreira, E F" uniqKey="Ferreira E">E.F. Ferreira</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Steele, J G" uniqKey="Steele J">J.G. Steele</name></author><author><name sortKey="Sanders, A E" uniqKey="Sanders A">A.E. Sanders</name></author><author><name sortKey="Slade, G D" uniqKey="Slade G">G.D. Slade</name></author><author><name sortKey="Allen, P F" uniqKey="Allen P">P.F. Allen</name></author><author><name sortKey="Lahti, S" uniqKey="Lahti S">S. Lahti</name></author><author><name sortKey="Nuttall, N" uniqKey="Nuttall N">N. Nuttall</name></author><author><name sortKey="Spencer, A J" uniqKey="Spencer A">A.J. Spencer</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sheiham, A" uniqKey="Sheiham A">A. Sheiham</name></author><author><name sortKey="Nicolau, B" uniqKey="Nicolau B">B. Nicolau</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hanson, B S" uniqKey="Hanson B">B.S. Hanson</name></author><author><name sortKey="Liedberg, B" uniqKey="Liedberg B">B. Liedberg</name></author><author><name sortKey="Owall, B" uniqKey="Owall B">B. Owall</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kowal, P" uniqKey="Kowal P">P. Kowal</name></author><author><name sortKey="Chatterji, S" uniqKey="Chatterji S">S. Chatterji</name></author><author><name sortKey="Naidoo, N" uniqKey="Naidoo N">N. Naidoo</name></author><author><name sortKey="Biritwum, R" uniqKey="Biritwum R">R. Biritwum</name></author><author><name sortKey="Wu, F" uniqKey="Wu F">F. Wu</name></author><author><name sortKey="Ridaura, R L" uniqKey="Ridaura R">R.L. Ridaura</name></author><author><name sortKey="Maximova, T" uniqKey="Maximova T">T. Maximova</name></author><author><name sortKey="Arokiasamy, P" uniqKey="Arokiasamy P">P. Arokiasamy</name></author><author><name sortKey="Phaswana Mafuya, N" uniqKey="Phaswana Mafuya N">N. Phaswana-Mafuya</name></author><author><name sortKey="Williams, S" uniqKey="Williams S">S. Williams</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Naidoo, N" uniqKey="Naidoo N">N. Naidoo</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Ferguson, B D" uniqKey="Ferguson B">B.D. Ferguson</name></author><author><name sortKey="Tandon, A" uniqKey="Tandon A">A. Tandon</name></author><author><name sortKey="Gakidou, E" uniqKey="Gakidou E">E. Gakidou</name></author><author><name sortKey="Murray, C J L" uniqKey="Murray C">C.J.L. Murray</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chobanian, A V" uniqKey="Chobanian A">A.V. Chobanian</name></author><author><name sortKey="Bakris, G L" uniqKey="Bakris G">G.L. Bakris</name></author><author><name sortKey="Black, H R" uniqKey="Black H">H.R. Black</name></author><author><name sortKey="Cushman, W C" uniqKey="Cushman W">W.C. Cushman</name></author><author><name sortKey="Green, L A" uniqKey="Green L">L.A. Green</name></author><author><name sortKey="Izzo, J L" uniqKey="Izzo J">J.L. Izzo</name></author><author><name sortKey="Jones, D W" uniqKey="Jones D">D.W. Jones</name></author><author><name sortKey="Materson, B J" uniqKey="Materson B">B.J. Materson</name></author><author><name sortKey="Oparil, S" uniqKey="Oparil S">S. Oparil</name></author><author><name sortKey="Wright, J T" uniqKey="Wright J">J.T. Wright</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Ustun, T" uniqKey="Ustun T">T. Üstün</name></author><author><name sortKey="Kostanjsek, N" uniqKey="Kostanjsek N">N. Kostanjsek</name></author><author><name sortKey="Chatterji, S" uniqKey="Chatterji S">S. Chatterji</name></author><author><name sortKey="Rehm, J" uniqKey="Rehm J">J. Rehm</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Stucki, G" uniqKey="Stucki G">G. Stucki</name></author><author><name sortKey="Kostanjsek, N" uniqKey="Kostanjsek N">N. Kostanjsek</name></author><author><name sortKey="Ustun, B" uniqKey="Ustun B">B. Ustün</name></author><author><name sortKey="Cieza, A" uniqKey="Cieza A">A. Cieza</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ramlagan, S" uniqKey="Ramlagan S">S. Ramlagan</name></author><author><name sortKey="Peltzer, K" uniqKey="Peltzer K">K. Peltzer</name></author><author><name sortKey="Phaswana Mafuya, N" uniqKey="Phaswana Mafuya N">N. Phaswana-Mafuya</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ahmad, O B" uniqKey="Ahmad O">O.B. Ahmad</name></author><author><name sortKey="Boschi Pinto, C" uniqKey="Boschi Pinto C">C. Boschi-Pinto</name></author><author><name sortKey="Lopez, A D" uniqKey="Lopez A">A.D. Lopez</name></author><author><name sortKey="Murray, C J L" uniqKey="Murray C">C.J.L. Murray</name></author><author><name sortKey="Lozano, R" uniqKey="Lozano R">R. Lozano</name></author><author><name sortKey="Inoue, M" uniqKey="Inoue M">M. Inoue</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Esan, T A" uniqKey="Esan T">T.A. Esan</name></author><author><name sortKey="Olusile, A O" uniqKey="Olusile A">A.O. Olusile</name></author><author><name sortKey="Akeredolu, P A" uniqKey="Akeredolu P">P.A. Akeredolu</name></author><author><name sortKey="Esan, A O" uniqKey="Esan A">A.O. Esan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hobdell, M H" uniqKey="Hobdell M">M.H. Hobdell</name></author><author><name sortKey="Myburgh, N G" uniqKey="Myburgh N">N.G. Myburgh</name></author><author><name sortKey="Lalloo, R" uniqKey="Lalloo R">R. Lalloo</name></author><author><name sortKey="Chikte, U M E" uniqKey="Chikte U">U.M.E. Chikte</name></author><author><name sortKey="Owen, C" uniqKey="Owen C">C. Owen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Thorpe, S" uniqKey="Thorpe S">S. Thorpe</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Haikola, B" uniqKey="Haikola B">B. Haikola</name></author><author><name sortKey="Oikarinen, K" uniqKey="Oikarinen K">K. Oikarinen</name></author><author><name sortKey="Soderholm, A L" uniqKey="Soderholm A">A.L. Söderholm</name></author><author><name sortKey="Remes Lyly, T" uniqKey="Remes Lyly T">T. Remes-Lyly</name></author><author><name sortKey="Sipil, K" uniqKey="Sipil K">K. Sipilä</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mercado, F B" uniqKey="Mercado F">F.B. Mercado</name></author><author><name sortKey="Marshall, R I" uniqKey="Marshall R">R.I. Marshall</name></author><author><name sortKey="Bartold, P M" uniqKey="Bartold P">P.M. Bartold</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Yavuzyilmaz, E" uniqKey="Yavuzyilmaz E">E. Yavuzyilmaz</name></author><author><name sortKey="Yamalik, N" uniqKey="Yamalik N">N. Yamalik</name></author><author><name sortKey="Calguner, M" uniqKey="Calguner M">M. Calgüner</name></author><author><name sortKey="Ersoy, F" uniqKey="Ersoy F">F. Ersoy</name></author><author><name sortKey="Baykara, M" uniqKey="Baykara M">M. Baykara</name></author><author><name sortKey="Yeniay, I" uniqKey="Yeniay I">I. Yeniay</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Han, E R" uniqKey="Han E">E.R. Han</name></author><author><name sortKey="Choi, I S" uniqKey="Choi I">I.S. Choi</name></author><author><name sortKey="Kim, H K" uniqKey="Kim H">H.K. Kim</name></author><author><name sortKey="Kang, Y W" uniqKey="Kang Y">Y.W. Kang</name></author><author><name sortKey="Park, J G" uniqKey="Park J">J.G. Park</name></author><author><name sortKey="Lim, J R" uniqKey="Lim J">J.R. Lim</name></author><author><name sortKey="Seo, J H" uniqKey="Seo J">J.H. Seo</name></author><author><name sortKey="Choi, J H" uniqKey="Choi J">J.H. Choi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Stewart, R" uniqKey="Stewart R">R. Stewart</name></author><author><name sortKey="Hirani, V" uniqKey="Hirani V">V. Hirani</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Shimazaki, Y" uniqKey="Shimazaki Y">Y. Shimazaki</name></author><author><name sortKey="Soh, I" uniqKey="Soh I">I. Soh</name></author><author><name sortKey="Saito, T" uniqKey="Saito T">T. Saito</name></author><author><name sortKey="Yamashita, Y" uniqKey="Yamashita Y">Y. Yamashita</name></author><author><name sortKey="Koga, T" uniqKey="Koga T">T. Koga</name></author><author><name sortKey="Miyazaki, H" uniqKey="Miyazaki H">H. Miyazaki</name></author><author><name sortKey="Takehara, T" uniqKey="Takehara T">T. Takehara</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sheiham, A" uniqKey="Sheiham A">A. Sheiham</name></author><author><name sortKey="Steele, J G" uniqKey="Steele J">J.G. Steele</name></author><author><name sortKey="Marcenes, W" uniqKey="Marcenes W">W. Marcenes</name></author><author><name sortKey="Lowe, C" uniqKey="Lowe C">C. Lowe</name></author><author><name sortKey="Finch, S" uniqKey="Finch S">S. Finch</name></author><author><name sortKey="Bates, C J" uniqKey="Bates C">C.J. Bates</name></author><author><name sortKey="Prentice, A" uniqKey="Prentice A">A. Prentice</name></author><author><name sortKey="Walls, A W G" uniqKey="Walls A">A.W.G. Walls</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Emami, E" uniqKey="Emami E">E. Emami</name></author><author><name sortKey="De Souza, R F" uniqKey="De Souza R">R.F. de Souza</name></author><author><name sortKey="Kabawat, M" uniqKey="Kabawat M">M. Kabawat</name></author><author><name sortKey="Feine, J S" uniqKey="Feine J">J.S. Feine</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lee, J S" uniqKey="Lee J">J.S. Lee</name></author><author><name sortKey="Weyant, R J" uniqKey="Weyant R">R.J. Weyant</name></author><author><name sortKey="Corby, P" uniqKey="Corby P">P. Corby</name></author><author><name sortKey="Kritchevsky, S B" uniqKey="Kritchevsky S">S.B. Kritchevsky</name></author><author><name sortKey="Harris, T B" uniqKey="Harris T">T.B. Harris</name></author><author><name sortKey="Rooks, R" uniqKey="Rooks R">R. Rooks</name></author><author><name sortKey="Rubin, S M" uniqKey="Rubin S">S.M. Rubin</name></author><author><name sortKey="Newman, A B" uniqKey="Newman A">A.B. Newman</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Reddy, N S" uniqKey="Reddy N">N.S. Reddy</name></author><author><name sortKey="Reddy, N A" uniqKey="Reddy N">N.A. Reddy</name></author><author><name sortKey="Narendra, R" uniqKey="Narendra R">R. Narendra</name></author><author><name sortKey="Reddy, S D" uniqKey="Reddy S">S.D. Reddy</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Joshipura, K J" uniqKey="Joshipura K">K.J. Joshipura</name></author><author><name sortKey="Rimm, E B" uniqKey="Rimm E">E.B. Rimm</name></author><author><name sortKey="Douglass, C W" uniqKey="Douglass C">C.W. Douglass</name></author><author><name sortKey="Trichopoulos, D" uniqKey="Trichopoulos D">D. Trichopoulos</name></author><author><name sortKey="Ascherio, A" uniqKey="Ascherio A">A. Ascherio</name></author><author><name sortKey="Willett, W C" uniqKey="Willett W">W.C. Willett</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Iwasaki, M" uniqKey="Iwasaki M">M. Iwasaki</name></author><author><name sortKey="Moynihan, P" uniqKey="Moynihan P">P. Moynihan</name></author><author><name sortKey="Manz, M C" uniqKey="Manz M">M.C. Manz</name></author><author><name sortKey="Taylor, G W" uniqKey="Taylor G">G.W. Taylor</name></author><author><name sortKey="Yoshihara, A" uniqKey="Yoshihara A">A. Yoshihara</name></author><author><name sortKey="Muramatsu, K" uniqKey="Muramatsu K">K. Muramatsu</name></author><author><name sortKey="Watanabe, R" uniqKey="Watanabe R">R. Watanabe</name></author><author><name sortKey="Miyazaki, H" uniqKey="Miyazaki H">H. Miyazaki</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gotfredsen, K" uniqKey="Gotfredsen K">K. Gotfredsen</name></author><author><name sortKey="Walls, A W" uniqKey="Walls A">A.W. Walls</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Avlund, K" uniqKey="Avlund K">K. Avlund</name></author><author><name sortKey="Holm Pedersen, P" uniqKey="Holm Pedersen P">P. Holm-Pedersen</name></author><author><name sortKey="Morse, D E" uniqKey="Morse D">D.E. Morse</name></author><author><name sortKey="Viitanen, M" uniqKey="Viitanen M">M. Viitanen</name></author><author><name sortKey="Winblad, B" uniqKey="Winblad B">B. Winblad</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Tramini, P" uniqKey="Tramini P">P. Tramini</name></author><author><name sortKey="Montal, S" uniqKey="Montal S">S. Montal</name></author><author><name sortKey="Valcarcel, J" uniqKey="Valcarcel J">J. Valcarcel</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Int J Environ Res Public Health</journal-id><journal-id journal-id-type="iso-abbrev">Int J Environ Res Public Health</journal-id><journal-id journal-id-type="publisher-id">ijerph</journal-id><journal-title-group><journal-title>International Journal of Environmental Research and Public Health</journal-title></journal-title-group><issn pub-type="ppub">1661-7827</issn><issn pub-type="epub">1660-4601</issn><publisher><publisher-name>MDPI</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">25361046</article-id><article-id pub-id-type="pmc">4245614</article-id><article-id pub-id-type="doi">10.3390/ijerph111111308</article-id><article-id pub-id-type="publisher-id">ijerph-11-11308</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Prevalence of Loss of All Teeth (Edentulism) and Associated Factors in Older Adults in China, Ghana, India, Mexico, Russia and South Africa <xref ref-type="author-notes" rid="fn1-ijerph-11-11308">†</xref></article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Peltzer</surname><given-names>Karl</given-names></name><xref ref-type="aff" rid="af1-ijerph-11-11308">1</xref><xref ref-type="aff" rid="af2-ijerph-11-11308">2</xref><xref ref-type="aff" rid="af3-ijerph-11-11308">3</xref><xref rid="c1-ijerph-11-11308" ref-type="corresp">*</xref></contrib><contrib contrib-type="author"><name><surname>Hewlett</surname><given-names>Sandra</given-names></name><xref ref-type="aff" rid="af4-ijerph-11-11308">4</xref></contrib><contrib contrib-type="author"><name><surname>Yawson</surname><given-names>Alfred E.</given-names></name><xref ref-type="aff" rid="af5-ijerph-11-11308">5</xref></contrib><contrib contrib-type="author"><name><surname>Moynihan</surname><given-names>Paula</given-names></name><xref ref-type="aff" rid="af6-ijerph-11-11308">6</xref></contrib><contrib contrib-type="author"><name><surname>Preet</surname><given-names>Raman</given-names></name><xref ref-type="aff" rid="af7-ijerph-11-11308">7</xref></contrib><contrib contrib-type="author"><name><surname>Wu</surname><given-names>Fan</given-names></name><xref ref-type="aff" rid="af8-ijerph-11-11308">8</xref></contrib><contrib contrib-type="author"><name><surname>Guo</surname><given-names>Godfrey</given-names></name><xref ref-type="aff" rid="af8-ijerph-11-11308">8</xref></contrib><contrib contrib-type="author"><name><surname>Arokiasamy</surname><given-names>Perianayagam</given-names></name><xref ref-type="aff" rid="af9-ijerph-11-11308">9</xref></contrib><contrib contrib-type="author"><name><surname>Snodgrass</surname><given-names>James J.</given-names></name><xref ref-type="aff" rid="af10-ijerph-11-11308">10</xref></contrib><contrib contrib-type="author"><name><surname>Chatterji</surname><given-names>Somnath</given-names></name><xref ref-type="aff" rid="af11-ijerph-11-11308">11</xref></contrib><contrib contrib-type="author"><name><surname>Engelstad</surname><given-names>Mark E.</given-names></name><xref ref-type="aff" rid="af12-ijerph-11-11308">12</xref></contrib><contrib contrib-type="author"><name><surname>Kowal</surname><given-names>Paul</given-names></name><xref ref-type="aff" rid="af11-ijerph-11-11308">11</xref><xref ref-type="aff" rid="af13-ijerph-11-11308">13</xref></contrib></contrib-group><contrib-group><contrib contrib-type="editor"><name><surname>de Abreu</surname><given-names>Mauro Henrique Nogueira Guimarães</given-names></name><role>External Editor</role></contrib></contrib-group><aff id="af1-ijerph-11-11308"><label>1</label>HIV/AIDS/STIs and TB (HAST), Human Sciences Research Council, Private Bag X41, Pretoria 0001, South Africa</aff><aff id="af2-ijerph-11-11308"><label>2</label>Department of Psychology, University of the Free State, Bloemfontein 9300, South Africa</aff><aff id="af3-ijerph-11-11308"><label>3</label>ASEAN Institute for Health Development, Madidol University, Salaya, Phutthamonthon, Nakhonpathom 73170, Thailand</aff><aff id="af4-ijerph-11-11308"><label>4</label>Department of Restorative Dentistry, University of Ghana Dental School, College of Health Sciences, Korle-Bu, Accra KB 460, Ghana; E-Mail:<email>sandrahewlett@yahoo.co.uk</email></aff><aff id="af5-ijerph-11-11308"><label>5</label>Department of Community Health, University of Ghana Medical School, College of Health Sciences, Korle-Bu, KB 4236, Accra, Ghana; E-Mail:<email>aeyawson@yahoo.com</email></aff><aff id="af6-ijerph-11-11308"><label>6</label>Institute of Health & Society, Centre for Oral Health Research, Newcastle University, Newcastle NE2 4BW, UK; E-Mail:<email>paula.moynihan@newcastle.ac.uk</email></aff><aff id="af7-ijerph-11-11308"><label>7</label>Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå SE-90187, Sweden; E-Mail:<email>raman.preet@epiph.umu.se</email></aff><aff id="af8-ijerph-11-11308"><label>8</label>Shanghai municipal Center for Disease Control and Prevention, No. 1380 West Zhongshan Rd, Changning District, Shanghai 200336, China; E-Mails:<email>fwu@scdc.sh.cn</email> (F.W.);<email>guoyanfei@scdc.sh.cn</email> (G.G.)</aff><aff id="af9-ijerph-11-11308"><label>9</label>International Institute for Population Studies, Mumbai, Maharashtra 400088, India; E-Mail:<email>parokiasamy@yahoo.co.uk</email></aff><aff id="af10-ijerph-11-11308"><label>10</label>Department of Anthropology, University of Oregon, Eugene, OR 97403, USA; E-Mail:<email>jjosh@uoregon.edu</email></aff><aff id="af11-ijerph-11-11308"><label>11</label>World Health Organization, SAGE, 1211 Geneva 27, Switzerland; E-Mails:<email>chatterjis@who.int</email> (S.C.);<email>kowalp@who.int</email> (P.K.)</aff><aff id="af12-ijerph-11-11308"><label>12</label>Department of Oral and Maxillofacial Surgery, Oregon Health and Science University, Portland OR 97201, USA; E-Mail:<email>engelsta@ohsu.edu</email></aff><aff id="af13-ijerph-11-11308"><label>13</label>University of Newcastle Research Centre for Gender, Health and Ageing, Newcastle, NSW 2305, Australia</aff><author-notes><fn id="fn1-ijerph-11-11308"><label>†</label><p>The SAGE Survey Group also contribute to this work, see acknowledgments.</p></fn><corresp id="c1-ijerph-11-11308"><label>*</label>Author to whom correspondence should be addressed; E-Mail: <email>karl.pel@mahidol.ac.th</email>; Tel.: +27-12-302-2000; Fax; +27-12-302-2601.</corresp></author-notes><pub-date pub-type="epub"><day>30</day><month>10</month><year>2014</year></pub-date><pub-date pub-type="ppub"><month>11</month><year>2014</year></pub-date><volume>11</volume><issue>11</issue><fpage>11308</fpage><lpage>11324</lpage><history><date date-type="received"><day>14</day><month>7</month><year>2014</year></date><date date-type="rev-recd"><day>08</day><month>10</month><year>2014</year></date><date date-type="accepted"><day>14</day><month>10</month><year>2014</year></date></history><permissions><copyright-statement>© 2014 by the authors; licensee MDPI, Basel, Switzerland.</copyright-statement><copyright-year>2014</copyright-year><license><license-p><pmc-comment>CREATIVE COMMONS</pmc-comment>This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution license (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">http://creativecommons.org/licenses/by/4.0/</ext-link>).</license-p></license></permissions><abstract><p>Little information exists about the loss of all one’s teeth (edentulism) among older adults in low- and middle-income countries. This study examines the prevalence of edentulism and associated factors among older adults in a cross-sectional study across six such countries. Data from the World Health Organization (WHO’s) Study on global AGEing and adult health (SAGE) Wave 1 was used for this study with adults aged 50-plus from China (<italic>N</italic> = 13,367), Ghana (<italic>N</italic> = 4724), India (<italic>N</italic> = 7150), Mexico (<italic>N</italic> = 2315), Russian Federation (<italic>N</italic> = 3938) and South Africa (<italic>N</italic> = 3840). Multivariate regression was used to assess predictors of edentulism. The overall prevalence of edentulism was 11.7% in the six countries, with India, Mexico, and Russia has higher prevalence rates (16.3%–21.7%) than China, Ghana, and South Africa (3.0%–9.0%). In multivariate logistic analysis sociodemographic factors (older age, lower education), chronic conditions (arthritis, asthma), health risk behaviour (former daily tobacco use, inadequate fruits and vegetable consumption) and other health related variables (functional disability and low social cohesion) were associated with edentulism. The national estimates and identified factors associated with edentulism among older adults across the six countries helps to identify areas for further exploration and targets for intervention.</p></abstract><kwd-group><kwd>edentulism</kwd><kwd>associated factors</kwd><kwd>China</kwd><kwd>Ghana</kwd><kwd>India</kwd><kwd>Mexico</kwd><kwd>Russia</kwd><kwd>South Africa</kwd></kwd-group></article-meta></front><body><sec><title>1. Introduction</title><p>Edentulism is the state of having lost all of one’s natural teeth [<xref rid="B1-ijerph-11-11308" ref-type="bibr">1</xref>]. Monitoring the occurrence of an oral “end state” such as edentulism is important because it is an indicator of both population health and the functioning and adequacy of a country's oral health care system [<xref rid="B2-ijerph-11-11308" ref-type="bibr">2</xref>]. The 2010 Global Burden of Disease Study results shows a steady decline in age-standardized population (Disability Adjusted Life Year) DALY rates for edentulism, from 144/100,000 in 1990 to 89/100,000 [<xref rid="B3-ijerph-11-11308" ref-type="bibr">3</xref>]. An even more recent review Kossioni [<xref rid="B4-ijerph-11-11308" ref-type="bibr">4</xref>] revealed that data on the oral health of community-dwelling (living in their own homes, not institutionalised) older people are scarce in many parts of the world, particularly in Africa, Asia and South America, and direct comparisons are not always possible due to methodological variations. Wu <italic>et al.</italic> [<xref rid="B5-ijerph-11-11308" ref-type="bibr">5</xref>] found a wide variation in edentulism prevalence among adults aged 50 and above in five ethnic groups in the United States: Asians, African Americans, Hispanics, Native Americans, and non-Hispanic Caucasians. In 2008, Native Americans had the highest predicated rate of edentulism based on oral exam (24%), followed by African Americans (19%), Caucasians (17%), Asians (14%), and Hispanics (14%). Dolan <italic>et al.</italic> [<xref rid="B6-ijerph-11-11308" ref-type="bibr">6</xref>] found that in persons 45 years and older in the USA that a total of 19% of subjects were edentulous by self-report, and Medina-Solís <italic>et al.</italic> [<xref rid="B7-ijerph-11-11308" ref-type="bibr">7</xref>] found that the prevalence of self-reported edentulism ranged from 2% in the 35–44 year age group to 26% in the 65–74 year age group in Mexico. Among Europeans, Müller <italic>et al.</italic> [<xref rid="B8-ijerph-11-11308" ref-type="bibr">8</xref>] observed in a review of clinical and cross-sectional interview studies that in the 1990s the prevalence of edentulism among 75-year-olds in a Swedish, Danish and Finnish city were 27%, 45% and 58% respectively. In 2003, Mojon [<xref rid="B9-ijerph-11-11308" ref-type="bibr">9</xref>] reports a range of 0% to 72% of the 65 to 74 year age group in Europe. The 2009 UK Adult Dental Health Survey self-reported that the percentage of adults who were edentulous was 5% for those aged 55–64 years and 15% for those aged 65–74 years [<xref rid="B10-ijerph-11-11308" ref-type="bibr">10</xref>].</p><p>Factors associated with edentulism include: (1) <underline>socioeconomic factors</underline> such as increasing age [<xref rid="B11-ijerph-11-11308" ref-type="bibr">11</xref>,<xref rid="B12-ijerph-11-11308" ref-type="bibr">12</xref>,<xref rid="B13-ijerph-11-11308" ref-type="bibr">13</xref>,<xref rid="B14-ijerph-11-11308" ref-type="bibr">14</xref>,<xref rid="B15-ijerph-11-11308" ref-type="bibr">15</xref>], being female [<xref rid="B12-ijerph-11-11308" ref-type="bibr">12</xref>,<xref rid="B13-ijerph-11-11308" ref-type="bibr">13</xref>,<xref rid="B16-ijerph-11-11308" ref-type="bibr">16</xref>], lower education [<xref rid="B14-ijerph-11-11308" ref-type="bibr">14</xref>,<xref rid="B17-ijerph-11-11308" ref-type="bibr">17</xref>], lower economic status [<xref rid="B6-ijerph-11-11308" ref-type="bibr">6</xref>,<xref rid="B12-ijerph-11-11308" ref-type="bibr">12</xref>,<xref rid="B16-ijerph-11-11308" ref-type="bibr">16</xref>,<xref rid="B17-ijerph-11-11308" ref-type="bibr">17</xref>,<xref rid="B18-ijerph-11-11308" ref-type="bibr">18</xref>], lower social class [<xref rid="B16-ijerph-11-11308" ref-type="bibr">16</xref>], health security [<xref rid="B11-ijerph-11-11308" ref-type="bibr">11</xref>], and rural residence [<xref rid="B19-ijerph-11-11308" ref-type="bibr">19</xref>]; (2) <underline>chronic conditions</underline> such as asthma [<xref rid="B20-ijerph-11-11308" ref-type="bibr">20</xref>], diabetes [<xref rid="B20-ijerph-11-11308" ref-type="bibr">20</xref>,<xref rid="B21-ijerph-11-11308" ref-type="bibr">21</xref>], arthritis [<xref rid="B20-ijerph-11-11308" ref-type="bibr">20</xref>], angina pectoris [<xref rid="B22-ijerph-11-11308" ref-type="bibr">22</xref>], stroke [<xref rid="B23-ijerph-11-11308" ref-type="bibr">23</xref>], hypertension [<xref rid="B24-ijerph-11-11308" ref-type="bibr">24</xref>] and obesity [<xref rid="B25-ijerph-11-11308" ref-type="bibr">25</xref>]; (3) <underline>health risk behaviour</underline> including smoking [<xref rid="B12-ijerph-11-11308" ref-type="bibr">12</xref>,<xref rid="B15-ijerph-11-11308" ref-type="bibr">15</xref>,<xref rid="B20-ijerph-11-11308" ref-type="bibr">20</xref>,<xref rid="B26-ijerph-11-11308" ref-type="bibr">26</xref>,<xref rid="B27-ijerph-11-11308" ref-type="bibr">27</xref>,<xref rid="B28-ijerph-11-11308" ref-type="bibr">28</xref>], former smoking [<xref rid="B15-ijerph-11-11308" ref-type="bibr">15</xref>,<xref rid="B26-ijerph-11-11308" ref-type="bibr">26</xref>], inadequate consumption of fruit and vegetables [<xref rid="B29-ijerph-11-11308" ref-type="bibr">29</xref>,<xref rid="B30-ijerph-11-11308" ref-type="bibr">30</xref>] and infrequent dental visits [<xref rid="B11-ijerph-11-11308" ref-type="bibr">11</xref>]; and, (4) <underline>other health-related factors</underline>, including functional disability [<xref rid="B31-ijerph-11-11308" ref-type="bibr">31</xref>], lower scores on cognitive testing [<xref rid="B32-ijerph-11-11308" ref-type="bibr">32</xref>,<xref rid="B33-ijerph-11-11308" ref-type="bibr">33</xref>], poorer self-rated level of general health [<xref rid="B6-ijerph-11-11308" ref-type="bibr">6</xref>], social cohesion [<xref rid="B16-ijerph-11-11308" ref-type="bibr">16</xref>,<xref rid="B34-ijerph-11-11308" ref-type="bibr">34</xref>], and self-esteem and quality of life [<xref rid="B33-ijerph-11-11308" ref-type="bibr">33</xref>,<xref rid="B35-ijerph-11-11308" ref-type="bibr">35</xref>,<xref rid="B36-ijerph-11-11308" ref-type="bibr">36</xref>]. Steele <italic>et al.</italic> [<xref rid="B37-ijerph-11-11308" ref-type="bibr">37</xref>] observed that social support is a determinant of oral health-related quality of life, and that psychosocial factors, such as loneliness and social isolation, were associated with onset of periodontal disease [<xref rid="B38-ijerph-11-11308" ref-type="bibr">38</xref>]. Social networks were associated with better self-rated oral health, and social capital had beneficial effects on the number of teeth [<xref rid="B39-ijerph-11-11308" ref-type="bibr">39</xref>]. </p><p>The aim of this study was to investigate the prevalence of edentulism and associated factors among older adults in six lower- and upper-middle income countries. The objectives include: (1) to estimate the prevalence of self-reported edentulism in older adults, and (2) to identify possible factors such as sociodemographics, chronic conditions, health risk behaviour and other health related variables associated edentulism in six lower- and upper-middle income countries.</p></sec><sec><title>2. Methods</title><sec><title>2.1. Sample and Procedure</title><p>Study on global AGEing and adult health (SAGE) is a longitudinal study of ageing, health and wellbeing with nationally representative cohorts of persons aged 50 years and older in China, Ghana, India, Mexico, the Russian Federation and South Africa, along with comparison samples of younger adults aged 18–49 years in each country [<xref rid="B40-ijerph-11-11308" ref-type="bibr">40</xref>]. Further information about the SAGE survey design and methods is available from a published data resource profile [<xref rid="B40-ijerph-11-11308" ref-type="bibr">40</xref>]. A broad range of health and health-related determinants and outcomes were measured as part of SAGE, including questions about oral health. SAGE Wave 1 was implemented as a face-to-face household interview between 2007 and 2010. All six countries implemented multistage cluster sampling strategies which resulted in nationally representative cohorts of older adults [<xref rid="B41-ijerph-11-11308" ref-type="bibr">41</xref>]. SAGE has been approved by the World Health Organization’s Ethical Review Board. Additionally, each partner organization obtained ethical clearance through their respective review bodies. Informed consent has been obtained from all study participants. The study complies with the STROBE statement.</p></sec><sec><title>2.2. Measures</title><p>A standardized survey instrument, including modules on health and its determinants, disability, risk factors, chronic conditions, anthropometric measurements (height, weight, waist and hip circumferences), blood pressure measures and cognition, were used across all six SAGE countries [<xref rid="B40-ijerph-11-11308" ref-type="bibr">40</xref>]. The procedures for including country-specific adaptations to the standardized questionnaire and translations into local languages from English follow those developed by and used for the World Health Survey [<xref rid="B42-ijerph-11-11308" ref-type="bibr">42</xref>]. The main outcome, edentulism, was assessed by self-report, “Have you lost all of your natural teeth?” Response options were “yes”and “no”. </p><p><underline>Sociodemographic covariates:</underline></p><p>Age, sex, years of education completed, place of residence (urban or rural), and economic status was obtained through self-report. Urban and rural categories were defined by each country based on census definitions. Economic status was estimated through wealth levels generated using a multi-step process, whereby asset ownership was converted to an asset ladder, Bayesian post-estimation method was used to generate raw continuous income estimates and these were then transformed into quintiles [<xref rid="B43-ijerph-11-11308" ref-type="bibr">43</xref>].</p><p><underline>Chronic conditions covariates:</underline></p><p>Blood pressure (systolic and diastolic) was measured three times on the right arm/wrist of the seated respondent using an automated recording device (OMRON R6 Wrist Blood Pressure Monitor, HEM-6000-E, Omron Healthcare Europe, B.V., Hoofddorp, and The Netherlands). Out of three measurements, the average of the last two readings was used. In accordance with the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, individuals with systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg and/or who reported the current use of antihypertensive medication were considered to be suffering from high blood pressure [<xref rid="B44-ijerph-11-11308" ref-type="bibr">44</xref>]. A further set of chronic conditions was assessed through self-report, with respondents asked if they had been diagnosed with a number of chronic conditions, including, angina, arthritis, asthma, and diabetes.</p><p><underline>Anthropometric Measurements:</underline></p><p>Participants were weighed and measured by trained researchers using standardised protocols [<xref rid="B40-ijerph-11-11308" ref-type="bibr">40</xref>]. Standing height was measured to the nearest 0.1 cm without shoes, using a stadiometer. Participants wearing light clothes, were weighed to the nearest 0.01 kg, on a load-cell-operated digital scale which was first calibrated using a standard weight and re-checked daily [<xref rid="B40-ijerph-11-11308" ref-type="bibr">40</xref>]. Body mass index (BMI) was calculated as weight in kg divided by height in metres squared. Participants underweight, normal eight, pre-obese and obesity were defined as ≤18.5, 18.5–24.9, ≥25.0–29.9 kg/m<sup>2</sup> and ≥30 kg/m<sup>2</sup>, respectively [<xref rid="B45-ijerph-11-11308" ref-type="bibr">45</xref>].</p><p><underline>Health risk behaviour covariates:</underline></p><p>Tobacco use. The first question asked ‘Have you ever smoked tobacco or used smokeless tobacco?’ Those who responded with “yes” were asked ‘Do you currently use (smoke, sniff or chew) any tobacco products such as cigarettes, cigars, pipes, chewing tobacco or snuff?’ The response options were ‘Yes, daily’, ‘Yes, but not daily’ and ‘No, not at all’. Everybody was asked, “In the past, did you ever smoke tobacco or use smokeless tobacco daily?” These questions are based on the STEPwise approach to surveillance (STEPS) of Non-Communicable Disease (NCD) risk factors [<xref rid="B46-ijerph-11-11308" ref-type="bibr">46</xref>].</p><p>Fruit and vegetable consumption was estimated by 24 h dietary recall using two questions ‘How many servings of fruit do you eat on a typical day?’ and ‘How many servings of vegetables do you eat on a typical day?’. Researchers were trained to show all respondents a nutrition risk factor card that indicates both in writing and pictorially general categories, amounts, and examples of fruit and vegetables in an attempt to standardize the serving size and number of servings reported. The nutrition card categorized one serving of vegetables into one of three groups: (a) one cup of raw green leafy vegetables such as spinach or salad; (b) one cup of other vegetables cooked or chopped raw, such as tomatoes, carrots, pumpkin, corn, Chinese cabbage, beans, or onions; and (c) one-half cup of vegetable juice. Furthermore, the nutrition card categorized one serving of fruit into one of three groups: (a) one medium-sized piece of fruit, such as an apple, banana, or orange; (b) one-half cup of cooked, chopped, or canned fruit; and (c) one-half cup of fruit juiced, not artificially flavored (4). Insufficient fruit and vegetable consumption was defined as less than five servings of fruits and/or vegetables a day [<xref rid="B47-ijerph-11-11308" ref-type="bibr">47</xref>]. </p><p><underline>Other health related risk covariates:</underline></p><p>Functional disability was measured by the 12-item WHO Disability Assessment Schedule, version 2.0 (WHODAS-2) [<xref rid="B48-ijerph-11-11308" ref-type="bibr">48</xref>]. Participants were asked about difficulties in the last 30 days with performing activity of daily living-type and instrumental activity of daily living-type questions. Responses to these questions were scored using a five-point Likert-type response scale: ‘none’, ‘mild’, ‘moderate’, ‘severe’ and ‘extreme/cannot do’. The computed WHODAS-2 score ranged from 0 to 48 and was later transformed into a score of 0–100 with 100 being severe or extreme disability [<xref rid="B48-ijerph-11-11308" ref-type="bibr">48</xref>]. WHODAS-2 subscales and summary indices were coded using the International Classification of Functioning, Disability and Health (ICF) disability categories [<xref rid="B49-ijerph-11-11308" ref-type="bibr">49</xref>], namely: No problem (0%–4%); Mild problem (5%–24%); Moderate problem (25%–49%); Severe problem (50%–95%); Extreme problem (95%–100%); and then dichotomised into ≥25% = 1 and <25% = 0 for analysis. Cronbach’s alpha for the WHODAS-2 was 0.92 in this sample.</p><p>Social cohesion was measured with nine items, starting with the introduction ‘How often in the last 12 months have you...’ e.g., attended any group, club, society, union, or organisational meeting?’ Response options ranged from never = 1 to daily = 5. The scores assigned to each of the items were ‘never’ (1), ‘once or twice a year’ (2), ‘once or twice per month’ (3), ‘once or twice per week’ (4), and ‘daily’ (5) were summed. These responses were used to create a single score and variable for overall social cohesion [<xref rid="B50-ijerph-11-11308" ref-type="bibr">50</xref>]. Cronbach’s alpha for this social cohesion index in this sample was 0.81.</p><p>Subjective overall general health status was assessed with one question: “In general, how would you rate your health today?” Response options ranged from 1 = very good to 5 = very bad. This was dichotomised into 1 = very good or good and 0 = moderate to very bad.</p><p>Cognitive functioning was assessed with one question, “Overall in the last 30 days, how much difficulty did you have with concentrating or remembering things?” Response options ranged from 1 = none to 5 = extreme or cannot do. Severe or extreme/cannot do is classified as poor cognitive functioning.</p></sec><sec><title>2.3. Data Analysis</title><p>Household-level and person-level analysis weights, based on the selection probability at each stage of sampling along with post stratification corrections, were applied to produce nationally representative cohorts [<xref rid="B40-ijerph-11-11308" ref-type="bibr">40</xref>]. Age and sex standardizations based on WHO’s World Standard Population [<xref rid="B51-ijerph-11-11308" ref-type="bibr">51</xref>] were carried out to adjust for between-country age and sex differences. The study population in this analysis consisted of adults aged 50-plus from China (<italic>N</italic> = 13,367), Ghana (<italic>N</italic> = 4724), India (<italic>N</italic> = 7150), Mexico (<italic>N</italic> = 2315), Russia (<italic>N</italic> = 3938) and South Africa (<italic>N</italic> = 3840). Computed estimates and odds ratios are reported with 95% confidence intervals and a two-side p-value of 0.05 used as the cut-off point for statistical significance. Associations between key outcomes of edentulism and sociodemographic, chronic conditions, health risk behaviour and other health related variables were evaluated by calculating odds ratios (OR). Unconditional multivariate logistic regression was used for evaluation of the association of explanatory variables for the outcome of edentulism (binary dependent variable). All variables statistically significant at the <italic>p</italic> < 0.05 levels in bivariate analyses were included in the multivariable model. In the analysis, weighted percentages are reported. The reported sample size refers to the sample that was asked the target question. Both the reported 95% confidence intervals and the <italic>p</italic> value are adjusted for the multi-stage stratified cluster sample design of the study. The data were analysed using STATA Version 11 (StataCorp, College Station, TX, USA, 2009).</p></sec></sec><sec><title>3. Results and Discussion</title><sec><title>3.1. Sample Characteristics</title><p>The overall sample included 34,138 persons 50 years and older from six countries, 52.1% women, 48.4% in the age group 50 to 59 years, 53.8% rural residence, and 29.9% had no and 29.4% had completed nine or more years of formal education. The overall prevalence of edentulism was 11.7%, with India, Mexico, and Russia have higher prevalence rates (16.3%–21.7%) than China, Ghana, and South Africa (3.0%–9.0%) (see <xref ref-type="table" rid="ijerph-11-11308-t001">Table 1</xref>).</p><table-wrap id="ijerph-11-11308-t001" position="float"><object-id pub-id-type="pii">ijerph-11-11308-t001_Table 1</object-id><label>Table 1</label><caption><p>Sample characteristics and prevalence rate of edentulism among older persons in China, Ghana, India, Mexico, Russia and South Africa, SAGE Wave 1.</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="center" valign="middle" rowspan="1" colspan="1"></th><th colspan="2" align="center" valign="middle" rowspan="1">Total Sample</th><th colspan="2" align="center" valign="middle" rowspan="1">Prevalence Rate of Edentulism</th></tr><tr style="border-top:solid thin"><th align="center" valign="middle" rowspan="1" colspan="1">Sociodemographics</th><th align="center" valign="middle" rowspan="1" colspan="1">N</th><th align="center" valign="middle" rowspan="1" colspan="1">%</th><th align="center" valign="middle" rowspan="1" colspan="1">N</th><th align="center" valign="middle" rowspan="1" colspan="1">95% CI</th></tr></thead><tbody><tr><td align="center" valign="middle" rowspan="1" colspan="1">All</td><td align="center" valign="middle" rowspan="1" colspan="1">35,334</td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1">4124</td><td align="center" valign="middle" rowspan="1" colspan="1">11.7 (10.7–12.8)</td></tr><tr style="border-top: solid thin"><td align="center" valign="middle" rowspan="1" colspan="1"><italic>Country</italic></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">China</td><td align="center" valign="middle" rowspan="1" colspan="1">13,367</td><td align="center" valign="middle" rowspan="1" colspan="1">37.8</td><td align="center" valign="middle" rowspan="1" colspan="1">1416</td><td align="center" valign="middle" rowspan="1" colspan="1">9.0 (8.0–9.0)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Ghana</td><td align="center" valign="middle" rowspan="1" colspan="1">4724</td><td align="center" valign="middle" rowspan="1" colspan="1">13.4</td><td align="center" valign="middle" rowspan="1" colspan="1">120</td><td align="center" valign="middle" rowspan="1" colspan="1">3.0 (2.3–3.6)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">India</td><td align="center" valign="middle" rowspan="1" colspan="1">7150</td><td align="center" valign="middle" rowspan="1" colspan="1">20.2</td><td align="center" valign="middle" rowspan="1" colspan="1">932</td><td align="center" valign="middle" rowspan="1" colspan="1">16.3 (14.3–18.4)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Mexico</td><td align="center" valign="middle" rowspan="1" colspan="1">2315</td><td align="center" valign="middle" rowspan="1" colspan="1">6.6</td><td align="center" valign="middle" rowspan="1" colspan="1">524</td><td align="center" valign="middle" rowspan="1" colspan="1">21.7 (15.5–27.8)</td></tr><tr style="border-top: solid thin"><td align="center" valign="middle" rowspan="1" colspan="1"><italic>Country</italic></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Russian Federation</td><td align="center" valign="middle" rowspan="1" colspan="1">3938</td><td align="center" valign="middle" rowspan="1" colspan="1">11.1</td><td align="center" valign="middle" rowspan="1" colspan="1">739</td><td align="center" valign="middle" rowspan="1" colspan="1">18.0 (13.7–22.3)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">South Africa</td><td align="center" valign="middle" rowspan="1" colspan="1">3840</td><td align="center" valign="middle" rowspan="1" colspan="1">10.9</td><td align="center" valign="middle" rowspan="1" colspan="1">369</td><td align="center" valign="middle" rowspan="1" colspan="1">8.5 (6.7–10.3)</td></tr><tr style="border-top: solid thin"><td align="center" valign="middle" rowspan="1" colspan="1"><italic>Gender</italic></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Female</td><td align="center" valign="middle" rowspan="1" colspan="1">19,145</td><td align="center" valign="middle" rowspan="1" colspan="1">52.1</td><td align="center" valign="middle" rowspan="1" colspan="1">2467</td><td align="center" valign="middle" rowspan="1" colspan="1">13.0 (11.8–14.1)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Male</td><td align="center" valign="middle" rowspan="1" colspan="1">16,180</td><td align="center" valign="middle" rowspan="1" colspan="1">47.9</td><td align="center" valign="middle" rowspan="1" colspan="1">1656</td><td align="center" valign="middle" rowspan="1" colspan="1">10.4 (9.1–11.7)</td></tr><tr style="border-top: solid thin"><td align="center" valign="middle" rowspan="1" colspan="1"><italic>Age</italic></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">50–59</td><td align="center" valign="middle" rowspan="1" colspan="1">14,471</td><td align="center" valign="middle" rowspan="1" colspan="1">46.4</td><td align="center" valign="middle" rowspan="1" colspan="1">751</td><td align="center" valign="middle" rowspan="1" colspan="1">4.9 (4.1–5.7)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">60–69</td><td align="center" valign="middle" rowspan="1" colspan="1">19,969</td><td align="center" valign="middle" rowspan="1" colspan="1">30.0</td><td align="center" valign="middle" rowspan="1" colspan="1">1142</td><td align="center" valign="middle" rowspan="1" colspan="1">10.8 (9.6–11.9)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">70–79</td><td align="center" valign="middle" rowspan="1" colspan="1">7320</td><td align="center" valign="middle" rowspan="1" colspan="1">18.2</td><td align="center" valign="middle" rowspan="1" colspan="1">1471</td><td align="center" valign="middle" rowspan="1" colspan="1">24.2 (21.7–26.8)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">80 and over</td><td align="center" valign="middle" rowspan="1" colspan="1">2574</td><td align="center" valign="middle" rowspan="1" colspan="1">5.4</td><td align="center" valign="middle" rowspan="1" colspan="1">760</td><td align="center" valign="middle" rowspan="1" colspan="1">37.3 (33.2–41.3)</td></tr><tr style="border-top: solid thin"><td align="center" valign="middle" rowspan="1" colspan="1"><italic>Educational Level</italic></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1">1395</td><td align="center" valign="middle" rowspan="1" colspan="1">17.8 (16.0–19.4)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">None</td><td align="center" valign="middle" rowspan="1" colspan="1">10,582</td><td align="center" valign="middle" rowspan="1" colspan="1">29.9</td><td align="center" valign="middle" rowspan="1" colspan="1">772</td><td align="center" valign="middle" rowspan="1" colspan="1">11.9 (10.3–13.4)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">1–4 years</td><td align="center" valign="middle" rowspan="1" colspan="1">4935</td><td align="center" valign="middle" rowspan="1" colspan="1">14.0</td><td align="center" valign="middle" rowspan="1" colspan="1">915</td><td align="center" valign="middle" rowspan="1" colspan="1">9.7 (7.9–11.4)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">5–8 years</td><td align="center" valign="middle" rowspan="1" colspan="1">7290</td><td align="center" valign="middle" rowspan="1" colspan="1">20.6</td><td align="center" valign="middle" rowspan="1" colspan="1">933</td><td align="center" valign="middle" rowspan="1" colspan="1">7.3 (6.0–8.6)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">9 or more years</td><td align="center" valign="middle" rowspan="1" colspan="1">10,397</td><td align="center" valign="middle" rowspan="1" colspan="1">29.4</td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Missing</td><td align="center" valign="middle" rowspan="1" colspan="1">2130</td><td align="center" valign="middle" rowspan="1" colspan="1">6.1</td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td></tr><tr style="border-top: solid thin"><td align="center" valign="middle" rowspan="1" colspan="1"><italic>Wealth <sup>1</sup></italic></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Lowest</td><td align="center" valign="middle" rowspan="1" colspan="1">6687</td><td align="center" valign="middle" rowspan="1" colspan="1">17.0</td><td align="center" valign="middle" rowspan="1" colspan="1">940</td><td align="center" valign="middle" rowspan="1" colspan="1">16.9 (14.8–19.0)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Low</td><td align="center" valign="middle" rowspan="1" colspan="1">6922</td><td align="center" valign="middle" rowspan="1" colspan="1">18.7</td><td align="center" valign="middle" rowspan="1" colspan="1">889</td><td align="center" valign="middle" rowspan="1" colspan="1">13.1 (11.2–15.0)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Medium</td><td align="center" valign="middle" rowspan="1" colspan="1">6905</td><td align="center" valign="middle" rowspan="1" colspan="1">19.6</td><td align="center" valign="middle" rowspan="1" colspan="1">844</td><td align="center" valign="middle" rowspan="1" colspan="1">12.3 (10.8–13.7)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">High</td><td align="center" valign="middle" rowspan="1" colspan="1">7238</td><td align="center" valign="middle" rowspan="1" colspan="1">21.8</td><td align="center" valign="middle" rowspan="1" colspan="1">743</td><td align="center" valign="middle" rowspan="1" colspan="1">9.4 (7.7–11.0)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Highest</td><td align="center" valign="middle" rowspan="1" colspan="1">7442</td><td align="center" valign="middle" rowspan="1" colspan="1">22.6</td><td align="center" valign="middle" rowspan="1" colspan="1">694</td><td align="center" valign="middle" rowspan="1" colspan="1">8.6 (7.2–10.0)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Missing</td><td align="center" valign="middle" rowspan="1" colspan="1">140</td><td align="center" valign="middle" rowspan="1" colspan="1">0.4</td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td></tr><tr style="border-top: solid thin"><td align="center" valign="middle" rowspan="1" colspan="1"><italic>Geolocality</italic></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Rural</td><td align="center" valign="middle" rowspan="1" colspan="1">17,725</td><td align="center" valign="middle" rowspan="1" colspan="1">53.8</td><td align="center" valign="middle" rowspan="1" colspan="1">1954</td><td align="center" valign="middle" rowspan="1" colspan="1">12.5 (11.3–13.7)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Urban</td><td align="center" valign="middle" rowspan="1" colspan="1">17,606</td><td align="center" valign="middle" rowspan="1" colspan="1">46.2</td><td align="center" valign="middle" rowspan="1" colspan="1">2169</td><td align="center" valign="middle" rowspan="1" colspan="1">10.7 (8.8–12.5)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Missing</td><td align="center" valign="middle" rowspan="1" colspan="1">3</td><td align="center" valign="middle" rowspan="1" colspan="1">0.0</td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td></tr><tr style="border-top: solid thin"><td align="center" valign="middle" rowspan="1" colspan="1"><bold>Chronic Conditions</bold></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td></tr><tr style="border-top: solid thin"><td align="center" valign="middle" rowspan="1" colspan="1">Angina</td><td align="center" valign="middle" rowspan="1" colspan="1">3157</td><td align="center" valign="middle" rowspan="1" colspan="1">8.8</td><td align="center" valign="middle" rowspan="1" colspan="1">626</td><td align="center" valign="middle" rowspan="1" colspan="1">16.9 (14.0–19.8)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Arthritis</td><td align="center" valign="middle" rowspan="1" colspan="1">7079</td><td align="center" valign="middle" rowspan="1" colspan="1">21.2</td><td align="center" valign="middle" rowspan="1" colspan="1">1189</td><td align="center" valign="middle" rowspan="1" colspan="1">14.9 (13.3–16.5)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Asthma</td><td align="center" valign="middle" rowspan="1" colspan="1">1302</td><td align="center" valign="middle" rowspan="1" colspan="1">3.5</td><td align="center" valign="middle" rowspan="1" colspan="1">243</td><td align="center" valign="middle" rowspan="1" colspan="1">23.0 (17.6–28.5)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Diabetes</td><td align="center" valign="middle" rowspan="1" colspan="1">2649</td><td align="center" valign="middle" rowspan="1" colspan="1">6.5</td><td align="center" valign="middle" rowspan="1" colspan="1">484</td><td align="center" valign="middle" rowspan="1" colspan="1">13.7 (10.9–16.5)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Hypertension</td><td align="center" valign="middle" rowspan="1" colspan="1">17,528</td><td align="center" valign="middle" rowspan="1" colspan="1">52.9</td><td align="center" valign="middle" rowspan="1" colspan="1">2241</td><td align="center" valign="middle" rowspan="1" colspan="1">12.7 (11.5–13.9)</td></tr><tr style="border-top: solid thin"><td align="center" valign="middle" rowspan="1" colspan="1"><bold>BMI</bold></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Normal</td><td align="center" valign="middle" rowspan="1" colspan="1">15,494</td><td align="center" valign="middle" rowspan="1" colspan="1">14.0</td><td align="center" valign="middle" rowspan="1" colspan="1">1735</td><td align="center" valign="middle" rowspan="1" colspan="1">11.1 (9.9–12.2)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Underweight</td><td align="center" valign="middle" rowspan="1" colspan="1">3637</td><td align="center" valign="middle" rowspan="1" colspan="1">53.7</td><td align="center" valign="middle" rowspan="1" colspan="1">541</td><td align="center" valign="middle" rowspan="1" colspan="1">19.0 (16.2–21.7)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Pre-Obese</td><td align="center" valign="middle" rowspan="1" colspan="1">8231</td><td align="center" valign="middle" rowspan="1" colspan="1">24.7</td><td align="center" valign="middle" rowspan="1" colspan="1">927</td><td align="center" valign="middle" rowspan="1" colspan="1">9.2 (8.0–10.3)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Obese</td><td align="center" valign="middle" rowspan="1" colspan="1">4759</td><td align="center" valign="middle" rowspan="1" colspan="1">7.7</td><td align="center" valign="middle" rowspan="1" colspan="1">658</td><td align="center" valign="middle" rowspan="1" colspan="1">11.3 (9.1–13.6)</td></tr><tr style="border-top: solid thin"><td align="center" valign="middle" rowspan="1" colspan="1"><bold>Health Risk Behaviour</bold></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Current daily tobacco use</td><td align="center" valign="middle" rowspan="1" colspan="1">8210</td><td align="center" valign="middle" rowspan="1" colspan="1">31.5</td><td align="center" valign="middle" rowspan="1" colspan="1">987</td><td align="center" valign="middle" rowspan="1" colspan="1">10.9 (9.4–12.4)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Past daily tobacco use</td><td align="center" valign="middle" rowspan="1" colspan="1">2899</td><td align="center" valign="middle" rowspan="1" colspan="1">8.1</td><td align="center" valign="middle" rowspan="1" colspan="1">437</td><td align="center" valign="middle" rowspan="1" colspan="1">15.7 (13.7–17.7)</td></tr><tr style="border-top: solid thin"><td align="center" valign="middle" rowspan="1" colspan="1"><bold>Health Risk Behaviour</bold></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Insufficient fruits and vegetables</td><td align="center" valign="middle" rowspan="1" colspan="1">16,820</td><td align="center" valign="middle" rowspan="1" colspan="1">38.0</td><td align="center" valign="middle" rowspan="1" colspan="1">2336</td><td align="center" valign="middle" rowspan="1" colspan="1">16.1 (14.2–18.0)</td></tr><tr style="border-top: solid thin"><td align="center" valign="middle" rowspan="1" colspan="1"><bold>Other Health Related Variables</bold></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Subjective health status (good/very good)</td><td align="center" valign="middle" rowspan="1" colspan="1">10,737</td><td align="center" valign="middle" rowspan="1" colspan="1">31.4</td><td align="center" valign="middle" rowspan="1" colspan="1">883</td><td align="center" valign="middle" rowspan="1" colspan="1">8.6 (7.0–10.2)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Poor cognitive functioning</td><td align="center" valign="middle" rowspan="1" colspan="1">2062</td><td align="center" valign="middle" rowspan="1" colspan="1">6.4</td><td align="center" valign="middle" rowspan="1" colspan="1">436</td><td align="center" valign="middle" rowspan="1" colspan="1">24.3 (20.7–28.0)</td></tr><tr style="border-top: solid thin"><td align="center" valign="middle" rowspan="1" colspan="1"><italic>Functional Disability</italic></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">None/Mild</td><td align="center" valign="middle" rowspan="1" colspan="1">25,553</td><td align="center" valign="middle" rowspan="1" colspan="1">79.4</td><td align="center" valign="middle" rowspan="1" colspan="1">2569</td><td align="center" valign="middle" rowspan="1" colspan="1">9.0 (8.1–10.0)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Moderate</td><td align="center" valign="middle" rowspan="1" colspan="1">5456</td><td align="center" valign="middle" rowspan="1" colspan="1">13.1</td><td align="center" valign="middle" rowspan="1" colspan="1">959</td><td align="center" valign="middle" rowspan="1" colspan="1">19.9 (17.3–22.5)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Severe/Extreme</td><td align="center" valign="middle" rowspan="1" colspan="1">1559</td><td align="center" valign="middle" rowspan="1" colspan="1">3.8</td><td align="center" valign="middle" rowspan="1" colspan="1">399</td><td align="center" valign="middle" rowspan="1" colspan="1">32.0 (27.2–36.7)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Missing</td><td align="center" valign="middle" rowspan="1" colspan="1">2766</td><td align="center" valign="middle" rowspan="1" colspan="1">3.7</td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1"><italic>Social Cohesion Index</italic></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Low</td><td align="center" valign="middle" rowspan="1" colspan="1">9030</td><td align="center" valign="middle" rowspan="1" colspan="1">39.2</td><td align="center" valign="middle" rowspan="1" colspan="1">1632</td><td align="center" valign="middle" rowspan="1" colspan="1">15.4 (13.7–17.1)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Medium</td><td align="center" valign="middle" rowspan="1" colspan="1">12,375</td><td align="center" valign="middle" rowspan="1" colspan="1">44.5</td><td align="center" valign="middle" rowspan="1" colspan="1">1448</td><td align="center" valign="middle" rowspan="1" colspan="1">10.0 (8.9–11.1)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">High</td><td align="center" valign="middle" rowspan="1" colspan="1">12,065</td><td align="center" valign="middle" rowspan="1" colspan="1">24.9</td><td align="center" valign="middle" rowspan="1" colspan="1">1027</td><td align="center" valign="middle" rowspan="1" colspan="1">10.4 (8.8–12.0)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Missing</td><td align="center" valign="middle" rowspan="1" colspan="1">1867</td><td align="center" valign="middle" rowspan="1" colspan="1">1.4</td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td></tr></tbody></table><table-wrap-foot><fn><p><sup>1</sup> Lowest wealth quintile indicates relative economic disadvantage and highest indicates a relative economic advantage. </p></fn></table-wrap-foot></table-wrap></sec><sec><title>3.2. Association between Socioeconomic and Health Variables and Edentulism</title><p>In bivariate analysis, sociodemographic factors (female sex, older age, lower education, lower wealth), chronic conditions (hypertension, angina, arthritis, asthma), BMI underweight, health risk behaviour (former daily tobacco use, inadequate fruits and vegetable consumption) and other health related variables (poor cognitive functioning, poor subjective health status, functional disability and low social cohesion) were found to be associated with edentulism. In multivariate analysis sociodemographic factors (older age, lower education), chronic conditions (arthritis, asthma), health risk behaviour (former daily tobacco use, inadequate fruits and vegetable consumption) and other health related variables (functional disability and low social cohesion) were associated with edentulism (see <xref ref-type="table" rid="ijerph-11-11308-t002">Table 2</xref>).</p><table-wrap id="ijerph-11-11308-t002" position="float"><object-id pub-id-type="pii">ijerph-11-11308-t002_Table 2</object-id><label>Table 2</label><caption><p>Odds ratios for likelihood of edentulism by selected background characteristics and health variables, SAGE Wave 1+.</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="center" valign="middle" rowspan="1" colspan="1"></th><th align="center" valign="middle" rowspan="1" colspan="1">Unadjusted Odds Ratio (95% CI)</th><th align="center" valign="middle" rowspan="1" colspan="1">Adjusted Odds Ratio (95% CI)</th></tr></thead><tbody><tr><td align="center" valign="middle" rowspan="1" colspan="1"><bold>Sociodemographics</bold></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td></tr><tr style="border-top: solid thin"><td align="center" valign="middle" rowspan="1" colspan="1"><italic>Gender</italic></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Female</td><td align="center" valign="middle" rowspan="1" colspan="1">1.00</td><td align="center" valign="middle" rowspan="1" colspan="1">1.00</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Male</td><td align="center" valign="middle" rowspan="1" colspan="1">0.78 (0.68–0.89) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">0.96 (0.81–1.13)</td></tr><tr style="border-top: solid thin"><td align="center" valign="middle" rowspan="1" colspan="1"><italic>Age in Years</italic></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">50–59</td><td align="center" valign="middle" rowspan="1" colspan="1">1.00</td><td align="center" valign="middle" rowspan="1" colspan="1">1.00</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">60–69</td><td align="center" valign="middle" rowspan="1" colspan="1">2.33 (2.02–2.74) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">1.98 (1.69–2.31) ***</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">70–79</td><td align="center" valign="middle" rowspan="1" colspan="1">6.22 (5.17–7.47) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">4.78 (4.01–5.71) ***</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">80 and over</td><td align="center" valign="middle" rowspan="1" colspan="1">11.55 (9.06–14.72) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">7.26 (5.74–9.20) ***</td></tr><tr style="border-top: solid thin"><td align="center" valign="middle" rowspan="1" colspan="1"><italic>Educational Level</italic></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">None</td><td align="center" valign="middle" rowspan="1" colspan="1">1.00</td><td align="center" valign="middle" rowspan="1" colspan="1">1.00</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">1–4 years</td><td align="center" valign="middle" rowspan="1" colspan="1">0.63 (0.54–0.73) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">0.87 (0.72–1.04)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">5–8 years</td><td align="center" valign="middle" rowspan="1" colspan="1">0.50 (0.41–0.62) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">0.81 (0.67–0.99) *</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">9 or more years</td><td align="center" valign="middle" rowspan="1" colspan="1">0.37 (0.30–0.45) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">0.74 (0.60–0.91) **</td></tr><tr style="border-top: solid thin"><td align="center" valign="middle" rowspan="1" colspan="1"><italic>Wealth</italic></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Lowest</td><td align="center" valign="middle" rowspan="1" colspan="1">1.00</td><td align="center" valign="middle" rowspan="1" colspan="1">1.00</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Low</td><td align="center" valign="middle" rowspan="1" colspan="1">0.74 (0.62–0.90) **</td><td align="center" valign="middle" rowspan="1" colspan="1">0.95 (0.80–1.13)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Medium</td><td align="center" valign="middle" rowspan="1" colspan="1">0.69 (0.58–0.82) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">1.03 (0.87–1.23)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">High</td><td align="center" valign="middle" rowspan="1" colspan="1">0.51 (0.41–0.63) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">0.89 (0.71–1.12)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Highest</td><td align="center" valign="middle" rowspan="1" colspan="1">0.46 (0.37–0.57) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">0.85 (0.68–1.06)</td></tr><tr style="border-top: solid thin"><td align="center" valign="middle" rowspan="1" colspan="1"><bold>Sociodemographics</bold></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td></tr><tr style="border-top: solid thin"><td align="center" valign="middle" rowspan="1" colspan="1"><italic>Geolocality</italic></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Rural</td><td align="center" valign="middle" rowspan="1" colspan="1">1.00</td><td align="center" valign="middle" rowspan="1" colspan="1"></td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Urban</td><td align="center" valign="middle" rowspan="1" colspan="1">0.83 (0.67–1.04)</td><td align="center" valign="middle" rowspan="1" colspan="1">---</td></tr><tr style="border-top: solid thin"><td align="center" valign="middle" rowspan="1" colspan="1"><bold>Chronic Conditions</bold></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Angina</td><td align="center" valign="middle" rowspan="1" colspan="1">1.62 (1.30–2.02) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">1.20 (0.96–1.51)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Arthritis</td><td align="center" valign="middle" rowspan="1" colspan="1">1.43 (1.24–1.65) **</td><td align="center" valign="middle" rowspan="1" colspan="1">1.23 (1.06–1.43) **</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Asthma</td><td align="center" valign="middle" rowspan="1" colspan="1">2.35 (1.74–3.18) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">1.63 (1.14–2.33) **</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Diabetes</td><td align="center" valign="middle" rowspan="1" colspan="1">1.21 (0.96–1.54)</td><td align="center" valign="middle" rowspan="1" colspan="1">---</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Hypertension</td><td align="center" valign="middle" rowspan="1" colspan="1">1.17 (1.01–1.37) *</td><td align="center" valign="middle" rowspan="1" colspan="1">1.07 (0.93–1.23)</td></tr><tr style="border-top: solid thin"><td align="center" valign="middle" rowspan="1" colspan="1"><bold>BMI</bold></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Normal</td><td align="center" valign="middle" rowspan="1" colspan="1">1.00</td><td align="center" valign="middle" rowspan="1" colspan="1">1.00</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Underweight</td><td align="center" valign="middle" rowspan="1" colspan="1">1.88 (1.56–2.27) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">1.19 (0.99–1.44)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Pre-Obese</td><td align="center" valign="middle" rowspan="1" colspan="1">0.81 (0.79–0.94) **</td><td align="center" valign="middle" rowspan="1" colspan="1">0.91 (0.78–1.06)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Obese</td><td align="center" valign="middle" rowspan="1" colspan="1">1.03 (0.82–1.29)</td><td align="center" valign="middle" rowspan="1" colspan="1">0.96 (0.75–1.22)</td></tr><tr style="border-top: solid thin"><td align="center" valign="middle" rowspan="1" colspan="1"><bold>Health Risk Behaviour</bold></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Current daily tobacco use</td><td align="center" valign="middle" rowspan="1" colspan="1">0.89 (0.78–1.02)</td><td align="center" valign="middle" rowspan="1" colspan="1">---</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Past daily tobacco use</td><td align="center" valign="middle" rowspan="1" colspan="1">1.45 (1.23–1.72) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">1.38 (1.09–1.74) **</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Insufficient fruits and vegetables</td><td align="center" valign="middle" rowspan="1" colspan="1">1.97 (1.63–2.37) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">1.37 (1.10–1.72) ***</td></tr><tr style="border-top: solid thin"><td align="center" valign="middle" rowspan="1" colspan="1"><bold>Other Health Related Variables</bold></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Subjective health status: (very) good</td><td align="center" valign="middle" rowspan="1" colspan="1">0.63 (0.51–0.76) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">1.11 (0.91–1.37)</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Poor cognitive functioning</td><td align="center" valign="middle" rowspan="1" colspan="1">2.65 (2.11–3.32) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">1.16 (0.89–1.51)</td></tr><tr style="border-top: solid thin"><td align="center" valign="middle" rowspan="1" colspan="1"><italic>Functional Disability</italic></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">None/Mild</td><td align="center" valign="middle" rowspan="1" colspan="1">1.00</td><td align="center" valign="middle" rowspan="1" colspan="1">1.00</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Moderate</td><td align="center" valign="middle" rowspan="1" colspan="1">2.50 (2.12–7.94) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">1.22 (1.02–1.46) *</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Severe/extreme</td><td align="center" valign="middle" rowspan="1" colspan="1">4.72 (3.72–6.00) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">1.51 (1.11–2.05) **</td></tr><tr style="border-top: solid thin"><td align="center" valign="middle" rowspan="1" colspan="1"><italic>Social Cohesion Index</italic></td><td align="center" valign="middle" rowspan="1" colspan="1"></td><td align="center" valign="middle" rowspan="1" colspan="1"></td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Low</td><td align="center" valign="middle" rowspan="1" colspan="1">1.00</td><td align="center" valign="middle" rowspan="1" colspan="1">1.00</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">Medium</td><td align="center" valign="middle" rowspan="1" colspan="1">0.61 (0.53–0.71) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">0.82 (0.70–0.95) *</td></tr><tr><td align="center" valign="middle" rowspan="1" colspan="1">High</td><td align="center" valign="middle" rowspan="1" colspan="1">0.64 (0.53–0.78) ***</td><td align="center" valign="middle" rowspan="1" colspan="1">0.92 (0.76–1.11)</td></tr></tbody></table><table-wrap-foot><fn><p>*** <italic>p</italic> < 0.001; ** <italic>p</italic> < 0.01; * <italic>p</italic> < 0.5.</p></fn></table-wrap-foot></table-wrap><p>The study found that the prevalence of edentulism in the six study middle income countries seemed lower than in comparable studies in the USA [<xref rid="B5-ijerph-11-11308" ref-type="bibr">5</xref>,<xref rid="B6-ijerph-11-11308" ref-type="bibr">6</xref>]. One may need to consider that rates in the US were based on oral exams, while in this study, they were by self-report, which may overestimate the prevalence. There was, however, a wide country variation with high prevalence in Mexico, Russia and India and low prevalence of edentulism in Ghana, South Africa and China. This relatively lower prevalence in Africa is consistent with other studies conducted in other African countries [<xref rid="B52-ijerph-11-11308" ref-type="bibr">52</xref>,<xref rid="B53-ijerph-11-11308" ref-type="bibr">53</xref>]. Some authors believe this difference in tooth loss patterns may reflect the fact that African populations tend in general to have much less dental caries [<xref rid="B54-ijerph-11-11308" ref-type="bibr">54</xref>] due to lower consumption of free sugars compared with industrialised nations such as the US. Thorpe [<xref rid="B54-ijerph-11-11308" ref-type="bibr">54</xref>], however, argues that levels of edentulism may be artificially low in developing countries due to a shorter life expectancy and thus a much lower percentage of the old and very old population. </p><p>In agreement with other studies [<xref rid="B11-ijerph-11-11308" ref-type="bibr">11</xref>,<xref rid="B12-ijerph-11-11308" ref-type="bibr">12</xref>,<xref rid="B13-ijerph-11-11308" ref-type="bibr">13</xref>,<xref rid="B14-ijerph-11-11308" ref-type="bibr">14</xref>,<xref rid="B15-ijerph-11-11308" ref-type="bibr">15</xref>,<xref rid="B17-ijerph-11-11308" ref-type="bibr">17</xref>], this study found that socioeconomic factors (older age and lower education) were associated with edentulism. Other socioeconomic factors (being female and lower wealth status) were in this study in bivariate analysis associated with edentulism, as found in other studies [<xref rid="B6-ijerph-11-11308" ref-type="bibr">6</xref>,<xref rid="B12-ijerph-11-11308" ref-type="bibr">12</xref>,<xref rid="B13-ijerph-11-11308" ref-type="bibr">13</xref>,<xref rid="B17-ijerph-11-11308" ref-type="bibr">17</xref>,<xref rid="B18-ijerph-11-11308" ref-type="bibr">18</xref>]. The role of sex in edentulism has been suggested to be both social and biological. The differences may be related to better dental attendance patterns and dental health behaviour and not just disease occurrence alone. Haikola <italic>et al.</italic> [<xref rid="B55-ijerph-11-11308" ref-type="bibr">55</xref>] believe that women might appreciate dental, oral and facial appearance more than men and therefore be a motivating factor for attending the clinic. </p><p>Regarding chronic conditions, this study found that having asthma and arthritis were associated with edentulism, as found in some previous studies [<xref rid="B20-ijerph-11-11308" ref-type="bibr">20</xref>]. In bivariate analysis, also angina and hypertension were found to be associated with edentulism, as also found in Mexico [<xref rid="B22-ijerph-11-11308" ref-type="bibr">22</xref>] and South Africa [<xref rid="B24-ijerph-11-11308" ref-type="bibr">24</xref>]. Several other clinical studies have suggested a possible association between rheumatoid arthritis and periodontitis and tooth loss [<xref rid="B56-ijerph-11-11308" ref-type="bibr">56</xref>]. This association between rheumatoid arthritis and edentulism has been attributed to the shared environmental or genetic risk factors that result in a similar pathobiology. Periodontal disease pathobiology might contribute to the development of rheumatoid arthritis or vice versa [<xref rid="B57-ijerph-11-11308" ref-type="bibr">57</xref>]. Han <italic>et al.</italic> [<xref rid="B58-ijerph-11-11308" ref-type="bibr">58</xref>] have attributed the increased tooth loss among asthmatics to the inhalation of corticosteroids, resulting in a reduced bone mineral density.</p><p>Hypertension and poor cognitive function and being underweight showed no association with edentulism though there was an association in the bivariate analysis diabetes, however, showed no association with edentulism though other studies have reported an association. Dietary factors have been implicated in the etiology of cognitive decline and dementia [<xref rid="B59-ijerph-11-11308" ref-type="bibr">59</xref>], diabetes, and cardiovascular disease. And dental health is an important determinant of nutritional status, body mass index (BMI), and general health in older people [<xref rid="B60-ijerph-11-11308" ref-type="bibr">60</xref>,<xref rid="B61-ijerph-11-11308" ref-type="bibr">61</xref>]. Some studies have observed that edentulism causes individuals to alter their diet, resorting to a diet that is low in fiber and high in saturated fat [<xref rid="B62-ijerph-11-11308" ref-type="bibr">62</xref>], putting them at a higher risk of being obese and developing these noncommunicable disease. Lee <italic>et al.</italic> [<xref rid="B63-ijerph-11-11308" ref-type="bibr">63</xref>] demonstrated that edentulism was associated with a weight gain of >5% in one year. In this study however, we found the reverse with edentulous individuals being more underweight rather than overweight. Thus, though hypertension, angina, and diabetes have been associated with tooth loss in other studies mainly in developing countries it wasn’t so in these middle income countries and may be attributed to dietary factors. The diet and dietary habits of edentulous individuals in these middle income countries may not be putting them at more risk of these heart diseases, diabetes or dementia. Furthermore the role of socioeconomic factors influencing this association cannot be ignored, with dietary habits among edentulous individuals may thus have to be assessed further as their diet may not be one of high risk for cardiovascular disease as compared to other studies. Alternatively, this study utilized a self report of diagnosed chronic conditions, this finding could be because there is a high prevalence of undiagnosed hypertension and diabetes in most of these middle income countries accounting for this finding.</p><p>Among health risk behaviours former smoking and inadequate fruits and vegetable consumption, as found in previous studies [<xref rid="B15-ijerph-11-11308" ref-type="bibr">15</xref>,<xref rid="B26-ijerph-11-11308" ref-type="bibr">26</xref>,<xref rid="B29-ijerph-11-11308" ref-type="bibr">29</xref>,<xref rid="B30-ijerph-11-11308" ref-type="bibr">30</xref>], were associated with edentulism. In this study only former smoking and not current smoking was associated with edentulism. It is possible that former smokers were heavier smokers than current smokers increasing the effect on tooth loss, as also found in some other studies [<xref rid="B15-ijerph-11-11308" ref-type="bibr">15</xref>,<xref rid="B26-ijerph-11-11308" ref-type="bibr">26</xref>]. In India, Reddy <italic>et al.</italic> [<xref rid="B64-ijerph-11-11308" ref-type="bibr">64</xref>] found that a mixed diet population had a higher level of edentulism compared with vegetarians. Edentulous individuals also were observed to be consuming inadequate amounts of fruits and vegetables necessary to provide adequate nutritional intake to maintain good health. Josipura <italic>et al.</italic> [<xref rid="B65-ijerph-11-11308" ref-type="bibr">65</xref>] noted a similar observation when they demonstrated that, compared to dentate individuals, edentulous respondents consumed fewer vegetables, less fibre, and less carotene intake, while consuming more cholesterol and saturated fats. This finding may thus predispose these edentulous individuals with chronic diseases. However, it cannot be assumed that low intake of fruits and vegetables in the edentulous is a result of the limited masticatory function. A high intake of fruits and vegetables has been shown to be associated with lower risk of periodontal disease, a major cause of tooth loss [<xref rid="B66-ijerph-11-11308" ref-type="bibr">66</xref>], which may mean that a low intake of fruits and vegetables may be an indirect cause edentulism. Dietary sugars are the most important factor in the development of dental caries, a major cause of tooth loss. In this study, it was not possible to explore whether intake of free sugars was associated with edentulism as the limited dietary data did not include information on sugar intake. </p><p>Consistent with another study [<xref rid="B31-ijerph-11-11308" ref-type="bibr">31</xref>], functional disability was in this study found to be associated with edentulism. It has been demonstrated that having fewer than 10 contacting pairs of upper and lower teeth yield impaired masticatory efficiency and are likely to result in a reduction in reported masticatory ability [<xref rid="B67-ijerph-11-11308" ref-type="bibr">67</xref>]. Unlike in some other studies [<xref rid="B32-ijerph-11-11308" ref-type="bibr">32</xref>,<xref rid="B33-ijerph-11-11308" ref-type="bibr">33</xref>], this study did not find poor cognitive functioning to be associated with edentulism. However, this study observed a significant association with functional disability, similar to a study by Avlund <italic>et al.</italic> [<xref rid="B68-ijerph-11-11308" ref-type="bibr">68</xref>]. Functional disability may pose a challenge with carrying out proper oral hygiene practices and with access to receiving dental care, thus predisposing them to dental disease and tooth loss. </p><p>Individuals belonging to social networks are more likely to follow health-enhancing behaviours and to have higher self-esteem and, hence, have better health [<xref rid="B34-ijerph-11-11308" ref-type="bibr">34</xref>]. In adults, social support has been observed to be a determinant of oral health-related quality of life [<xref rid="B37-ijerph-11-11308" ref-type="bibr">37</xref>] and psychosocial factors, such as loneliness and social isolation, were associated with onset of periodontal disease [<xref rid="B38-ijerph-11-11308" ref-type="bibr">38</xref>]. Social networks are also associated with better self-rated oral health, and social capital had beneficial effects on the number of teeth [<xref rid="B39-ijerph-11-11308" ref-type="bibr">39</xref>]. Poorer social support was found to be associated with having fewer functioning teeth, worse dental behaviours, and more periodontal attachment loss [<xref rid="B68-ijerph-11-11308" ref-type="bibr">68</xref>]. </p><p>The ageing population is increasing globally—one in nine persons worldwide are aged 60 years and over and it is predicted that by 2050 this will increase to one in five people in developing countries [<xref rid="B69-ijerph-11-11308" ref-type="bibr">69</xref>]. This, coupled with the observed levels of edentulism in middle income countries suggests that edentulism and its impact on health and wellbeing will remain a significant health challenge to these nations.</p></sec><sec><title>3.3. Study Limitations</title><p>This study had several limitations. Firstly, the questionnaire was interviewer-administered, it is possible that some study participants may have mis-reported either intentionally or inadvertently on any of the questions asked. Intentional miss-reporting was probably minimised by the fact that study participants completed the questionnaires anonymously. Edentulism was only assessed with a single question. Oral examinations assessing the number of teeth and saliva flow [<xref rid="B35-ijerph-11-11308" ref-type="bibr">35</xref>] are important in future studies. In addition, some other measures relied on a single question, such as subjective health and cognitive functioning, which have its limitations. Furthermore, this study was based on data collected in a cross sectional survey. We cannot, therefore, ascribe causality to any of the associated factors in the study. Finally, the analysis was limited to the variables included in SAGE, and other factors such as undernutrition (e.g., inadequate percentage body fat), inadequate oral hygiene and sugar intake [<xref rid="B29-ijerph-11-11308" ref-type="bibr">29</xref>,<xref rid="B70-ijerph-11-11308" ref-type="bibr">70</xref>] found significant in previous studies should be included in future research.</p></sec></sec><sec><title>4. Conclusions</title><p>The national estimates and identified risk factors of edentulism among older adults across the six countries can help policy makers and public-health researchers to understand the importance of edentulism and it overall impact on the health of elderly. This study can help to advance the need for health programmes focusing on elderly that are also inclusive of oral health promotion and prevention.</p></sec></body><back><ack><title>Acknowledgements</title><p>The SAGE Survey Group also contribute to this work. The SAGE Collaborators can be seen below: George P. Mensah, Department of Community Health, University of Ghana Medical School; Jiang Yong, National Center for Chronic and Noncommunicable Disease Control and Prevention, China Center for Disease Control and Prevention, Beijing, China; Zheng Yang, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China; Sulabha Parasuraman, Hemkhothang Lhungdim, T.V. Sekher, International Institute for Population Sciences, Mumbai, India; Rosalba Rosa, National Institute of Public Health, Cuernavaca, Mexico; Vitaly Belov and Natalia Lushkina, National Research Institute of Public Health (FSBI, RAMS) Moscow, Russian Federation; Monde Makiwane, Khangelani Zuma, Shandir Ramlagan, Adlai Davids, Ntombizodwa Mbelle and Gladys Matseke, Human Sciences Research Council, Pretoria, South Africa; Margie Schneider, independent consultant, Johannesburg, South Africa; Cily Tabane, University of the Witwatersrand, Johannesburg, South Africa. </p><p>We thank the respondents in each country for their continued contributions. We acknowledge the expertise and contributions of the country Primary Investigators and their respective survey teams. The Study on global AGEing and adult health (SAGE) is supported by the US National Institute on Aging’s Division of Behavioral and Social Research (BSR) through Interagency Agreements with WHO (OGHA 04034785; YA1323-08-CN-0020; Y1-AG-1005-01) and grant R01AG034479. The National Institute on Aging's Division of Behavioral and Social Research, under the directorship of Dr Richard Suzman, has been instrumental in providing continuous intellectual and other technical support to SAGE. Financial and/or in-kind support has come from the governments of China and South Africa (National Department of Health) to their respective national studies. The Shanghai CDC contributed financial and in-kind support for SAGE China. WHO provided salary support for members of the WHO SAGE team.</p></ack><notes><title>Author Contributions</title><p>Karl Peltzer, Somnath Chatterji and Paul Kowal designed the study, all other authors participated in data collection or writing and approving the final manuscript.</p></notes><notes><title>Conflicts of Interest</title><p>The authors declare no conflict of interest.</p></notes><ref-list><title>References</title><ref id="B1-ijerph-11-11308"><label>1.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Sussex</surname><given-names>P.V.</given-names></name></person-group><article-title>Edentulism from a New Zealand perspective—A review of the literature</article-title><source>N. Z. Dental J.</source><year>2008</year><volume>104</volume><fpage>84</fpage><lpage>96</lpage></element-citation></ref><ref id="B2-ijerph-11-11308"><label>2.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Thomson</surname><given-names>W.M.</given-names></name></person-group><article-title>Monitoring edentulism in older New Zealand adults over two decades: A review and commentary</article-title><source>Int. J. Dent.</source><year>2012</year><volume>2012</volume><pub-id pub-id-type="doi">10.1155/2012/375407</pub-id></element-citation></ref><ref id="B3-ijerph-11-11308"><label>3.</label><element-citation publication-type="book"><person-group person-group-type="author"><collab>Institute for Health Metrics and Evaluation (IHME)</collab></person-group><source>The Global Burden of Disease: Generating Evidence, Guiding Policy</source><publisher-name>University of Washington</publisher-name><publisher-loc>Seattle, WA, USA</publisher-loc><year>2013</year></element-citation></ref><ref id="B4-ijerph-11-11308"><label>4.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kossioni</surname><given-names>A.E.</given-names></name></person-group><article-title>Current status and trends in oral health in community dwelling older adults: A global perspective</article-title><source>Oral Health Prev. Dent.</source><year>2013</year><volume>11</volume><fpage>331</fpage><lpage>340</lpage><pub-id pub-id-type="pmid">23878840</pub-id></element-citation></ref><ref id="B5-ijerph-11-11308"><label>5.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Wu</surname><given-names>B.</given-names></name><name><surname>Liang</surname><given-names>J.</given-names></name><name><surname>Plassman</surname><given-names>B.L.</given-names></name><name><surname>Remle</surname><given-names>C.</given-names></name><name><surname>Luo</surname><given-names>X.</given-names></name></person-group><article-title>Edentulism trends among middle-aged and older adults in the United States: Comparison of five racial/ethnic groups</article-title><source>Community Dent. Oral Epidemiol.</source><year>2012</year><volume>40</volume><fpage>145</fpage><lpage>153</lpage><pub-id pub-id-type="doi">10.1111/j.1600-0528.2011.00640.x</pub-id><pub-id pub-id-type="pmid">21974715</pub-id></element-citation></ref><ref id="B6-ijerph-11-11308"><label>6.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Dolan</surname><given-names>T.A.</given-names></name><name><surname>Gilbert</surname><given-names>G.H.</given-names></name><name><surname>Duncan</surname><given-names>R.P.</given-names></name><name><surname>Foerster</surname><given-names>U.</given-names></name></person-group><article-title>Risk indicators of edentulism, partial tooth loss and prosthetic status among black and white middle-aged and older adults</article-title><source>Community Dent. Oral Epidemiol.</source><year>2001</year><volume>29</volume><fpage>329</fpage><lpage>340</lpage><pub-id pub-id-type="doi">10.1034/j.1600-0528.2001.290502.x</pub-id><pub-id pub-id-type="pmid">11553105</pub-id></element-citation></ref><ref id="B7-ijerph-11-11308"><label>7.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Medina-Solís</surname><given-names>C.E.</given-names></name><name><surname>Pérez-Núñez</surname><given-names>R.</given-names></name><name><surname>Maupomé</surname><given-names>G.</given-names></name><name><surname>Avila-Burgos</surname><given-names>L.</given-names></name><name><surname>Pontigo-Loyola</surname><given-names>A.P.</given-names></name><name><surname>Patiño-Marín</surname><given-names>N.</given-names></name><name><surname>Villalobos-Rodelo</surname><given-names>J.J.</given-names></name></person-group><article-title>National survey on edentulism and its geographic distribution, among Mexicans 18 years of age and older (with emphasis in WHO age groups)</article-title><source>J. Oral Rehabil.</source><year>2008</year><volume>35</volume><fpage>237</fpage><lpage>244</lpage><pub-id pub-id-type="doi">10.1111/j.1365-2842.2007.01767.x</pub-id><pub-id pub-id-type="pmid">18321258</pub-id></element-citation></ref><ref id="B8-ijerph-11-11308"><label>8.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Müller</surname><given-names>F.</given-names></name><name><surname>Naharro</surname><given-names>M.</given-names></name><name><surname>Carlsson</surname><given-names>G.E.</given-names></name></person-group><article-title>What are the prevalence and incidence of tooth loss in the adult and elderly population in Europe?</article-title><source>Clin. Oral Implant. Res.</source><year>2007</year><volume>18</volume><fpage>2</fpage><lpage>14</lpage><pub-id pub-id-type="doi">10.1111/j.1600-0501.2007.01459.x</pub-id></element-citation></ref><ref id="B9-ijerph-11-11308"><label>9.</label><element-citation publication-type="book"><person-group person-group-type="author"><name><surname>Mojon</surname><given-names>P.</given-names></name></person-group><article-title>The world without teeth: Demographic trends</article-title><source>Implant Overdentures: The Standard of Care for Edentulous Patients</source><person-group person-group-type="editor"><name><surname>Feine</surname><given-names>J.S.</given-names></name><name><surname>Carlsson</surname><given-names>G.E.</given-names></name></person-group><publisher-name>Quintes-sence</publisher-name><publisher-loc>Chicago, IL, USA</publisher-loc><year>2003</year><fpage>3</fpage><lpage>14</lpage></element-citation></ref><ref id="B10-ijerph-11-11308"><label>10.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Steele</surname><given-names>J.G.</given-names></name><name><surname>Treasure</surname><given-names>E.T.</given-names></name><name><surname>O’Sullivan</surname><given-names>I.</given-names></name><name><surname>Morris</surname><given-names>J.</given-names></name><name><surname>Murray</surname><given-names>J.J.</given-names></name></person-group><article-title>Adult dental health survey 2009: Transformations in British oral health 1968–2009</article-title><source>Br. Dent. J.</source><year>2012</year><volume>213</volume><fpage>523</fpage><lpage>527</lpage><pub-id pub-id-type="doi">10.1038/sj.bdj.2012.1067</pub-id><pub-id pub-id-type="pmid">23175081</pub-id></element-citation></ref><ref id="B11-ijerph-11-11308"><label>11.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Doğan</surname><given-names>B.G.</given-names></name><name><surname>Gökalp</surname><given-names>S.</given-names></name></person-group><article-title>Tooth loss and edentulism in the Turkish elderly</article-title><source>Arch. Gerontol. Geriatr.</source><year>2012</year><volume>54</volume><fpage>e162</fpage><lpage>e166</lpage><pub-id pub-id-type="doi">10.1016/j.archger.2012.01.003</pub-id><pub-id pub-id-type="pmid">22293677</pub-id></element-citation></ref><ref id="B12-ijerph-11-11308"><label>12.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Gaio</surname><given-names>E.J.</given-names></name><name><surname>Haas</surname><given-names>A.N.</given-names></name><name><surname>Carrard</surname><given-names>V.C.</given-names></name><name><surname>Oppermann</surname><given-names>R.V.</given-names></name><name><surname>Albandar</surname><given-names>J.</given-names></name><name><surname>Susin.</surname><given-names>C.</given-names></name></person-group><article-title>Oral health status in elders from South Brazil: A population-based study</article-title><source>Gerodontology</source><year>2012</year><volume>29</volume><fpage>214</fpage><lpage>223</lpage><pub-id pub-id-type="doi">10.1111/j.1741-2358.2011.00617.x</pub-id><pub-id pub-id-type="pmid">22486627</pub-id></element-citation></ref><ref id="B13-ijerph-11-11308"><label>13.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Hugo</surname><given-names>F.N.</given-names></name><name><surname>Hilgert</surname><given-names>J.B.</given-names></name><name><surname>de Sousa Mda</surname><given-names>L.</given-names></name><name><surname>da Silva</surname><given-names>D.D.</given-names></name><name><surname>Pucca</surname><given-names>G.A.</given-names><suffix>Jr.</suffix></name></person-group><article-title>Correlates of partial tooth loss and edentulism in the Brazilian elderly</article-title><source>Community Dent. Oral Epidemiol.</source><year>2007</year><volume>35</volume><fpage>224</fpage><lpage>232</lpage><pub-id pub-id-type="doi">10.1111/j.0301-5661.2007.00346.x</pub-id><pub-id pub-id-type="pmid">17518969</pub-id></element-citation></ref><ref id="B14-ijerph-11-11308"><label>14.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Mendes</surname><given-names>D.C.</given-names></name><name><surname>Poswar Fde</surname><given-names>O.</given-names></name><name><surname>de Oliveira</surname><given-names>M.V.</given-names></name><name><surname>Haikal</surname><given-names>D.S.</given-names></name><name><surname>da Silveira</surname><given-names>M.F.</given-names></name><name><surname>Martins</surname><given-names>A.M.</given-names></name><name><surname>De Paula</surname><given-names>A.M.</given-names></name></person-group><article-title>Analysis of socio-demographic and systemic health factors and the normative conditions of oral health care in a population of the Brazilian elderly</article-title><source>Gerodontology</source><year>2012</year><volume>29</volume><fpage>e206</fpage><lpage>e214</lpage><pub-id pub-id-type="doi">10.1111/j.1741-2358.2010.00446.x</pub-id><pub-id pub-id-type="pmid">21083742</pub-id></element-citation></ref><ref id="B15-ijerph-11-11308"><label>15.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Northridge</surname><given-names>M.E.</given-names></name><name><surname>Ue</surname><given-names>F.V.</given-names></name><name><surname>Borrell</surname><given-names>L.N.</given-names></name><name><surname>De La Cruz</surname><given-names>L.D.</given-names></name><name><surname>Chakraborty</surname><given-names>B.</given-names></name><name><surname>Bodnar</surname><given-names>S.</given-names></name><name><surname>Marshall</surname><given-names>S.</given-names></name><name><surname>Lamster</surname><given-names>I.B.</given-names></name></person-group><article-title>Tooth loss and dental caries in community-dwelling older adults in northern Manhattan</article-title><source>Gerodontology</source><year>2012</year><volume>29</volume><fpage>e464</fpage><lpage>e473</lpage><pub-id pub-id-type="doi">10.1111/j.1741-2358.2011.00502.x</pub-id><pub-id pub-id-type="pmid">21718349</pub-id></element-citation></ref><ref id="B16-ijerph-11-11308"><label>16.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Wennström</surname><given-names>A.</given-names></name><name><surname>Ahlqwist</surname><given-names>M.</given-names></name><name><surname>Stenman</surname><given-names>U.</given-names></name><name><surname>Björkelund</surname><given-names>C.</given-names></name><name><surname>Hakeberg</surname><given-names>M.</given-names></name></person-group><article-title>Trends in tooth loss in relation to socio-economic status among Swedish women, aged 38 and 50 years: Repeated cross-sectional surveys 1968–2004</article-title><source>BMC Oral Health</source><year>2013</year><volume>13</volume><pub-id pub-id-type="doi">10.1186/1472-6831-13-63</pub-id><pub-id pub-id-type="pmid">24010726</pub-id></element-citation></ref><ref id="B17-ijerph-11-11308"><label>17.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Moreira Rda</surname><given-names>S.</given-names></name><name><surname>Nico</surname><given-names>L.S.</given-names></name><name><surname>Tomita</surname><given-names>N.E.</given-names></name></person-group><article-title>Spatial risk and factors associated with edentulism among elderly persons in Southeast Brazil</article-title><source>Cad. Saude. Publica.</source><year>2011</year><volume>27</volume><fpage>2041</fpage><lpage>2054</lpage><pub-id pub-id-type="pmid">22031208</pub-id></element-citation></ref><ref id="B18-ijerph-11-11308"><label>18.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Starr</surname><given-names>J.M.</given-names></name><name><surname>Hall</surname><given-names>R.</given-names></name></person-group><article-title>Predictors and correlates of edentulism in healthy older people</article-title><source>Curr. Opin. Clin. Nutr. Metab. Care</source><year>2010</year><volume>13</volume><fpage>19</fpage><lpage>23</lpage><pub-id pub-id-type="doi">10.1097/MCO.0b013e328333aa37</pub-id><pub-id pub-id-type="pmid">19898233</pub-id></element-citation></ref><ref id="B19-ijerph-11-11308"><label>19.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Vargas</surname><given-names>C.M.</given-names></name><name><surname>Yellowitz</surname><given-names>J.A.</given-names></name><name><surname>Hayes</surname><given-names>K.L.</given-names></name></person-group><article-title>Oral health status of older rural adults in the United States</article-title><source>J. Am. Dent. Assoc.</source><year>2003</year><volume>134</volume><fpage>479</fpage><lpage>486</lpage><pub-id pub-id-type="doi">10.14219/jada.archive.2003.0199</pub-id><pub-id pub-id-type="pmid">12733783</pub-id></element-citation></ref><ref id="B20-ijerph-11-11308"><label>20.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Felton</surname><given-names>D.A.</given-names></name></person-group><article-title>Edentulism and comorbid factors</article-title><source>Tex. Dent. J.</source><year>2010</year><volume>127</volume><fpage>389</fpage><lpage>401</lpage><pub-id pub-id-type="pmid">20446489</pub-id></element-citation></ref><ref id="B21-ijerph-11-11308"><label>21.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Patel</surname><given-names>M.H.</given-names></name><name><surname>Kumar</surname><given-names>J.V.</given-names></name><name><surname>Moss</surname><given-names>M.E.</given-names></name></person-group><article-title>Diabetes and tooth loss: An analysis of data from the national health and nutrition examination survey, 2003–2004</article-title><source>J. Am. Dent. Assoc.</source><year>2013</year><volume>144</volume><fpage>478</fpage><lpage>485</lpage><pub-id pub-id-type="doi">10.14219/jada.archive.2013.0149</pub-id><pub-id pub-id-type="pmid">23633695</pub-id></element-citation></ref><ref id="B22-ijerph-11-11308"><label>22.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Medina-Solís</surname><given-names>C.E.</given-names></name><name><surname>Pontigo-Loyola</surname><given-names>A.P.</given-names></name><name><surname>Pérez-Campos</surname><given-names>E.</given-names></name><name><surname>Hernández-Cruz</surname><given-names>P.</given-names></name><name><surname>Avila-Burgos</surname><given-names>L.</given-names></name><name><surname>Kowolik</surname><given-names>M.J.</given-names></name><name><surname>Maupomé</surname><given-names>G.</given-names></name></person-group><article-title>Association between edentulism and angina pectoris in Mexican adults 35 years of age and older: A multivariate analysis of a population-based survey</article-title><source>J. Periodontol.</source><year>2014</year><volume>85</volume><fpage>406</fpage><lpage>416</lpage><pub-id pub-id-type="doi">10.1902/jop.2013.130186</pub-id><pub-id pub-id-type="pmid">23895250</pub-id></element-citation></ref><ref id="B23-ijerph-11-11308"><label>23.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Elter</surname><given-names>J.R.</given-names></name><name><surname>Offenbacher</surname><given-names>S.</given-names></name><name><surname>Toole</surname><given-names>J.F.</given-names></name><name><surname>Beck</surname><given-names>J.D.</given-names></name></person-group><article-title>Relationship of periodontal disease and edentulism to stroke/TIA</article-title><source>J. Dent. Res.</source><year>2003</year><volume>82</volume><fpage>998</fpage><lpage>1001</lpage><pub-id pub-id-type="doi">10.1177/154405910308201212</pub-id><pub-id pub-id-type="pmid">14630902</pub-id></element-citation></ref><ref id="B24-ijerph-11-11308"><label>24.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ayo-Yusuf</surname><given-names>O.A.</given-names></name><name><surname>Ayo-Yusuf</surname><given-names>I.J.</given-names></name></person-group><article-title>Association of tooth loss with hypertension</article-title><source>S. Afr. Med. J.</source><year>2008</year><volume>98</volume><fpage>381</fpage><lpage>385</lpage><pub-id pub-id-type="pmid">18637310</pub-id></element-citation></ref><ref id="B25-ijerph-11-11308"><label>25.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Österberg</surname><given-names>T.</given-names></name><name><surname>Dey</surname><given-names>D.K.</given-names></name><name><surname>Sundh</surname><given-names>V.</given-names></name><name><surname>Carlsson</surname><given-names>G.E.</given-names></name><name><surname>Jansson</surname><given-names>J.O.</given-names></name><name><surname>Mellström</surname><given-names>D.</given-names></name></person-group><article-title>Edentulism associated with obesity: A study of four national surveys of 16,416 Swedes aged 55–84 years</article-title><source>Acta. Odontol. Scand.</source><year>2010</year><volume>68</volume><fpage>360</fpage><lpage>367</lpage><pub-id pub-id-type="doi">10.3109/00016357.2010.514721</pub-id><pub-id pub-id-type="pmid">20840004</pub-id></element-citation></ref><ref id="B26-ijerph-11-11308"><label>26.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Arora</surname><given-names>M.</given-names></name><name><surname>Schwarz</surname><given-names>E.</given-names></name><name><surname>Sivaneswaran</surname><given-names>S.</given-names></name><name><surname>Banks</surname><given-names>E.</given-names></name></person-group><article-title>Cigarette smoking and tooth loss in a cohort of older Australians: The 45 and up study</article-title><source>J. Am. Dent. Assoc.</source><year>2010</year><volume>141</volume><fpage>1242</fpage><lpage>1249</lpage><pub-id pub-id-type="doi">10.14219/jada.archive.2010.0052</pub-id><pub-id pub-id-type="pmid">20884927</pub-id></element-citation></ref><ref id="B27-ijerph-11-11308"><label>27.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Hanioka</surname><given-names>T.</given-names></name><name><surname>Ojima</surname><given-names>M.</given-names></name><name><surname>Tanaka</surname><given-names>K.</given-names></name><name><surname>Aoyama</surname><given-names>H.</given-names></name></person-group><article-title>Association of total tooth loss with smoking, drinking alcohol and nutrition in elderly Japanese: Analysis of national database</article-title><source>Gerodontology</source><year>2007</year><volume>24</volume><fpage>87</fpage><lpage>92</lpage><pub-id pub-id-type="doi">10.1111/j.1741-2358.2007.00166.x</pub-id><pub-id pub-id-type="pmid">17518955</pub-id></element-citation></ref><ref id="B28-ijerph-11-11308"><label>28.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Islas-Granillo</surname><given-names>H.</given-names></name><name><surname>Borges-Yañez</surname><given-names>S.A.</given-names></name><name><surname>Lucas-Rincón</surname><given-names>S.E.</given-names></name><name><surname>Medina-Solís</surname><given-names>C.E.</given-names></name><name><surname>Casanova-Rosado</surname><given-names>A.J.</given-names></name><name><surname>Márquez-Corona</surname><given-names>M.L.</given-names></name><name><surname>Maupomé</surname><given-names>G.</given-names></name></person-group><article-title>Edentulism risk indicators among Mexican elders 60-year-old and older</article-title><source>Arch. Gerontol. Geriatr.</source><year>2011</year><volume>53</volume><fpage>258</fpage><lpage>262</lpage><pub-id pub-id-type="doi">10.1016/j.archger.2010.12.014</pub-id><pub-id pub-id-type="pmid">21242008</pub-id></element-citation></ref><ref id="B29-ijerph-11-11308"><label>29.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>De Marchi</surname><given-names>R.J.</given-names></name><name><surname>Hugo</surname><given-names>F.N.</given-names></name><name><surname>Padilha</surname><given-names>D.M.</given-names></name><name><surname>Hilgert</surname><given-names>J.B.</given-names></name><name><surname>Machado</surname><given-names>D.B.</given-names></name><name><surname>Durgante</surname><given-names>P.C.</given-names></name><name><surname>Antunes</surname><given-names>M.T.</given-names></name></person-group><article-title>Edentulism, use of dentures and consumption of fruit and vegetables in south Brazilian community-dwelling elderly</article-title><source>J. Oral Rehabil.</source><year>2011</year><volume>38</volume><fpage>533</fpage><lpage>540</lpage><pub-id pub-id-type="doi">10.1111/j.1365-2842.2010.02189.x</pub-id><pub-id pub-id-type="pmid">21198774</pub-id></element-citation></ref><ref id="B30-ijerph-11-11308"><label>30.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Tsakos</surname><given-names>G.</given-names></name><name><surname>Herrick</surname><given-names>K.</given-names></name><name><surname>Sheiham</surname><given-names>A.</given-names></name><name><surname>Watt</surname><given-names>R.G.</given-names></name></person-group><article-title>Edentulism and fruit and vegetable intake in low-income adults</article-title><source>J. Dent. Res.</source><year>2010</year><volume>89</volume><fpage>462</fpage><lpage>467</lpage><pub-id pub-id-type="doi">10.1177/0022034510363247</pub-id><pub-id pub-id-type="pmid">20207704</pub-id></element-citation></ref><ref id="B31-ijerph-11-11308"><label>31.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Yu</surname><given-names>Y.H.</given-names></name><name><surname>Lai</surname><given-names>Y.L.</given-names></name><name><surname>Cheung</surname><given-names>W.S.</given-names></name><name><surname>Kuo</surname><given-names>H.K.</given-names></name></person-group><article-title>Oral health status and self-reported functional dependence in community-dwelling older adults</article-title><source>J. Am. Geriatr. Soc.</source><year>2011</year><volume>59</volume><fpage>519</fpage><lpage>523</lpage><pub-id pub-id-type="doi">10.1111/j.1532-5415.2010.03311.x</pub-id><pub-id pub-id-type="pmid">21391942</pub-id></element-citation></ref><ref id="B32-ijerph-11-11308"><label>32.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Naorungroj</surname><given-names>S.</given-names></name><name><surname>Slade</surname><given-names>G.D.</given-names></name><name><surname>Beck</surname><given-names>J.D.</given-names></name><name><surname>Mosley</surname><given-names>T.H.</given-names></name><name><surname>Gottesman</surname><given-names>R.F.</given-names></name><name><surname>Alonso</surname><given-names>A.</given-names></name><name><surname>Heiss</surname><given-names>G.</given-names></name></person-group><article-title>Cognitive decline and oral health in middle-aged adults in the ARIC Study</article-title><source>J. Dent. Res.</source><year>2013</year><volume>92</volume><fpage>795</fpage><lpage>801</lpage><pub-id pub-id-type="doi">10.1177/0022034513497960</pub-id><pub-id pub-id-type="pmid">23872988</pub-id></element-citation></ref><ref id="B33-ijerph-11-11308"><label>33.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Starr</surname><given-names>J.M.</given-names></name><name><surname>Hall</surname><given-names>R.J.</given-names></name><name><surname>Macintyre</surname><given-names>S.</given-names></name><name><surname>Deary</surname><given-names>I.J.</given-names></name><name><surname>Whalley</surname><given-names>L.J.</given-names></name></person-group><article-title>Predictors and correlates of edentulism in the healthy old people in Edinburgh (HOPE) study</article-title><source>Gerodontology</source><year>2008</year><volume>25</volume><fpage>199</fpage><lpage>204</lpage><pub-id pub-id-type="doi">10.1111/j.1741-2358.2008.00227.x</pub-id><pub-id pub-id-type="pmid">18422607</pub-id></element-citation></ref><ref id="B34-ijerph-11-11308"><label>34.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Tsakos</surname><given-names>G.</given-names></name><name><surname>Sabbah</surname><given-names>W.</given-names></name><name><surname>Chandola</surname><given-names>T.</given-names></name><name><surname>Newton</surname><given-names>T.</given-names></name><name><surname>Kawachi</surname><given-names>I.</given-names></name><name><surname>Aida</surname><given-names>J.</given-names></name><name><surname>Sheiham</surname><given-names>A.</given-names></name><name><surname>Marmot</surname><given-names>M.G.</given-names></name><name><surname>Watt</surname><given-names>R.G.</given-names></name></person-group><article-title>Social relationships and oral health among adults aged 60 years or older</article-title><source>Psychosom. Med.</source><year>2013</year><volume>75</volume><fpage>178</fpage><lpage>186</lpage><pub-id pub-id-type="doi">10.1097/PSY.0b013e31827d221b</pub-id><pub-id pub-id-type="pmid">23324876</pub-id></element-citation></ref><ref id="B35-ijerph-11-11308"><label>35.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Hugo</surname><given-names>F.N.</given-names></name><name><surname>Hilgert</surname><given-names>J.B.</given-names></name><name><surname>de Sousa Mda</surname><given-names>L.</given-names></name><name><surname>Cury</surname><given-names>J.A.</given-names></name></person-group><article-title>Oral status and its association with general quality of life in older independent-living south-Brazilians</article-title><source>Community Dent. Oral Epidemiol.</source><year>2009</year><volume>37</volume><fpage>231</fpage><lpage>240</lpage><pub-id pub-id-type="doi">10.1111/j.1600-0528.2009.00459.x</pub-id><pub-id pub-id-type="pmid">19302576</pub-id></element-citation></ref><ref id="B36-ijerph-11-11308"><label>36.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Rodrigues</surname><given-names>S.M.</given-names></name><name><surname>Oliveira</surname><given-names>A.C.</given-names></name><name><surname>Vargas</surname><given-names>A.M.</given-names></name><name><surname>Moreira</surname><given-names>A.N.E.</given-names></name><name><surname>Ferreira</surname><given-names>E.F.</given-names></name></person-group><article-title>Implications of edentulism on quality of life among elderly</article-title><source>Int. J. Environ. Res. Public Health</source><year>2012</year><volume>9</volume><fpage>100</fpage><lpage>109</lpage><pub-id pub-id-type="doi">10.3390/ijerph9010100</pub-id><pub-id pub-id-type="pmid">22470281</pub-id></element-citation></ref><ref id="B37-ijerph-11-11308"><label>37.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Steele</surname><given-names>J.G.</given-names></name><name><surname>Sanders</surname><given-names>A.E.</given-names></name><name><surname>Slade</surname><given-names>G.D.</given-names></name><name><surname>Allen</surname><given-names>P.F.</given-names></name><name><surname>Lahti</surname><given-names>S.</given-names></name><name><surname>Nuttall</surname><given-names>N.</given-names></name><name><surname>Spencer</surname><given-names>A.J.</given-names></name></person-group><article-title>How do age and tooth loss affect oral health impacts and quality of life? A study comparing two national samples</article-title><source>Community Dent. Oral Epidemiol.</source><year>2004</year><volume>32</volume><fpage>107</fpage><lpage>114</lpage><pub-id pub-id-type="doi">10.1111/j.0301-5661.2004.00131.x</pub-id><pub-id pub-id-type="pmid">15061859</pub-id></element-citation></ref><ref id="B38-ijerph-11-11308"><label>38.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Sheiham</surname><given-names>A.</given-names></name><name><surname>Nicolau</surname><given-names>B.</given-names></name></person-group><article-title>Evaluation of social and psychological factors in periodontal disease</article-title><source>Periodontol. 2000</source><year>2005</year><volume>39</volume><fpage>118</fpage><lpage>131</lpage><pub-id pub-id-type="doi">10.1111/j.1600-0757.2005.00115.x</pub-id><pub-id pub-id-type="pmid">16135067</pub-id></element-citation></ref><ref id="B39-ijerph-11-11308"><label>39.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Hanson</surname><given-names>B.S.</given-names></name><name><surname>Liedberg</surname><given-names>B.</given-names></name><name><surname>Owall</surname><given-names>B.</given-names></name></person-group><article-title>Social network, social support and dental status in elderly Swedish men</article-title><source>Community Dent. Oral Epidemiol.</source><year>1994</year><volume>22</volume><fpage>331</fpage><lpage>337</lpage><pub-id pub-id-type="doi">10.1111/j.1600-0528.1994.tb02063.x</pub-id><pub-id pub-id-type="pmid">7813188</pub-id></element-citation></ref><ref id="B40-ijerph-11-11308"><label>40.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kowal</surname><given-names>P.</given-names></name><name><surname>Chatterji</surname><given-names>S.</given-names></name><name><surname>Naidoo</surname><given-names>N.</given-names></name><name><surname>Biritwum</surname><given-names>R.</given-names></name><name><surname>Wu</surname><given-names>F.</given-names></name><name><surname>Ridaura</surname><given-names>R.L.</given-names></name><name><surname>Maximova</surname><given-names>T.</given-names></name><name><surname>Arokiasamy</surname><given-names>P.</given-names></name><name><surname>Phaswana-Mafuya</surname><given-names>N.</given-names></name><name><surname>Williams</surname><given-names>S.</given-names></name><etal></etal></person-group><article-title>Data resource profile: The World Health Organization Study on global AGEing and adult health (SAGE)</article-title><source>Int. J. Epidemiol.</source><year>2012</year><volume>41</volume><fpage>1639</fpage><lpage>1649</lpage><pub-id pub-id-type="doi">10.1093/ije/dys210</pub-id><pub-id pub-id-type="pmid">23283715</pub-id></element-citation></ref><ref id="B41-ijerph-11-11308"><label>41.</label><element-citation publication-type="webpage"><person-group person-group-type="author"><name><surname>Naidoo</surname><given-names>N.</given-names></name></person-group><article-title>SAGE Working Paper No. 5 WHO Study on global AGEing and adult health (SAGE) Waves 0 and 1—Sampling Information for China, Ghana, India, Mexico, Russia, and South Africa, 2012. Retrieved from the World Health Organization Study on global AGEing and adult health (SAGE)</article-title><comment>Available online:<ext-link ext-link-type="uri" xlink:href="www.who.int/healthinfo/sage/SAGEWorkingPaper5_Wave1Sampling.pdf">www.who.int/healthinfo/sage/SAGEWorkingPaper5_Wave1Sampling.pdf</ext-link></comment><date-in-citation>(accessed on 14 July 2014)</date-in-citation></element-citation></ref><ref id="B42-ijerph-11-11308"><label>42.</label><element-citation publication-type="webpage"><person-group person-group-type="author"><collab>World Health Organization (WHO)</collab></person-group><article-title>Chronic Diseases and Health Promotion: Steps Manual</article-title><year>2013</year><comment>Available online:<ext-link ext-link-type="uri" xlink:href="http://www.who.int/chp/steps/manual/en/">http://www.who.int/chp/steps/manual/en/</ext-link></comment><date-in-citation>(accessed on 20 February 2013)</date-in-citation></element-citation></ref><ref id="B43-ijerph-11-11308"><label>43.</label><element-citation publication-type="book"><person-group person-group-type="author"><name><surname>Ferguson</surname><given-names>B.D.</given-names></name><name><surname>Tandon</surname><given-names>A.</given-names></name><name><surname>Gakidou</surname><given-names>E.</given-names></name><name><surname>Murray</surname><given-names>C.J.L.</given-names></name></person-group><article-title>Estimating permanent income using asset and indicator variables</article-title><source>Health Systems Performance Assessment: Debates, Methods And Empiricism</source><person-group person-group-type="editor"><name><surname>Murray</surname><given-names>C.J.L.</given-names></name><name><surname>Evans</surname><given-names>D.B.</given-names></name></person-group><publisher-name>World Health Organization</publisher-name><publisher-loc>Geneva, Switzerland</publisher-loc><year>2003</year><fpage>747</fpage><lpage>760</lpage></element-citation></ref><ref id="B44-ijerph-11-11308"><label>44.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Chobanian</surname><given-names>A.V.</given-names></name><name><surname>Bakris</surname><given-names>G.L.</given-names></name><name><surname>Black</surname><given-names>H.R.</given-names></name><name><surname>Cushman</surname><given-names>W.C.</given-names></name><name><surname>Green</surname><given-names>L.A.</given-names></name><name><surname>Izzo</surname><given-names>J.L.</given-names><suffix>Jr.</suffix></name><name><surname>Jones</surname><given-names>D.W.</given-names></name><name><surname>Materson</surname><given-names>B.J.</given-names></name><name><surname>Oparil</surname><given-names>S.</given-names></name><name><surname>Wright</surname><given-names>J.T.</given-names><suffix>Jr.</suffix></name><etal></etal></person-group><article-title>Seventh report of the joint national committee of prevention, detection, evaluation, and treatment of high blood pressure</article-title><source>Hypertension</source><year>2003</year><volume>42</volume><fpage>1206</fpage><lpage>1252</lpage><pub-id pub-id-type="doi">10.1161/01.HYP.0000107251.49515.c2</pub-id><pub-id pub-id-type="pmid">14656957</pub-id></element-citation></ref><ref id="B45-ijerph-11-11308"><label>45.</label><element-citation publication-type="webpage"><person-group person-group-type="author"><collab>World Health Organisation (WHO)</collab></person-group><article-title>The International Classification of Adult Underweight, Overweight and Obesity according to BMI</article-title><comment>Available online:<ext-link ext-link-type="uri" xlink:href="http://apps.who.int/bmi/index.jsp?introPage=intro_3.html">http://apps.who.int/bmi/index.jsp?introPage=intro_3.html</ext-link></comment><date-in-citation>(accessed on 15 June 2014)</date-in-citation></element-citation></ref><ref id="B46-ijerph-11-11308"><label>46.</label><element-citation publication-type="book"><person-group person-group-type="author"><collab>World Health Organisation (WHO)</collab></person-group><source>The WHO STEPwise approach to Surveillance of noncommunicable diseases (STEPS) Non-communicable Diseases and Mental Health, WHO/NMH/CCS/03.01</source><publisher-name>World Health Organization</publisher-name><publisher-loc>Geneva, Switzerland</publisher-loc><year>2003</year></element-citation></ref><ref id="B47-ijerph-11-11308"><label>47.</label><element-citation publication-type="book"><person-group person-group-type="author"><collab>World Health Organisation (WHO)</collab></person-group><source>Diet, Nutrition, and the Prevalence of Chronic Diseases</source><publisher-name>World Health Organization</publisher-name><publisher-loc>Geneva, Switzerland</publisher-loc><year>2003</year></element-citation></ref><ref id="B48-ijerph-11-11308"><label>48.</label><element-citation publication-type="book"><source>Measuring Health And Disability: Manual For Who Disability Assessment Schedule</source><comment>WHODAS 2.0</comment><person-group person-group-type="editor"><name><surname>Üstün</surname><given-names>T.</given-names></name><name><surname>Kostanjsek</surname><given-names>N.</given-names></name><name><surname>Chatterji</surname><given-names>S.</given-names></name><name><surname>Rehm</surname><given-names>J.</given-names></name></person-group><publisher-name>World Health Organization</publisher-name><publisher-loc>Geneva, Switzerland</publisher-loc><year>2010</year></element-citation></ref><ref id="B49-ijerph-11-11308"><label>49.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Stucki</surname><given-names>G.</given-names></name><name><surname>Kostanjsek</surname><given-names>N.</given-names></name><name><surname>Ustün</surname><given-names>B.</given-names></name><name><surname>Cieza</surname><given-names>A.</given-names></name></person-group><article-title>ICF-based classification and measurement of functioning</article-title><source>Eur. J. Phys. Rehabil. Med.</source><year>2008</year><volume>44</volume><fpage>315</fpage><lpage>328</lpage><pub-id pub-id-type="pmid">18762741</pub-id></element-citation></ref><ref id="B50-ijerph-11-11308"><label>50.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ramlagan</surname><given-names>S.</given-names></name><name><surname>Peltzer</surname><given-names>K.</given-names></name><name><surname>Phaswana-Mafuya</surname><given-names>N.</given-names></name></person-group><article-title>Social capital and health among older adults in South Africa</article-title><source>BMC Geriatrics</source><year>2013</year><volume>13</volume><pub-id pub-id-type="doi">10.1186/1471-2318-13-100</pub-id></element-citation></ref><ref id="B51-ijerph-11-11308"><label>51.</label><element-citation publication-type="book"><person-group person-group-type="author"><name><surname>Ahmad</surname><given-names>O.B.</given-names></name><name><surname>Boschi-Pinto</surname><given-names>C.</given-names></name><name><surname>Lopez</surname><given-names>A.D.</given-names></name><name><surname>Murray</surname><given-names>C.J.L.</given-names></name><name><surname>Lozano</surname><given-names>R.</given-names></name><name><surname>Inoue</surname><given-names>M.</given-names></name></person-group><source>Age Standardization of Rates: A New Who Standard</source><publisher-name>World Health Organization</publisher-name><publisher-loc>Geneva, Switzerland</publisher-loc><year>2001</year></element-citation></ref><ref id="B52-ijerph-11-11308"><label>52.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Esan</surname><given-names>T.A.</given-names></name><name><surname>Olusile</surname><given-names>A.O.</given-names></name><name><surname>Akeredolu</surname><given-names>P.A.</given-names></name><name><surname>Esan</surname><given-names>A.O.</given-names></name></person-group><article-title>Socio-demographic factors and edentulism: The Nigerian experience</article-title><source>BMC Oral Health</source><year>2004</year><volume>4</volume><pub-id pub-id-type="doi">10.1186/1472-6831-4-3</pub-id></element-citation></ref><ref id="B53-ijerph-11-11308"><label>53.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Hobdell</surname><given-names>M.H.</given-names></name><name><surname>Myburgh</surname><given-names>N.G.</given-names></name><name><surname>Lalloo</surname><given-names>R.</given-names></name><name><surname>Chikte</surname><given-names>U.M.E.</given-names></name><name><surname>Owen</surname><given-names>C.</given-names></name></person-group><article-title>Oral disease in Africa: A challenge to change oral health priorities</article-title><source>Oral Dis.</source><year>1997</year><volume>3</volume><fpage>216</fpage><lpage>222</lpage><pub-id pub-id-type="doi">10.1111/j.1601-0825.1997.tb00044.x</pub-id><pub-id pub-id-type="pmid">9643215</pub-id></element-citation></ref><ref id="B54-ijerph-11-11308"><label>54.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Thorpe</surname><given-names>S.</given-names></name></person-group><article-title>Oral health issues in the African region: Current situation and future perspectives</article-title><source>J. Dent. Educ.</source><year>2006</year><volume>70</volume><fpage>8</fpage><lpage>15</lpage></element-citation></ref><ref id="B55-ijerph-11-11308"><label>55.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Haikola</surname><given-names>B.</given-names></name><name><surname>Oikarinen</surname><given-names>K.</given-names></name><name><surname>Söderholm</surname><given-names>A.L.</given-names></name><name><surname>Remes-Lyly</surname><given-names>T.</given-names></name><name><surname>Sipilä</surname><given-names>K.</given-names></name></person-group><article-title>Prevalence of edentulousness and related factors among elderly Finns</article-title><source>J. Oral Rehabil.</source><year>2008</year><volume>35</volume><fpage>827</fpage><lpage>835</lpage><pub-id pub-id-type="doi">10.1111/j.1365-2842.2008.01873.x</pub-id><pub-id pub-id-type="pmid">18482342</pub-id></element-citation></ref><ref id="B56-ijerph-11-11308"><label>56.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Mercado</surname><given-names>F.B.</given-names></name><name><surname>Marshall</surname><given-names>R.I.</given-names></name><name><surname>Bartold</surname><given-names>P.M.</given-names></name></person-group><article-title>Inter-relationships between rheumatoid arthritis and periodontal disease</article-title><source>J. Clin. Periodontol.</source><year>2003</year><volume>30</volume><fpage>761</fpage><lpage>772</lpage><pub-id pub-id-type="doi">10.1034/j.1600-051X.2003.00371.x</pub-id><pub-id pub-id-type="pmid">12956651</pub-id></element-citation></ref><ref id="B57-ijerph-11-11308"><label>57.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Yavuzyilmaz</surname><given-names>E.</given-names></name><name><surname>Yamalik</surname><given-names>N.</given-names></name><name><surname>Calgüner</surname><given-names>M.</given-names></name><name><surname>Ersoy</surname><given-names>F.</given-names></name><name><surname>Baykara</surname><given-names>M.</given-names></name><name><surname>Yeniay</surname><given-names>I.</given-names></name></person-group><article-title>Clinical and immunological characteristics of patients with rheumatoid arthritis and periodontal disease</article-title><source>J. Nihon Univ. Sch. Dent.</source><year>1992</year><volume>34</volume><fpage>89</fpage><lpage>95</lpage><pub-id pub-id-type="doi">10.2334/josnusd1959.34.89</pub-id><pub-id pub-id-type="pmid">1500954</pub-id></element-citation></ref><ref id="B58-ijerph-11-11308"><label>58.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Han</surname><given-names>E.R.</given-names></name><name><surname>Choi</surname><given-names>I.S.</given-names></name><name><surname>Kim</surname><given-names>H.K.</given-names></name><name><surname>Kang</surname><given-names>Y.W.</given-names></name><name><surname>Park</surname><given-names>J.G.</given-names></name><name><surname>Lim</surname><given-names>J.R.</given-names></name><name><surname>Seo</surname><given-names>J.H.</given-names></name><name><surname>Choi</surname><given-names>J.H.</given-names></name></person-group><article-title>Inhaled corticosteroid-related tooth problems in asthmatics</article-title><source>J. Asthma.</source><year>2009</year><volume>46</volume><fpage>160</fpage><lpage>164</lpage><pub-id pub-id-type="doi">10.1080/02770900802553102</pub-id><pub-id pub-id-type="pmid">19253123</pub-id></element-citation></ref><ref id="B59-ijerph-11-11308"><label>59.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Stewart</surname><given-names>R.</given-names></name><name><surname>Hirani</surname><given-names>V.</given-names></name></person-group><article-title>Dental health and cognitive impairment in an English national survey population</article-title><source>J. Am. Geriatr. Soc.</source><year>2007</year><volume>55</volume><fpage>1410</fpage><lpage>1414</lpage><pub-id pub-id-type="doi">10.1111/j.1532-5415.2007.01298.x</pub-id><pub-id pub-id-type="pmid">17767683</pub-id></element-citation></ref><ref id="B60-ijerph-11-11308"><label>60.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Shimazaki</surname><given-names>Y.</given-names></name><name><surname>Soh</surname><given-names>I.</given-names></name><name><surname>Saito</surname><given-names>T.</given-names></name><name><surname>Yamashita</surname><given-names>Y.</given-names></name><name><surname>Koga</surname><given-names>T.</given-names></name><name><surname>Miyazaki</surname><given-names>H.</given-names></name><name><surname>Takehara</surname><given-names>T.</given-names></name></person-group><article-title>Influence of dentition status on physical disability, mental impairment, and mortality in institutionalized elderly people</article-title><source>J. Dent. Res.</source><year>2001</year><volume>80</volume><fpage>340</fpage><lpage>345</lpage><pub-id pub-id-type="doi">10.1177/00220345010800010801</pub-id><pub-id pub-id-type="pmid">11269726</pub-id></element-citation></ref><ref id="B61-ijerph-11-11308"><label>61.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Sheiham</surname><given-names>A.</given-names></name><name><surname>Steele</surname><given-names>J.G.</given-names></name><name><surname>Marcenes</surname><given-names>W.</given-names></name><name><surname>Lowe</surname><given-names>C.</given-names></name><name><surname>Finch</surname><given-names>S.</given-names></name><name><surname>Bates</surname><given-names>C.J.</given-names></name><name><surname>Prentice</surname><given-names>A.</given-names></name><name><surname>Walls</surname><given-names>A.W.G.</given-names></name></person-group><article-title>The relationship among dental status, nutrient intake, and nutritional status in older people</article-title><source>J. Dent. Res.</source><year>2001</year><volume>80</volume><fpage>408</fpage><lpage>413</lpage><pub-id pub-id-type="doi">10.1177/00220345010800020201</pub-id><pub-id pub-id-type="pmid">11332523</pub-id></element-citation></ref><ref id="B62-ijerph-11-11308"><label>62.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Emami</surname><given-names>E.</given-names></name><name><surname>de Souza</surname><given-names>R.F.</given-names></name><name><surname>Kabawat</surname><given-names>M.</given-names></name><name><surname>Feine</surname><given-names>J.S.</given-names></name></person-group><article-title>The impact of edentulism on oral and general health</article-title><source>Int. J. Dent.</source><year>2013</year><fpage>2013</fpage><pub-id pub-id-type="doi">10.1155/2013/498305</pub-id></element-citation></ref><ref id="B63-ijerph-11-11308"><label>63.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Lee</surname><given-names>J.S.</given-names></name><name><surname>Weyant</surname><given-names>R.J.</given-names></name><name><surname>Corby</surname><given-names>P.</given-names></name><name><surname>Kritchevsky</surname><given-names>S.B.</given-names></name><name><surname>Harris</surname><given-names>T.B.</given-names></name><name><surname>Rooks</surname><given-names>R.</given-names></name><name><surname>Rubin</surname><given-names>S.M.</given-names></name><name><surname>Newman</surname><given-names>A.B.</given-names></name></person-group><article-title>Edentulism and nutritional status in a biracial sample of well-functioning, community-dwelling elderly: The health, aging, and body composition study</article-title><source>Am. J. Clin. Nutr.</source><year>2004</year><volume>79</volume><fpage>295</fpage><lpage>302</lpage><pub-id pub-id-type="pmid">14749237</pub-id></element-citation></ref><ref id="B64-ijerph-11-11308"><label>64.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Reddy</surname><given-names>N.S.</given-names></name><name><surname>Reddy</surname><given-names>N.A.</given-names></name><name><surname>Narendra</surname><given-names>R.</given-names></name><name><surname>Reddy</surname><given-names>S.D.</given-names></name></person-group><article-title>Epidemiological survey on edentulousness</article-title><source>J. Contemp. Dent. Pract.</source><year>2012</year><volume>13</volume><fpage>562</fpage><lpage>570</lpage><pub-id pub-id-type="doi">10.5005/jp-journals-10024-1187</pub-id><pub-id pub-id-type="pmid">23151711</pub-id></element-citation></ref><ref id="B65-ijerph-11-11308"><label>65.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Joshipura</surname><given-names>K.J.</given-names></name><name><surname>Rimm</surname><given-names>E.B.</given-names></name><name><surname>Douglass</surname><given-names>C.W.</given-names></name><name><surname>Trichopoulos</surname><given-names>D.</given-names></name><name><surname>Ascherio</surname><given-names>A.</given-names></name><name><surname>Willett</surname><given-names>W.C.</given-names></name></person-group><article-title>Poor oral health and coronary heart disease</article-title><source>J. Dent. Res.</source><year>1996</year><volume>75</volume><fpage>1631</fpage><lpage>1636</lpage><pub-id pub-id-type="doi">10.1177/00220345960750090301</pub-id><pub-id pub-id-type="pmid">8952614</pub-id></element-citation></ref><ref id="B66-ijerph-11-11308"><label>66.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Iwasaki</surname><given-names>M.</given-names></name><name><surname>Moynihan</surname><given-names>P.</given-names></name><name><surname>Manz</surname><given-names>M.C.</given-names></name><name><surname>Taylor</surname><given-names>G.W.</given-names></name><name><surname>Yoshihara</surname><given-names>A.</given-names></name><name><surname>Muramatsu</surname><given-names>K.</given-names></name><name><surname>Watanabe</surname><given-names>R.</given-names></name><name><surname>Miyazaki</surname><given-names>H.</given-names></name></person-group><article-title>Dietary antioxidants and periodontal disease in community-based older Japanese: A 2-year follow-up study</article-title><source>Public Health Nutr.</source><year>2013</year><volume>16</volume><fpage>330</fpage><lpage>338</lpage><pub-id pub-id-type="doi">10.1017/S1368980012002637</pub-id><pub-id pub-id-type="pmid">22613693</pub-id></element-citation></ref><ref id="B67-ijerph-11-11308"><label>67.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Gotfredsen</surname><given-names>K.</given-names></name><name><surname>Walls</surname><given-names>A.W.</given-names></name></person-group><article-title>What dentition assures oral function?</article-title><source>Clin. Oral Implants Res.</source><year>2007</year><volume>18</volume><fpage>34</fpage><lpage>45</lpage><pub-id pub-id-type="doi">10.1111/j.1600-0501.2007.01436.x</pub-id><pub-id pub-id-type="pmid">17594368</pub-id></element-citation></ref><ref id="B68-ijerph-11-11308"><label>68.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Avlund</surname><given-names>K.</given-names></name><name><surname>Holm-Pedersen</surname><given-names>P.</given-names></name><name><surname>Morse</surname><given-names>D.E.</given-names></name><name><surname>Viitanen</surname><given-names>M.</given-names></name><name><surname>Winblad</surname><given-names>B.</given-names></name></person-group><article-title>Tooth loss and caries prevalence in very old Swedish people: the relationship to cognitive function and functional ability</article-title><source>Gerodontology</source><year>2004</year><volume>21</volume><fpage>17</fpage><lpage>26</lpage><pub-id pub-id-type="doi">10.1046/j.1741-2358.2003.00003.x</pub-id><pub-id pub-id-type="pmid">15074536</pub-id></element-citation></ref><ref id="B69-ijerph-11-11308"><label>69.</label><element-citation publication-type="webpage"><person-group person-group-type="author"><collab>UNFPA</collab></person-group><article-title>Ageing in the Twenty-First Century</article-title><year>2012</year><comment>Available online:<ext-link ext-link-type="uri" xlink:href="https://www.unfpa.org/public/home/publications/pid/11584">https://www.unfpa.org/public/home/publications/pid/11584</ext-link></comment><date-in-citation>(accessed on 10 July 2014)</date-in-citation></element-citation></ref><ref id="B70-ijerph-11-11308"><label>70.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Tramini</surname><given-names>P.</given-names></name><name><surname>Montal</surname><given-names>S.</given-names></name><name><surname>Valcarcel</surname><given-names>J.</given-names></name></person-group><article-title>Tooth loss and associated factors in long-term institutionalised elderly patients</article-title><source>Gerodontology</source><year>2007</year><volume>24</volume><fpage>196</fpage><lpage>203</lpage><pub-id pub-id-type="doi">10.1111/j.1741-2358.2007.00183.x</pub-id><pub-id pub-id-type="pmid">17999730</pub-id></element-citation></ref></ref-list></back></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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