Association between oral health-related quality of life and structural determinants of health among elderly populations. a systematic review and meta-analysis.

Background: Oral diseases disproportionately affect poorer and disadvantaged groups of society. Despite this, there is scarce evidence regarding the monitoring of the structural determinants of health and their impact on oral health status. Thus, this systematic review addresses the question: Is oral health-related quality of life (OHRQoL) of elderly persons (aged ≥ 60 years) associated with structural determinants of health?

Methods: The present systematic review of observational studies applied the following inclusion and exclusion criteria; inclusion criteria: participants living in the community aged ≥ 60 years, reporting OHRQoL using Oral Health Impact Profile (OHIP), Geriatric Oral Health Assessment Index (GOHAI) or Oral Impact Daily Profile (OIDP).

Exclusion criteria: studies reporting outcomes of participants aged < 60 years and residing in long-term care facilities. Three electronic databases (i.e., Embase, MEDLINE via Pubmed and Scopus) were screened (last searched on 23rd August 2024). Quality assessment of the included studies was performed using the tailored quality assessment tool developed by the National Heart, Lung and Blood Institute for observational cohort and cross-sectional studies. Meta-analysis; the overall sum score of OHIP, GOHAI and OIDP were transformed on a scale of 0-100. Sub-group analyses were performed for OHRQoL sum scores stratified by the following variables: Country-level income, Gini index, unemployment rate, Human Development Index (HDI), out-of-pocket health expenditure, health expenditure per capita, prevalence of dental caries, edentulism and periodontal disease.

Results: The search identified 910 records. After deduplication, title, abstract and full-text review, 45 papers were included for data extraction. The highest OHRQoL sum scores were recorded in studies from countries with high-middle to high income (77.9, 95% CI 70.2-85.6), low Gini index (91.3, 95% CI 90.0-92.6), high to very high HDI (78.4, 95% CI 71.1-85.8) and lowest out-of-pocket expenditure (83.9, 95% CI 75.2-92.6). Countries with low dental caries prevalence reported higher OHRQoL compared to countries with high dental caries prevalence (81.5, 95% CI 76.5-86.6). Limitations include the fair quality of > 50% of the studies included and the high inter- study heterogeneity.

Conclusions: Structural determinants of health contribute to a good quality of life related to oral health. Upstream interventions are essential for improving oral health conditions and quality of life among older adults.

Registration: The review protocol was registered (CRD42024573590) with the International Prospective Register of Systematic Reviews (PROSPERO) system.