Abstract
There are a number of studies linking social capital to oral health among older adults, although the evidence base mainly relies on cross-sectional study designs. The possibility of reverse causality is seldom discussed, even though oral health problems could potentially lead to lower social participation. Furthermore, few studies clearly distinguish between the effects of different dimensions of social capital on oral health. The objective of the study was to examine the longitudinal associations between individual social capital and oral health among older adults. We analyzed longitudinal data from the 3rd and 5th waves of the English Longitudinal Study of Ageing (ELSA). Structural social capital was operationalized using measures of social participation, and volunteering. Number of close ties and perceived emotional support comprised the functional dimension of social capital. Oral health measures were having no natural teeth (edentate vs. dentate), self-rated oral health and oral health-related quality of life. Time-lag and autoregressive models were used to explore the longitudinal associations between social capital and oral health. We imputed all missing data, using multivariate imputation by chained equations. We found evidence of bi-directional longitudinal associations between self-rated oral health, volunteering and functional social capital. Functional social capital was a strong predictor of change in oral health-related quality of life – the adjusted odds ratio of reporting poor oral health-related quality of life was 1.75 (1.33–2.30) for older adults with low vs. high social support. However in the reverse direction, poor oral health-related quality of life was not associated with changes in social capital. This suggests that oral health may not be a determinant of social capital. In conclusion, social capital may be a determinant of subjective oral health among older adults rather than edentulousness, despite many cross-sectional studies on the latter.
Highlights
There is an increasing number of studies that suggest social capital may have a beneficial influence on oral health, most do not distinguish between two key aspects of social capital —the structural and functional dimensions [1]
Poor-self-rated oral health and edentate status were more prevalent among participants with lower structural and functional social capital, but OIDP was only associated with functional social capital
It appears that functional social capital at baseline was a stronger predictor of oral health-related quality of life at follow-up compared to the other way around
Summary
There is an increasing number of studies that suggest social capital may have a beneficial influence on oral health, most do not distinguish between two key aspects of social capital —the structural and functional dimensions [1]. The structural dimension emphasizes the behavioral aspects of the concept, namely participation in social activities and voluntary organizations. The functional dimension refers to people’s subjective values and perceptions, and emphasizes the relational content and quality of social interactions within the structure of social relationships [2]. A recent meta-analysis of cohort studies showed an inverse association between structural social capital—in terms of social participation and social networks—and mortality. Functional social capital is believed to shape attitudes and values to behavior [4], and appears to be strongly related to mental health in particular [8]
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