Skip to main content

Association between social capital and oral health among adults aged 50 years and over in China: a cross-sectional study

Abstract

Background

Social capital has a potential effect in protecting oral health among population. However, no study has explored the association between social capital and oral health in the Chinese context. Due to the unique culture, political, social context in China, it is important to understand their association in the Chinese context. The study aims to investigate the association between cognitive and structural dimensions of social capital with edentulism among adults aged 50 years and over in China.

Method

The study used data from the WHO SAGE (Study on Global AGEing and Adult Health) wave 1 China component. Structural social capital was operationalized as social participation. Cognitive social capital was operationalized as perceived community trust and perceived community safety. Community-level social capital was measured by aggregating individual-level social capital into community level. Oral health was measured using a final marker of oral health status, self-reported edentulism. A 2-level multilevel logistic regression was used to evaluate the association between different dimensions of social capital and oral health.

Results

In total, 12,856 individuals were included in the study, the overall prevalence of edentulism was 9.1% (95% CI 8.3–10.0). Multilevel logistic analysis revealed that individual-level social capital and community-level social capital are independently associated with edentulism. Individuals with low structural social capital and living in areas with low structural social capital have, respectively, 1.54 (95% CI 1.18–2.01) and 2.14 (95% CI 1.47–3.12) times higher odds for edentulism, after adjustment for potential confounders (age, sex, marital status, residence locality, wealth, education level, chronic conditions) and a potential mediator(smoking).

Conclusions

Living in a community with lower structural social capital and individual with low structural social capital is associated with higher risk for edentulism among adults aged 50 years and over in China.

Peer Review reports

Background

According to Global Burden of Disease in 2017, there are nearly 3.5 billion population affected by oral diseases around the world [1]. Oral health is an important public health issue globally, including in China. Among the Chinese population oral diseases is very common, particularly among older adults. According to the 4th national oral health epidemiological survey in China, the prevalence of dental caries and periodontal disease among the age group 55–74 were 96.8% and 92.9%, respectively [2]. These oral diseases are the main reason for tooth loss among Chinese population [3]. Factors that increase the risk for caries and periodontal diseases highly relate to health behaviors, such as, smoking, drinking, oral hygiene, dental attendance, eating food high in sugar [4,5,6]. Edentulism, which refers to the loss of all natural teeth, is a final status for tooth loss and is a good indicator of lifelong exposure to oral health risk factors. According to the 4th survey, the prevalence of edentulism aged 45 and above increased from 12.1% in 2013 to 14.6% in 2015 [3].

Traditionally, studies exploring possible determinants of oral health have paid most attention to biological and behavioral factors [7, 8] However, health behavior is also determined by a range of sociopolitical factors, for example, social capital [9]. Evidence has shown that social capital, which is defined by Putnam as “features of organizations, such as networks, trust and social norms of reciprocity” [10], is associated with oral health in different contexts [11,12,13]. For example, in Brazilian, a higher level of neighborhood social capital was reported to have an association with lower risk of dental caries [14] and lower risk of dental injury [15] among adolescence. In the US, a study found that more numbers of close friends is associated with fewer decayed teeth among individuals age 60 and above [16]. In Japan, participation in hobby clubs, sports groups was associated with reduced risk of tooth loss among older people[17]. The association between social capital and oral health was also found in other countries, including England [18], Indonesia [19, 20], South African [21], Korea [22], India [23]. Although studies have explored the association between social capital and different health outcomes in the Chinese context, including, loneliness [24, 25], depression [26,27,28], life satisfaction [29], self-rated health [30,31,32], mental health [33, 34], health-related quality of life [35, 36], cognitive functions [37], however, no study has explored its association with oral health. Due to different epidemiological characteristics of oral health conditions and differences in political, socioeconomic, cultural context, and health care system in China, social capital may have a different effect on oral health. Therefore, it is important to explore the association in the Chinese context.

In addition, to explore the mechanism between social capital and oral health, it is important to understand the association of different dimensions of social capital with oral health. Islam developed a very useful division for social capital and broke social capital into two dimensions: cognitive social capital and structural social capital [11]. Cognitive dimension of social capital refers to individuals’ subjective perception of the community or society the individuals belong to, while structural social capital refers to the actual behavior to build social networks [38]. Giordano and colleagues suggested that researchers should both explore the cognitive and structural dimensions of social capital [39], due to it may impacts health through different pathways [40]. Structural social capital is shaped by institutions, policies, and culture, which potentially have strong impact on objective health of individuals, while cognitive social capital is suggested to affect health through psychosocial mechanisms and potentially have impact on subjective health of individuals [40].

Therefore, the present study aims to explore the association of cognitive and structural social capital at the individual- and community-level and edentulism among adults aged 50 and over in China.

Methods

Study sample and design

SAGE(Study on Global AGEing and Adult Health) was a stratified, multistage sampled longitudinal cohort study conducted by WHO. It investigated individuals aged 18 years and over with a focus on individuals aged 50 and over in six developing countries. Data from SAGE wave 1 China component 2007–2010 was used in this study. Sample was stratified by 8 nationally representative provinces. A total of 64 townships and community blocks was selected from the 8 provinces using probability proportional to size method, and then, 127 villages and neighborhoods was selected from the townships and community blocks using probability proportional to size method. From each villages and neighborhoods, two residential blocks were selected using cluster random sampling. Altogether 15,050 individuals were randomly sampled from the residential blocks using a face-to-face questionnaire for data collection. The response rate for the questionnaire was 98% according to the working sheet of SAGE. Villages in rural areas and neighborhoods in urban areas, which are administrative boundaries with a similar population density, were defined as communities in this study. The study is a cross-sectional study with a focus on individual respondents aged 50+ years. Thus, individuals who aged below 50 years and had missing data for the outcome variable were excluded. The final sample size for the study is 12,856 [41].

Variables

Outcome variable

Self-reported edentulism was the dependent variable. Respondents were asked the question: “Have you lost all of your natural teeth?” Participants who answered “yes” were coded as edentulism (lose all natural teeth).

Main exposure variables

Individual social capital was measured using a social-cohesion based approach which is based on Putnam’s definition of social capital [10]. The approach is most widely used in public health. It inquires the potential availability of resources in the group (e.g. social participation, trust) instead of inquiring individual’s social network connections (e.g. number of close ties) [30]. Cognitive social capital was measured by two dimensions: perceived community trust and perceived community safety through 4 questions. Two questions about trust in different groups of people were asked. Participants were asked, “generally speaking, would you say that you can trust: (1) your neighbors; (2) co-workers?” The answers were a 5-item scale from 1 = to a very great extent to 5 = to a very small extent and were reverse coded as 1 = to a very small extend to 5 = to a very great extend. Perceived community safety was measured by asking 2 questions, “How safe from crime and violence do you feel when you are alone at home?” and “How safe do you feel when walking down your street alone after dark?” The answers were from 1 = completely safe to 5 = not safe at all and the answers were reverse coded. The final cognitive social capital score was the sum of the scores of perceived community trust and perceived community safety with a range from 4 to 20 (Cronbach alpha = 0.6638). Cognitive social capital score was divided into tertile, higher score indicates higher social capital.

Structural social capital, which refers to the actual behavior to build social network, was measured by assessing the frequency of social participation, including formal social participation (e.g. participate in public activities like school, public activities) and informal social participation (e.g. participate leisure activities with friends, families). It was measured by 9 questions that indicate the frequency of community activities involved in the past 12 months, including, how often in the last 12 months (1) have you attended public meetings; (2) attended religious services; (3) attended social meetings, programs, activities, or events or to visit friends or relatives; (4) attending any group, club, society, union, or organization meeting; (5) meeting personally with a community leader; (6) interacting with neighbors; (7) having friends over to home; (8) been in the home of someone living in a different neighborhood; (9) socializing with co-workers. The score was summed up to represent the total score of individual structural social capital, with a range from 9 to 45 (Cronbach alpha = 0.6246). Then, the score was divided into tertiles, namely, high, middle, low.

Community-level cognitive social capital was measured by aggregating individual cognitive social capital into group level. The mean value of cognitive social capital in each community were calculated and centered. Based on the centered mean value of cognitive social capital of each community, these communities were grouped into tertile, namely, high-, intermediate- and low community level cognitive social capital. Community-level structural social capital was measured in the same way. Totally 127 communities were used in calculating the community-level social capital. This method was prevalent being used in measuring group-level social capital by previous studies [42,43,44].

Covariates

Data on demographic variables were collected, including sex, age, highest education, marital status, locality( rural or urban), and household income. Age was grouped into 4 groups: 50–59 years, 60–69 years, 70–79 years, and 80- years. According to the highest education obtained, participants also were categorized into 6 groups: no formal education, primary school uncompleted, primary school completed, secondary school completed, high school completed, and college or above. Marital status was dichotomized into two groups including married (currently married or cohabited) and unmarried (never married, divorced, separated, and widowed). The locality was grouped into two categories including rural and urban areas based on the participants’ address at which the data was collected. Household income was categorized into 5 quintiles depended on dwelling characteristics and asset possessions calculated by principle components analysis provided by the data [45].

Seven common chronic diseases including angina, stroke, diabetes, chronic lung diseases, asthma, hypertension, and depression were assessed through self-report. Participants were asked, “ have you ever been diagnosed with the above chronic conditions?” The answers were yes or no. A total number of chronic diseases was calculated.

Smoking status was measured by two questions: “Do you ever smoked tobacco or used smokeless tobacco? (yes or no)” and “Do you currently use any tobacco products such as cigarettes, cigars, pipes, chewing tobacco or snuff? (yes daily; yes, not daily; no, not at all)”. Based on the two questions participants were categorized into four groups: non-smoker, former smoker, current smoker (not daily), and current smoker (daily).

Method of analysis

Statistic analyses were operated in Stata SE version 16.0 (Stata Corp, College Station, TX). The weights calculated by selection probability and post-stratification were standardized by dividing each weight by the mean weights of the sample. The commands “svy” of Stata were used to incorporate weight into the analysis. Descriptive statistic was used to describe the characteristics of the study population, including age, sex, residence locality, educational level, marital status, household income, behavioral factors, and chronic health conditions, adjusted by standardized weights. A 2-level random intercept, fixed slope multilevel logistic model was used to evaluate the association between two dimensions of social capital and edentulism. Crude odds ratios were calculated by univariate multilevel logistic analysis. A conceptual model based on Rouxel [46] and Watt [47] was developed to test association between social capital and edentulism in Fig. 1. A series of multilevel logistic models were established. Initially, we included community level social capital (model 1), then we added individual level social capital (model 2), followed by adjusting for potential confounders (model 3), and, finally, we included a potential mediator, oral health-related behaviour (smoking), in model 4. The Statistic analysis were estimated with a 95% confidence interval. A significant level was set at p value \(<0.05\).

Fig. 1
figure 1

Conceptual model of individual and community social capital on edentulism

Ethical consideration

SAGE was approved by the Ethical Review Board of WHO (RPC146), and the ethical review committee of China (approval notice 200601). Informed consent was obtained from all participants.

Results

The socioeconomic, demographic, behavioral characteristics, and chronic health condition of the study sample were illustrated in Table 1. A total of 12,856 individuals aged 50 and above were included in the analysis. The overall average age of 12,856 respondents in 127 communities was 63.0 (standard deviation; 9.3) years old. The overall prevalence of participants being edentulate was 9.1% (95% CI 8.3–10.0). The majority of the participants of the sample population were between 50 to 69 years old (77.3%), currently married (85.4%), completed primary school and above (58.7%), never smoker (64.1%), and never drinker (66%), sufficient fruit or vegetable intaking (90.1%), having no chronic diseases (61%). Nearly half (47.6%) of the participants lived in urban areas. The proportion of highest and lowest wealth quintile were, respectively, 21.9% and 16.1%.

Table 1 Sociodemographic characteristics of the study population (n = 12,856)

Table 2 shows the distribution of edentulism and the crude odds ratio of covariables for edentulism. Descriptive statistics show that the prevalence of edentulism is higher among females (10.1%) than males (8.0%). The age group 80+ has the highest prevalence of edentulism (37.1%). Those living in rural areas (10.4%) have higher prevalence of edentulism than those living in urban areas (7.6%). Compared with those married (7.6%), those unmarried (17.6%) have higher prevalence of edentulism. Those have lower educational level and in lower household income quintile have higher prevalence of edentulism than the counterpart. Crude odds ratio of covariables (Table 2) were calculated by univariate multilevel logistic regression analysis. The crude odds ratio of covariates identified variables that were associated with edentulism. Edentulism was significantly associated with being females, oldest age group, no formal education, unmarried, lowest household income, living in rural area, smoking, and having one chronic diseases.

Table 2 Distribution of covariables by edentate status and crude odds ratio of covariables for edentulism (n = 12,856)

Table 3 shows crude odds ratio of social capital variables for edentulism calculated by uni-variate multilevel logistic regression. At individual level lowest cognitive and structural social capital was,respectively, associated with 1.34 (95% CI 1.08–1.67) and 2.44 (95% CI 1.92–3.11) times higher odds of edentulism compared with highest social capital group. At community level, lowest cognitive and structural social capital was, respectively, associated with 1.18 (95% CI 0.83–1.66) and 1.81 (95% CI 1.28–2.58) times higher odds of edentulism compared with highest social capital group. Table 4 shows adjusted and unadjusted odds ratio of social capital variables for edentulism. Model 0 was a null model including no explanatory variable, which is baseline for community differences. In model 1, community-level social capital was included, individuals living in low structural social capital areas have higher odds for edentulism. In model 2, individual and community level social capital was included. Individual-level low structural social capital was significantly associated with edentulism with odds of 2.39 (95% CI 1.86–3.08). No significant association was found between community social capital variables, individual cognitive social capital and edentulism. After adjusting for potential confounders (model 3), including socioeconomic factor, demographic factors and chronic condition, only structural dimension of individual and community social capital were significantly associated with edentulism, the odds were respectively, 1.54 (95% CI 1.18–2.02) and 2.11 (95% CI 1.45–3.07). In the final model (model 4), further include a potential mediator (smoking), the structural dimension of both level social capital is still significantly associated with edentulism. The intraclass correlation for model 0 was 13.53%, which indicated that 13.53% of individual health variance was attributable to the community differences. After adjusting for all explanatory variables in final model, intraclass correlation reduced to 10.93%, indicating the model fits better.

Table 3 Crude odds ratios (OR) of social capital variables for edentulism
Table 4 Multilevel logistic regression model for edentulism unadjusted and adjusted by covariates

Discussion

The present study investigated the association of cognitive and structural social capital at both individual- and community-level and edentulism among adults aged 50 and over in China. After adjusting for potential confounders and a potential mediator, individual with low structural social capital and living in areas with low structural social capital was independently associated with higher odds for edentulism. While cognitive dimension social capital was not associated with edentulism in this study. The result indicates that the structural dimension of social capital has a larger influence on edentulism than the cognitive dimension among Chinese adults aged 50 years and over.

At the individual level, the result of the association between structural social capital and edentulism is consistent with the previous study by Rouxel et al, who conducted a cross-sectional study of 8552 individuals aged 50 years and older in the English population and found that structural social capital—as measured by volunteer status and membership in organizations—was associated with edentulism [40]. Also, a cross-sectional study conducted in Korea found that having less than one general social network (structural social capital) was associated with higher risk of poor chewing ability among the old population aged 70 and over in the rural area. Also, other studies that didn’t differentiate the cognitive and structural social capital found a consistent association between individual structural social capital and the oral health measured by number of remaining teeth [17, 43, 48, 49]. Despite these studies used different measurements for structural social capital, their findings are consistent. This study didn’t find an association between individual cognitive social capital and edentulism. However, cognitive social capital is often associated with subjective oral health indicators reported by other studies, such as self-reported oral health [18, 40, 50]. This inconsistency in the association between individual cognitive social capital and oral health might be that cognitive social capital impact oral health through psychosocial pathway and was suggested affect individual’s subjective health (e.g. self-reported oral health), rather than objective oral health measurement (e.g. edentulism).At community level, the present study found that it is the structural dimension of social capital, not the cognitive dimension, is associated with higher odds of edentulism. This finding is also consistent with a previous study. Koyama and colleagues conducted a longitudinal cohort study on community social capital and tooth loss and found that civic participation at baseline is associated with dental loss among Japanese older adults, but not community trust and attachment [17].

The mechanism between social capital and health is not fully understood. There are several hypothesized ways linking social capital and oral health that may explain our findings. Firstly, social capital may impact oral health through a psychosocial pathway, and it has been reported that individual with lower social capital is vulnerable to psychosocial stressors, thus, deteriorate immune system and ability of the body to defence oral bacteria [51]. Also, psychosocial stressors may trigger coping mechanisms related to health-compromising behaviors which increase the risk of dental caries and periodontal diseases, such as, smoking, eating sweet food, drinking alcohol [52]. In addition, social capital can impact oral health through increasing access to dental health care. For example, friends or family members could help to drive them to a hospital or make a dental appointment for them. Moreover, at community level, individuals can benefit from being members of a community. A closely connected community has high level of collective efficiency, which can promote collective action. For example, lobby local authorities for increasing access to health care. Another group-level mechanism is informal social control, which is the ability of a community to maintain social order. In a cohesive community, members are more likely to intervene when witnessing misbehavior, such as health-compromising behavior. Moreover, community social capital can impact health through social contagion. For instance, oral health-related information or behavior norms spread more quickly in a tight-knit community.

In the theoretical framework, oral health related behaviour, smoking, was included as a potential mediator. Previous studies found that social capital is associated with smoking [53]. In our study, smoking is significantly associated with edentulism in the final model. Also, smoking was found a strong association with oral health reported by other study [54]. Thus, these associations suggested the potential mediator effect of smoking on association between social capital and oral health. Besides, other oral health related behaviors, like eating sweet and access to dental health care also are potential mediators of interest. Future studies are needed to further explore their mediator effect to better understand the mechanism between social capital and oral health.

This study have explored the association of cognitive and structural dimensions of social capital and oral health in Chinese context. It is important to understand the influence of social capital in the Chinese context. Firstly, as a result of dental health care is expensive in China, and most of the cost is not covered by medical insurance, which increase the importance of the role of social capital. In addition, due to high state ownership in China, government officials in China have control on more resources than those in other countries, which means that having relationship with government officials may receive more potential benefit [55]. Lastly and most importantly, China had long time implemented “one child policy”, which increased the number of older population living alone and reduced the number of close ties (having one child) of older population [56]. Those unique context make China an important research object. Despite this study have explored association between cognitive and structural dimension social capital and edentulism. It is also important to understand the influence of other forms of social capital in the Chinese context. For example, some studies found that different dimensions of social capital play a different role in oral health. For example, in Japan, a cross-sectional study found that horizontal social capital, which refers to relationship ties that exist among equal individual or groups who have equal or similar access to power or resources, play a more important role in oral health among the old population than vertical social capital [43]. Moreover, a cross-sectional study of 967 students aged 18 and 19 years showed that it was vertical trust (trust between students and teachers), but not horizontal trust (trust between students), was associated with poor self-reported oral health [57]. Additionally, among the Brazilian population, a multilevel cross-sectional study found that bonding social capital was associated with dental pain, but not bridging social capital [44]. Understanding which form of social capital has a more important effect on oral health can help to develop a more effective intervention for oral health.

One strength of the present study is that we both assessed individual- and community-level social capital using multilevel perspective. Social capital is both characteristics of individual and community [38]. An individual can mobilize community resources through their individual network. Another strength of the study is that it used a relatively large sample size and the data were nationally representative of community-dwelling aged 50 and above in China. In addition, the data was face-to-face collected using a valid questionnaire. The questionnaire had been tested by a polit study in three developing countries (Ghana, India and the Republic of Tanzania) and performed well with good face validity [58]. However, there were some limitations of the study. First, it was a cross-sectional study. We don’t know temporal sequencing of social capital and edentulism. Thus, we can not make a causal inference. In addition, we can not rule out reverse causality between social capital and edentulism. For example, edentulism may lead to health selection. Individuals with bad oral health may reduce social participation due to embarrassment caused by teeth. A future prospective study is needed to further explore the relationship between social capital and oral health. Second, information on use of prosthesis was lacking in SAGE data, which might be a potential factor that affect social participation. Future study is needed to take into account the use of prosthesis of edentulism individuals. In addition, information on edentulism was collected by self-report which may introduce information bias and social desirability bias. However, edentulism is not a sensitive issue in aged 50 and older adults in Chinese population and collected face-to-face by well-trained interviewers. The bias was considered to be minimal in our study. Third, the questions used for measurement of social capital may not have captured the whole dimension of social capital, because of the concept of social capital is still controversary, which inevitably result in divergent measurements and controversial operationalisations. Despite there is no best measurement for social capital, we used measurement commonly used by previous studies (social participation, trust, safety) [59]. The internal consistency of the scales we used for measuring social capital was not perfect, but was adequate with a value of Cronbach alpha above 0.6 [60]. Fourth, the measurement of individual-level trust in the present study, which is commonly used by previous studies for measurement of social capital [59], cannot distinguish between the actual trustworthiness of others and an individual’s tendency to trust others. We were interested in whether interpersonal trust or a trustworthy environment have a protective effect on oral health, not an individual’s tendency to trust. Thus, an individual’s variance of the tendency to trust may have biased the result of the study. Finally, the construction of community variables from individual level is one limitation. Community level social capital were measured by aggregating data, which may risk multilinearity due to variables were from same data source. Mean centering was used in our study to reduce multilinearity caused by aggregating data.

Conclusions

This study evaluates the association of both cognitive and structural dimensions of social capital and edentulism at both individual- and community-level. It provides evidence that individual-level social capital and community-level social capital were independently associated with edentulism among the old adults in China. Individuals with low structural social capital and living in low structural social capital areas have higher risk for edentulism. In addition, the structural dimension of social capital may play a more important role in edentulism among adults aged 50 yearrs and over in China. Due to the protective role in health, social capital can be considered as a potential tool to promote oral health among Chinese population.

Availability of data and materials

The datasets supporting the conclusions of this article are available upon request in the website of WHO (https://apps.who.int/healthinfo/systems/surveydata/index.php/catalog/13).

Abbreviations

SAGE:

Study on Global AGEing and Adult Health

WHO:

World Health Organisation

CI:

Confidence interval

OR:

Odds ratio

References

  1. Bernabe E, et al. Global, regional, and national levels and trends in burden of oral conditions from 1990 to 2017: a systematic analysis for the global burden of disease 2017 study. J Dent Res. 2020;99(4):362–73. https://doi.org/10.1177/0022034520908533.

    Article  PubMed  Google Scholar 

  2. Si Y, et al. Oral health status of Chinese residents and suggestions for prevention and treatment strategies. Global Health J. 2019;3(2):50–4. https://doi.org/10.1016/j.glohj.2019.06.004.

    Article  Google Scholar 

  3. National Health and Family Planning Commission: Press Conference on the results Obtained from the 4th national oral health epidemiology survey 2017 (2017). https://bit.ly/3goO89k

  4. Edman K, Holmlund A, Norderyd O. Caries disease among an elderly population—a 10-year longitudinal study. Int J Dental Hygiene. 2021;19(2):166–75. https://doi.org/10.1111/idh.12490.

    Article  Google Scholar 

  5. George A, Villarosa AR, Ingram S, Fatema K, Elliott K, Grace R, Kemp L, Scharkie S, Anderson C, Bucknall N, Wright DC, Comino E. Oral health status, behaviours, food and beverage consumption of aboriginal children in Australia. Health Promot J Aust. 2021;32(2):208–15. https://doi.org/10.1002/hpja.354.

    Article  Google Scholar 

  6. Selva Süme Keşir S, Ebru Olgun H. Smoking and periodontal health. Curr Oral Health Rep. 2018;5(1):50–62. https://doi.org/10.1007/s40496-018-0170-6.

    Article  Google Scholar 

  7. Abu-Gharbieh E, Saddik B, El-Faramawi M, Hamidi S, Basheti M. Oral health knowledge and behavior among adults in the United Arab Emirates. Biomed Res Int. 2019;2019:7568679. https://doi.org/10.1155/2019/7568679.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Yuen HK, Wolf BJ, Bandyopadhyay D, Magruder KM, Salinas CF, London SD. Oral health knowledge and behavior among adults with diabetes. Diabetes Res Clin Pract. 2009;86(3):239–46. https://doi.org/10.1016/j.diabres.2009.09.010.

    Article  PubMed  PubMed Central  Google Scholar 

  9. World Health Organization: A Conceptual Framework for Action on the Social Determinants of Health. https://bit.ly/3gSQOLv

  10. Putnam R. Bowling alone: the collapse and revival of American community. New York: Simon and Schuster; 2000.

    Google Scholar 

  11. Islam MK, Merlo J, Kawachi I, Lindström M, Gerdtham U-G. Social capital and health: does egalitarianism matter? a literature review. Int J Equity Health. 2006. https://doi.org/10.1186/1475-9276-5-3.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Himanshu H, Arokiasamy P, Talukdar B. Illustrative effects of social capital on health and quality of life among older adult in India: results from who-sage India. Arch Gerontol Geriatr. 2019;82:15–21. https://doi.org/10.1016/j.archger.2019.01.005.

    Article  PubMed  Google Scholar 

  13. Amegbor PM, Braimah JA, Adjaye-Gbewonyo D, Rosenberg MW, Sabel CE. Effect of cognitive and structural social capital on depression among older adults in Ghana: a multilevel cross-sectional analysis. Arch Gerontol Geriatr. 2020;89:104045. https://doi.org/10.1016/j.archger.2020.104045.

    Article  PubMed  Google Scholar 

  14. Pattussi MP, Hardy R, Sheiham A. The potential impact of neighborhood empowerment on dental caries among adolescents. Commun Dent Oral Epidemiol. 2006;34(5):344–50. https://doi.org/10.1111/j.1600-0528.2006.00283.x.

    Article  Google Scholar 

  15. Pattussi MP, Hardy R, Sheiham A. Neighborhood social capital and dental injuries in Brazilian adolescents. Am J Public Health. 2006;96(8):1462–8. https://doi.org/10.2105/AJPH.2005.066159.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Tsakos G, Sabbah W, Chandola T, Newton T, Kawachi I, Aida J, Sheiham A, Marmot MG, Watt RG. Social relationships and oral health among adults aged 60 years or older. Psychosom Med. 2013;75(2):178–86. https://doi.org/10.1097/PSY.0b013e31827d221b.

    Article  PubMed  Google Scholar 

  17. Koyama S, Aida J, Saito M, Kondo N, Sato Y, Matsuyama Y, Tani Y, Sasaki Y, Kondo K, Ojima T, Yamamoto T, Tsuboya T, Osaka K. Community social capital and tooth loss in Japanese older people: a longitudinal cohort study. BMJ Open. 2016. https://doi.org/10.1136/bmjopen-2015-010768.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Rouxel P, Tsakos G, Demakakos P, Zaninotto P, Chandola T, Watt RG. Is social capital a determinant of oral health among older adults? Findings from the English longitudinal study of ageing. PLoS ONE. 2015. https://doi.org/10.1371/journal.pone.0125557.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Santoso CMA, Bramantoro T, Nguyen MC, Bagoly Z, Nagy A. Factors affecting dental service utilisation in Indonesia: a population-based multilevel analysis. Int J Environ Res Public Health. 2020;17(15):1–11. https://doi.org/10.3390/ijerph17155282.

    Article  Google Scholar 

  20. Pengpid S, Peltzer K. The prevalence of edentulism and their related factors in Indonesia, 2014/15. BMC Oral Health. 2018. https://doi.org/10.1186/s12903-018-0582-7.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Olutola BG, Ayo-Yusuf OA. Socio-environmental factors associated with self-rated oral health in South Africa: a multilevel effects model. Int J Environ Res Public Health. 2012;9(10):3465–83. https://doi.org/10.3390/ijerph9103465.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Kim EK, Jung YS, Kim KH, Kim KR, Kwon GH, Choi YH, Lee HK. Social capital and oral health: the association of social capital with edentulism and chewing ability in the rural elderly. Arch Gerontol Geriatr. 2018;74:100–5. https://doi.org/10.1016/j.archger.2017.10.002.

    Article  PubMed  Google Scholar 

  23. Kumar YS, Rakesh PS, Kalyana-Chakravarthy P, Vijay Kumar S. Relationship between dental caries experience and social capital among children-a pilot study. Indian J Commun Med. 2019;44(5):3–6. https://doi.org/10.4103/ijcm.IJCM_11_19.

    Article  Google Scholar 

  24. Bai Z, Wang Z, Shao T, Qin X, Hu Z. Association between social capital and loneliness among older adults: a cross-sectional study in Anhui province, china. BMC Geriatrics. 2021. https://doi.org/10.1186/s12877-020-01973-2.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Jiang D, Hou Y, Hao J, Zhou J, Jiang J, Wang Q. Association between personal social capital and loneliness among widowed older people. Int J Environ Res Public Health. 2020;17(16):1–11. https://doi.org/10.3390/ijerph17165799.

    Article  Google Scholar 

  26. Xu W, Sun H, Zhu B, Yu X, Niu Y, Kou C, Li W. The prevalence of depressive symptoms and its determinants among adults in mainland china: results from a national household survey. J Affect Disord. 2021;281:220–7. https://doi.org/10.1016/j.jad.2020.12.009.

    Article  PubMed  Google Scholar 

  27. Zhu W, Li H, Wang X, Mao C. Social capital and depression among migrant hypertensive patients in primary care. J Am Soc Hypertens. 2018;12(8):621–6. https://doi.org/10.1016/j.jash.2018.06.006.

    Article  PubMed  Google Scholar 

  28. Sun J, Xiao T, Lyu S, Zhao R. The relationship between social capital and depressive symptoms among the elderly in china: the mediating role of life satisfaction. Risk Manag Healthcare Policy. 2020;13:205–13. https://doi.org/10.2147/RMHP.S247355.

    Article  Google Scholar 

  29. Li W, Sun H, Xu W, Ma W, Yuan X, Niu Y, Kou C. Individual social capital and life satisfaction among mainland Chinese adults: based on the 2016 China family panel studies. Int J Environ Res Public Health. 2021;18(2):1–14. https://doi.org/10.3390/ijerph18020441.

    Article  Google Scholar 

  30. Zhang J, Xu S, Lu N. Community-based cognitive social capital and self-rated health among older Chinese adults: the moderating effects of education. Int J Environ Res Public Health. 2019. https://doi.org/10.3390/ijerph16152741.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Lu N, Zhang J. Social capital and self-rated health among older adults living in urban China: a mediation model. Sustainability (Switzerland). 2019. https://doi.org/10.3390/su11205566.

    Article  PubMed Central  Google Scholar 

  32. Gu J, Zhu R. Social capital and self-rated health: empirical evidence from china. Int J Environ Res Public Health. 2020;17(23):1–15. https://doi.org/10.3390/ijerph17239108.

    Article  Google Scholar 

  33. Sun Q, Lu N. Social capital and mental health among older adults living in urban China in the context of Covid-19 pandemic. Int J Environ Res Public Health. 2020;17(21):1–11. https://doi.org/10.3390/ijerph17217947.

    Article  Google Scholar 

  34. Han J, Jia P, Huang Y, Gao B, Yu B, Yang S, Yu J, Xiong J, Liu C, Xie T, Dong P, Yang C, Wang Z, Yang S. Association between social capital and mental health among older people living with HIV: The Sichuan older HIV-infected cohort study (sohics). BMC Public Health. 2020. https://doi.org/10.1186/s12889-020-08705-6.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Yang Y, Wang S, Chen L, Luo M, Xue L, Cui D, Mao Z. Socioeconomic status, social capital, health risk behaviors, and health-related quality of life among Chinese older adults. Health Quality Life Outcomes. 2020. https://doi.org/10.1186/s12955-020-01540-8.

    Article  Google Scholar 

  36. Gao B, Yang S, Liu X, Ren X, Liu D, Li N. Association between social capital and quality of life among urban residents in less developed cities of Western China. Medicine (United States). 2018. https://doi.org/10.1097/MD.0000000000009656.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Jiang N, Wu B, Lu N, Dong T. Neighborhood-based social capital and cognitive function among older adults in five low- and middle-income countries: evidence from the world health organization study on global ageing and adult health. Int J Geriatr Psychiatry. 2020;35(4):365–75. https://doi.org/10.1002/gps.5239.

    Article  PubMed  Google Scholar 

  38. Kawachi I, Berkman LF. Social capital, social cohesion and health. 2nd ed. Oxford: Oxford University Press; 2014.

    Google Scholar 

  39. Giordano GN, Lindström M. Social capital and change in psychological health over time. Soc Sci Med. 2011;72(8):1219–27. https://doi.org/10.1016/j.socscimed.2011.02.029.

    Article  PubMed  Google Scholar 

  40. Rouxel P, Tsakos G, Demakakos P, Zaninotto P, Watt RG. Social capital and oral health among adults 50 years and older. Psychosom Med. 2015;77(8):927–37. https://doi.org/10.1097/psy.0000000000000197.

    Article  PubMed  Google Scholar 

  41. Wu F, Yong J, Keqin R, Juncheng Q, Xinjian L, Shaoxu Y, Ye L, Jiying X, Guo Y, Yang Z, Tao C, Zongqi Z, Guixiang S, Naidoo N, Kowal P. China: Study on global ageing and adult health (sage) wave 1 national report. (2015). https://doi.org/10.13140/RG.2.1.1507.7287

  42. Lagaert S, Snaphaan T, Vyncke V, Hardyns W, Pauwels LJR, Willems S. A multilevel perspective on the health effect of social capital: evidence for the relative importance of individual social capital over neighborhood social capital. Int J Environ Res Public Health. 2021;18(4):1526. https://doi.org/10.3390/ijerph18041526.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Aida J, Hanibuchi T, Nakade M, Hirai H, Osaka K, Kondo K. The different effects of vertical social capital and horizontal social capital on dental status: a multilevel analysis. Soc Sci Med. 2009;69(4):512–8. https://doi.org/10.1016/j.socscimed.2009.06.003.

    Article  PubMed  Google Scholar 

  44. Santiago BM, Valença AMG, Vettore MV. Social capital and dental pain in Brazilian Northeast: a multilevel cross-sectional study. BMC Oral Health. 2013. https://doi.org/10.1186/1472-6831-13-2.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Ferguson B, Tandon A, Gakidou E, Murray C. Estimating permanent income using indicator variables. Health Systems Performance Assessment: Debates, Methods and Empiricism; 2010.

  46. Rouxel PL, Heilmann A, Aida J, Tsakos G, Watt RG. Social capital: theory, evidence, and implications for oral health. Commun Dent Oral Epidemiol. 2015;43:97–105.

    Article  Google Scholar 

  47. Watt A, Sheiham RG. Integrating the common risk factor approach into a social determinants framework. Commun Dent Oral Epidemiol. 2012;40:289–96.

    Article  Google Scholar 

  48. Aida J, Kuriyama S, Ohmori-Matsuda K, Hozawa A, Osaka K, Tsuji I. The association between neighborhood social capital and self-reported dentate status in elderly Japanese—the Ohsaki cohort 2006 study. Commun Dent Oral Epidemiol. 2011;39(3):239–49. https://doi.org/10.1111/j.1600-0528.2010.00590.x.

    Article  Google Scholar 

  49. Takeuchi K, Aida J, Kondo K, Osaka K. Social participation and dental health status among older Japanese adults: a population-based cross-sectional study. PLoS ONE. 2013;8(4):61741. https://doi.org/10.1371/journal.pone.0061741.

    Article  Google Scholar 

  50. Amaral Júnior OL, Menegazzo GR, Fagundes MLB, Campagnol PB, Giordani JMDA. Social capital and self’ reported oral health at baseline of the Brazilian longitudinal study of aging. Commun Dent Oral Epidemiol. 2020. https://doi.org/10.1111/cdoe.12596.

  51. Boyce WT, Den Besten PK, Stamperdahl J, Zhan L, Jiang Y, Adler NE, Featherstone JD. Social inequalities in childhood dental caries: the convergent roles of stress, bacteria and disadvantage. Soc Sci Med. 2010;71(9):1644–52. https://doi.org/10.1016/j.socscimed.2010.07.045.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Pohjola V, Nurkkala M, Virtanen JI. Psychological distress, oral health behaviour and related factors among adolescents: finnish school health promotion study. BMC Oral Health. 2021. https://doi.org/10.1186/s12903-020-01357-3.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Åslund C, Nilsson KW. Social capital in relation to alcohol consumption, smoking, and illicit drug use among adolescents: a cross-sectional study in Sweden. Int J Equity Health. 2013;12:33.

    Article  Google Scholar 

  54. Johnson GK, Hill M. Cigarette smoking and the periodontal patient. J Periodontol. 2004;75:196–209.

    Article  Google Scholar 

  55. Zhang H, Han R, Wang L, Lin R. Social capital in China: a systematic literature review. Asian Bus Manag. 2021;20(1):32–77. https://doi.org/10.1057/s41291-019-00081-3.

    Article  Google Scholar 

  56. Pletcher K. one-child policy: Encyclopedia Britannica. https://bit.ly/3gAwqP0

  57. Furuta M, Ekuni D, Takao S, Suzuki E, Morita M, Kawachi I. Social capital and self-rated oral health among young people. Commun Dent Oral Epidemiol. 2012;40(2):97–104. https://doi.org/10.1111/j.1600-0528.2011.00642.x.

    Article  Google Scholar 

  58. Kowal P, Biritwum R, Haldia K, Isingo R, Kumoogola Y, Mathur A, Naidoo N, Urassa M, Chatterji S. WHO Study on global AGEing and adult health (SAGE): summary results of a pilot (2005) in three countries. SAGE Working Paper No. 2. Geneva: Switzerland; 2012. (2015). https://doi.org/10.13140/RG.2.1.1998.0640

  59. Villalonga-Olives E, Kawachi I. The measurement of social capital. Gac Sanit. 2015;29(1):62–4. https://doi.org/10.1016/j.gaceta.2014.09.006.

    Article  PubMed  Google Scholar 

  60. Taber KS. The use of cronbach’s alpha when developing and reporting research instruments in science education. Res Sci Educ. 2018;48(6):1273–96. https://doi.org/10.1007/s11165-016-9602-2.

Download references

Acknowledgements

This paper uses data from WHO’s Study on Global Ageing and Adult Health (SAGE). SAGE is supported by the US National Institute on Aging through Interagency Agreements OGHA 04034785; YA1323-08-CN-0020; Y1-AG-1005-0) and through research Grants R01-AG034479 and R21-AG034263.Grant from Ribbingska Minnesfonden (JMJ).

Funding

Open access funding provided by University of Gothenburg. Open access funding provided by University of Gothenburg. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors

Author information

Authors and Affiliations

Authors

Contributions

SL, JMJ conceived the study. SL performed data analysis and wrote draft manuscript. YG instructed the methods and strategies of statistical analysis. YG, JMJ checked the data analysis, reviewed and revised the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Suyang Li.

Ethics declarations

Ethics approval and consent to participate

SAGE was approved by the Ethical Review Board of WHO (RPC146), and the ethical review committee of China (approval notice 200601). All study procedures were conducted in accordance with the ethical standards of the Declaration of Helsinki. The study is based on the publically available dataset SAGE, which does not have any identifiable information on survey participants. Hence, no ethical approval or informed consent is needed for the present study.

Consent for publication

Not applicable. No personal information was provided in this paper.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Li, S., Guo, Y. & Miao Jonasson, J. Association between social capital and oral health among adults aged 50 years and over in China: a cross-sectional study. BMC Oral Health 22, 68 (2022). https://doi.org/10.1186/s12903-022-02102-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12903-022-02102-8

Keywords

  • Ageing
  • Social capital
  • Oral health
  • Edentulism