The Controlled Direct Effect of Early-Life Socioeconomic Position on Periodontitis in a Birth Cohort.

American Journal of Epidemiology, Oxford University Press (OUP), ISSN 1476-6256

Volume 188, 6, 2019

DOI:10.1093/aje/kwz054, Dimensions: pub.1112418861, PMID: 30834447,



  1. (1) Australian Research Centre for Population Oral Health
  2. (2) University of Adelaide, grid.1010.0
  3. (3) Aarhus University, grid.7048.b, AU
  4. (4) Griffith University, grid.1022.1
  5. (5) Federal University of Pelotas, grid.411221.5


This study used data from the 1982 Pelotas Birth Cohort Study, Brazil, to estimate the controlled direct effect of early-life socioeconomic position (SEP) on periodontitis at age 31 years, controlling for adulthood income and education, smoking, and dental hygiene. Sex was included as a covariate. Early-life SEP was measured at participant birth based on income, health services payment mode, maternal education, height, and skin color (lower versus middle/higher SEP). Periodontitis was assessed through clinical examination at age 31 years (healthy, mild periodontitis, or moderate-to-severe disease). Adulthood behaviors (smoking, dental hygiene) were the mediators, and adulthood SEP (education and income) represented the exposure-induced mediator-outcome confounders. A regression-based approach was used to assess the controlled direct effect of early-life SEP on periodontitis. Multinomial regression models were used to estimate risk ratios and their 95% confidence intervals. The prevalences of mild and moderate-to-severe periodontitis were 23.0% and 14.3%, respectively (n = 539). Individuals from the lowest early-life SEP had a higher risk of moderate-to-severe periodontitis controlled for mediators and exposure-induced mediator-outcome confounders: risk ratio = 1.85 (95% confidence interval: 1.06, 3.24), E value 3.1. We found that early-life SEP was associated with the development of periodontitis in adulthood that was not mediated by adulthood SEP and behaviors.

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