Disparities in oral health by immigration status in the United States

Background: Few investigators have explored differences in oral health status between immigrants and natives. To address this gap, the authors used nationally representative data to characterize disparities in oral health among noncitizens, naturalized citizens, and native adults. Methods: The 2013 to 2014 National Health and Nutrition Examination Survey, a nationally representative in-person survey, provides oral health data for US natives, naturalized citizens, and noncitizens. Univariate and multivariate regression analyses were conducted to compare evidence of caries and periodontal disease, as well as recommendations for oral health care, stratified by immigration status for adults. Results: More than one-half of noncitizens (50.5%) received a diagnosis of periodontal disease, and 38.0% had caries; for natives, these rates were 34.4% and 27.0%, respectively. Differences between natives and naturalized citizens were not statistically significant. After adjusting for age, sex, race or ethnicity, education, poverty, tobacco smoking status, and number of permanent teeth, noncitizens still had 45% higher adjusted odds of periodontal disease and 60% higher odds of receiving recommendations for oral health care than natives. However, differences between noncitizens and natives were no longer important after adjusting for insurance. Conclusions: Noncitizen immigrants reported having substantially poorer oral health than natives in the United States. However, disparities between noncitizens and natives are no longer important when accounting for health insurance. Practical Implications: Although noncitizen adults have a higher likelihood of poor oral health than native adults, having insurance may close this gap. Health care reform initiatives should provide dental benefits for adults to help mitigate the current economic and legal barriers that many immigrants face when accessing oral health care.