• Carol C Guarnizo-Herreño, Georgios Tsakos, Aubrey Sheiham, Michael G Marmot, Ichiro Kawachi, and Richard G Watt.
• Department of Epidemiology and Public Health, University College London, London WC1E 7HB, UK Departamento de Salud Colectiva, Facultad de Odontología, Universidad Nacional de Colombia, Bogotá, Colombia c.guarnizo-herreno.11@ucl.ac.uk.
• BMJ. 2015 Jan 1;351:h6543.

ObjectiveTo compare oral health in the US and England and to assess levels of educational and income related oral health inequalities between both countries.DesignCross sectional analysis of US and English national surveys.SettingNon-institutionalised adults living in their own homes.ParticipantsOral health measures and socioeconomic indicators were assessed in nationally representative samples: the Adult Dental Health Survey 2009 for England, and the US National Health and Nutrition Examination Survey 2005-08. Adults aged ≥25 years were included in analyses with samples of 8719 (England) and 9786 (US) for analyses by education, and 7184 (England) and 9094 (US) for analyses by income.Main Outcome MeasuresNumber of missing teeth, self rated oral health, and oral impacts on daily life were outcomes. Educational attainment and household income were used as socioeconomic indicators. Age standardised estimates of oral health were compared between countries and across educational and income groups. Regression models were fitted, and relative and absolute inequalities were measured using the relative index of inequality (RII) and the slope index of inequality (SII).ResultsThe mean number of missing teeth was significantly higher in the US (7.31 (standard error 0.15)) than in England (6.97 (0.09)), while oral impacts were higher in England. There was evidence of significant social gradients in oral health in both countries, although differences in oral health by socioeconomic position varied according to the oral health measure used. Consistently higher RII and SII values were found in the US than in England, particularly for self rated oral health. RII estimates for self rated oral health by education were 3.67 (95% confidence interval 3.23 to 4.17) in the US and 1.83 (1.59 to 2.11) in England. In turn, SII values were 42.55 (38.14 to 46.96) in the US and 18.43 (14.01 to 22.85) in England.ConclusionsThe oral health of US citizens is not better than the English, and there are consistently wider educational and income oral health inequalities in the US compared with England.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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