Living alone and oral health disparities in Chinese older adults: a national cross-sectional study

With China’s rapidly aging population, the oral health of older adults living alone has become a growing concern due to their limited social support and potential health disparities. This study aimed to compare oral health status between Chinese adults aged 65–74 living alone versus those cohabiting with others and identify factors associated with oral health disparities. A cross-sectional analysis utilized data from China’s 4th National Oral Health Survey, including 4,406 participants (312 living alone; 4,094 cohabiting). Oral examinations assessed caries, periodontal status, and tooth loss; structured questionnaires captured demographics, socioeconomic status, behaviors, and self-perceived oral health. The survey was conducted according to the basic methods proposed by the World Health Organization (WHO). Older adults living alone (7.1%) showed worse oral health: higher caries prevalence (83.01% vs. 76.26%), more tooth loss (8.26 vs. 6.76), less occluding pairs (6.85 vs. 8.14), lower oral health knowledge scores (5.88 ± 2.51 vs. 6.32 ± 2.31), and worse self-perceived oral health (P < 0.05). Regression confirmed living situation, age, gender, education, income, area, smoking and drinking alcohol as key predictors of oral health outcomes (P < 0.05). Oral health is significantly poorer among Chinese seniors living alone and is significantly associated with socioeconomic and behavioral factors. Targeted interventions—including enhanced social support, financial aid, and oral health education—are urgently needed for this vulnerable group.