Periodontal Disease Among People Living With Diabetes: Examining Social Determinants of Health in an All of Us Study Sample

OBJECTIVES: Approximately 12% of the American population live with a form of diabetes mellitus (DM). People living with DM (PLD) are at a significantly higher risk of developing comorbid conditions, such as periodontal disease (PD). The pathological link between DM and PD is well documented, but the social factors, or social determinants of health (SDH) which may contribute to the link between the diseases are less understood. Our objective is to examine the SDH factors associated with PD among PLD using a national database with the aim of informing intervention strategies for affected subpopulations. METHODS: Utilizing the All of Us national database, we drew a sample of PLD, including those with and without PD, that completed surveys regarding SDH, their overall health, and healthcare utilization. We calculated marginal odds ratios between each variable and PD diagnosis. Analyses were performed using the All of Us Workbench and R 4.3.1. RESULTS: The total cohort consisted of 7971 participants; 342 participants had PD. Significant variables found to increase PLD's risk of PD included male gender, being a current smoker, reporting inability to afford healthcare, and perceived discrimination in healthcare. CONCLUSIONS: Using a large, national cohort, we demonstrate the association between specific SDH and PD among PLD. Our work underscores the importance of considering these variables for intervention strategies and emphasizes the need for preventative oral care programs for PLD.