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How Tooth Loss Disrupts the Education Gradient in Mortality Risk among US-Born and Foreign-Born Adults


In this study, we examine the impact of a severe health condition—complete tooth loss—on educational gradients in adult mortality risk among racial/ethnic groups by nativity in the United States. We use the 1999–2014 National Health Interview Survey Linked Mortality File (NHIS-LMF) to estimate Cox proportional hazards models of the risk of death for non-Hispanic White, non-Hispanic Black, and other-Hispanic populations, considering both Mexican-origin and other-Hispanic adults (N = 373,041). We find that although White, Black, and other-Hispanic adults have significant education gradients in mortality risk, these gradients disappear for individuals who have experienced complete tooth loss. Both foreign-born and US-born Mexican adults show no significant relationship between education and mortality risk, regardless of tooth loss status. Our results indicate that policies that focus on preventing tooth loss may be more effective at reducing disparities than those that improve care for adults with existing tooth loss.

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All data used in this study are publicly available. NHIS data are available at


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We acknowledge assistance provided by the Population Research Institute, which is supported by an infrastructure grant by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (P2CHD041025) and by the Pennsylvania State University and its Social Science Research Institute.

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Correspondence to Yuliana Levchenko.

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Levchenko, Y., Fenelon, A. How Tooth Loss Disrupts the Education Gradient in Mortality Risk among US-Born and Foreign-Born Adults. Popul Res Policy Rev 41, 811–823 (2022).

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  • Tooth loss
  • Mortality
  • Migrant oral health
  • Edentulism