How do state-level racism, sexism, and income inequality shape edentulism-related racial inequities in contemporary United States? A structural intersectionality approach to population oral health.

OBJECTIVE: Research on racial oral health inequities has relied on individual-level data with the premise being that the unequal distribution of dental diseases is an intractable problem. We address these insufficiencies by examining the relationships between structural racism, structural sexism, state-level income inequality, and edentulism-related racial inequities according to a structural intersectionality approach. METHODS: Data were from two sources, the 2010 survey of the U.S. Behavioral Risk Factor Surveillance System, and Patricia Homan et al.'s (2021) study on the health impacts from interlocking systems of oppression. While the first contains information on edentulism from a large probabilistic sample of older (65+) respondents, the second provides estimates of racism, sexism, and income inequality across the US states. Taking into account a range of individual characteristics and contextual factors in multilevel models, we determine the extent to which structural forms of marginalization underlie racial inequities in edentulism. RESULTS: Our analysis reveals that structural racism, structural sexism, and state-level income inequality are associated with the overall frequency of edentulism and the magnitude of edentulism-related racial inequities, both individually and intersectionally. Coupled with living in states with both high racism and sexism (but not income inequality), the odds of edentulism were 60% higher among non-Hispanic Blacks, relative to Whites residing where these structural oppressions were at their lowest. CONCLUSIONS: These findings provide evidence that racial oral health inequities cannot be disentangled from social forces that differentially allocate power and resources among population groups. Mitigating race-based inequities in oral health entails dismantling the multifaceted systems of oppression in the contemporary U.S. society.