Oral Health and Dental Care Utilization Among Formerly Incarcerated Older Adults in the United States

ABSTRACT. Oral health is a vital component of overall health, especially in older adulthood. Nonetheless, as individuals age into older adulthood, they experience more significant oral health problems and challenges with utilizing dental care. However, there is limited research about how earlier life characteristics, especially stressful experiences, influence older adults' oral health and dental care. A widespread stressful life event in the United States with potentially harmful implications for oral health is incarceration. The United States currently has the highest incarceration rate in the world and has experienced a nearly 300% increase in the incarceration rate of older adults over the past three decades, leaving millions of older adults either currently or formerly incarcerated. Prior research among adolescents and young adults finds incarceration is a risk factor for worse oral health and not utilizing dental care services. However, no previous research has assessed the impact of earlier life incarceration on oral health and dental care among older adults over 50. The proposed study breaks new ground by providing the first comprehensive investigation of the influence of incarceration on the oral health and dental care of older adults in the United States. To study this topic, we will leverage longitudinal data from the Health and Retirement Study (n = 14,293)—the only nationally representative dataset of individuals over 50 in the U.S. with measures of oral health, dental care utilization, and incarceration history. This study has three aims. Aim 1 will examine the association between incarceration history and incarceration duration, with edentulism and dental care utilization, focusing on variations by race and ethnicity, socioeconomic status, and overall health. Aim 2 identifies socioeconomic factors and health behaviors that mediate the relationship between the history of incarceration and edentulism and dental care utilization. Aim 3 uses the longitudinal nature of the Health and Retirement Study from 2014 to 2022 to assess how incarceration history corresponds to trajectories of edentulism and dental care utilization over time. The conclusions of this research can provide an evidence base necessary to understand oral health inequities among formerly incarcerated older adults and spur interventions to connect formerly incarcerated older adults to dental care systems to improve oral health and overall health.