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Abstract

Objective: This thesis investigated oral health equity among middle-aged and older adults using two complementary studies: a scoping review and a secondary data analysis. The first study examined how oral health equity has been conceptualized and measured globally. The second identified key predictors of oral health among aging Canadians using longitudinal data, focusing on patterns of (in)equity over time. Methods: For the scoping review, 10,101 records were identified through comprehensive searches in databases such as MEDLINE and Embase; 25 studies were included. We examined equity definitions, measurement approaches, and how aging-related (in)equities were considered. The second study consisted of a secondary analysis of data from the Canadian Longitudinal Study on Aging involving 50,000 participants across three time points between 2011 and 2021. Random Forest models were applied at each time point to identify top predictors of self-perceived oral health (SPOH), which were then examined to explore their variation over time and implications for (in)equity. Results: The scoping review found that while many studies defined oral health equity in terms of fairness and social justice, most operationalized it through the principle of “equal care for equal need,” using the Horizontal Inequity index. Nearly all included studies focused on dental care utilization, with limited attention to oral health outcomes or distinguishing age-related decline from inequity. Of the 50,000 CLSA participants, a secondary analysis of 38,527 found that age, income, education, dental insurance, mortgage status, and financial barriers consistently emerged as key predictors of SPOH. Oral health declined over the ten-year period. Individuals with higher income and education were better protected against this decline. Financial barriers remained low across all income groups, suggesting other systemic barriers beyond affordability, likely reflecting a biased and non-representative sample. Conclusion: The scoping review showed variation in how equity is defined but a common reliance on how it has been measured. Few studies used oral health outcomes, and none addressed aging-specific inequities. The secondary analysis revealed persistent structural barriers among Canadian adults, albeit different from similar studies. Nonetheless, these findings underscore the need for equity frameworks that address quality, availability, and lifelong disadvantage, not just affordability.