Examining the associations between oral health and social isolation: A cross-national comparative study between Japan and England

Shihoko Koyama, Masashige Saito, Noriko Cable, Takaaki Ikeda, Taishi Tsuji, Taiji Noguchi, Hazem Abbas, Isao Miyashiro, Ken Osaka, Katsunori Kondo, Richard G. Watt, Jun Aida

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23 Citations (Scopus)


In Western countries, the most important part of the face in communication is the mouth, whereas it is the eyes in Asian countries; thus oral health could be more important in social interactions in Western countries. Our aim was to examine differences in the association between oral health status and social isolation among older people by comparing Japan and England. We used cross-sectional information obtained from adults aged 65+ in two ongoing prospective cohort studies: The Japan Gerontological Evaluation Study (JAGES, N = 120,195) and the English Longitudinal Study of Ageing (ELSA, N = 3,958). The dependent variable, social isolation score (SIS) was calculated from five factors (marital status, social support from children, social support from family, social support from friends, and social participation). The independent variables were self-reported number of remaining teeth (0, 1–9, 10–19, ≥20) and denture use (≥20 teeth, 10–19 teeth with denture, 10–19 teeth without denture, 0–9 teeth with denture, 0–9 teeth without denture), while the covariates in the model were: sex, age, educational attainment, self-rated health, number of comorbidities, household annual equivalized income, mental health status, daily living activities, and smoking status. We examined associations between oral health status and SIS by applying an ordered logit model by country. Compared to England, more Japanese participants were socially isolated (1.4% vs. 5.8%), but fewer were edentulous (13.1% vs. 7.7%). In both countries, poorer oral health further increased the odds of being socially isolated. Pooled analysis of the ordered logit model with an interaction term showed that the association of number of remaining teeth with SIS was stronger in edentulous participants and in England (odds ratio = 1.50, 95% Confidence interval:1.26–1.80). In both countries, oral health was associated with social isolation; this association could be stronger in England than in Japan.

Original languageEnglish
Article number113895
JournalSocial Science and Medicine
Publication statusPublished - 2021 May


  • Cross-national comparative study
  • ELSA
  • Number of remaining teeth
  • Social isolation


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