Differentiation of Self-Rated Oral Health Between American Non-Citizens and Citizens

Document Type


Publication Date



Background: Oral health disparities exist in the USA. However, little is known of the relationship between oral health disparity and citizenship. The aims of this study were: (i) to describe the differences in self-rated oral health (SROH) between adult American citizens and non-citizens (>20 years of age); and (ii) to test whether factors such as frequency of dentist visits and socio-economic status (SES) are differently associated with SROH in these two groups. Methods: The data used in this study were drawn from the National Health and Nutrition Examination Survey conducted in 2011–2012. Weighted logistic regression models were used to detect the strengths of the association between a series of predictors and SROH. Results: More non-citizens (59.54%) than their citizen peers (26.24%) rated their oral health as fair/bad. All factors analysed in this study were differently associated with SROH based on citizenship. More specifically, natural characteristics, such as ethnicity and age, were significantly associated with SROH among non-citizens, and SES was significantly associated with American citizens. Among non-citizens, Hispanic, Non-Hispanic Black and Asian subjects were more likely than Non-Hispanic White subjects to report their oral health as being ‘good’. Family poverty level, education and the frequency of dentist visits were significantly associated with SROH among citizens. Conclusion: The findings of this study indicate that American immigrants report their oral health across most dimensions as being worse than do American citizens. Each explanatory factor may have a different strength of association with SROH in immigrants and citizens, which implies that different steps should be taken within these groups to reduce disparities in oral health.