Living alone and oral health disparities in Chinese older adults: a national cross-sectional study

BACKGROUND: With China's rapidly aging population, the oral health of older adults living alone has become a growing concern due to their limited social support and potential health disparities. This study aimed to compare oral health status between Chinese adults aged 65-74 living alone versus those cohabiting with others and identify factors associated with oral health disparities. METHODS: A cross-sectional analysis utilized data from China's 4th National Oral Health Survey, including 4,406 participants (312 living alone; 4,094 cohabiting). Oral examinations assessed caries, periodontal status, and tooth loss; structured questionnaires captured demographics, socioeconomic status, behaviors, and self-perceived oral health. The survey was conducted according to the basic methods proposed by the World Health Organization (WHO). RESULTS: Older adults living alone (7.1%) showed worse oral health: higher caries prevalence (83.01% vs. 76.26%), more tooth loss (8.26 vs. 6.76), less occluding pairs (6.85 vs. 8.14), lower oral health knowledge scores (5.88 ± 2.51 vs. 6.32 ± 2.31), and worse self-perceived oral health (P < 0.05). Regression confirmed living situation, age, gender, education, income, area, smoking and drinking alcohol as key predictors of oral health outcomes (P < 0.05). CONCLUSION: Oral health is significantly poorer among Chinese seniors living alone and is significantly associated with socioeconomic and behavioral factors. Targeted interventions-including enhanced social support, financial aid, and oral health education-are urgently needed for this vulnerable group.