Tooth loss and physical function among older adults related to race and ethnicity in Hawai‘i: A cross-sectional study from 2014 to 2020

• Significant association between severe tooth loss and the prevalence of ADLs exists. • There were racial/ethnic disparities in ADL limitations. • The association between severe tooth loss and ADLs varies by race/ethnicity. Oral health and functional limitations are major health concerns among aging populations in the U.S. and globally. Although the relationship between tooth loss and physical disabilities is well documented, less is known about the role of race and ethnicity in this association. This study examined the association between tooth loss and ADL (activities of daily living) limitations across various racial/ethnic groups in Hawai‘i. We examined severe tooth loss and functional limitations in relation to sociodemographic factors, including race/ethnicity, using four waves of data from the Hawaiʻi Behavioral Risk Factor Surveillance System collected between 2014 and 2020. Weighted Poisson regression was used to estimate the unadjusted and adjusted prevalence ratio of severe tooth loss and functional limitations. There was a significant association between severe tooth loss and the prevalence of ADL limitations among older adults in Hawai‘i. Notably, this association varied by race/ethnicity: After adjusting for sociodemographic covariates, it was stronger among White, Native Hawaiian, and Japanese respondents compared to Filipinos. These results suggest that the relationship between severe tooth loss and physical decline is differentiated by race/ethnicity, and that socioeconomic variables (including education and income) play a complicated role in the association. Awareness of the unique challenges and inequities faced by older racially/ethnically marginalized populations is critical for policymakers to develop strategies to achieve health equity, which must entail addressing these interrelated health problems and their structural determinants at every level.