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However, it remains unclear whether SES modifies the relationship between obesity and periodontal disease. This study investigated the influence of SES on the association between obesity and periodontal disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>We used multilevel Poisson regression, after adjusting for potential confounding factors including population-level SES, to analyze the body mass index (BMI) and periodontal parameters of 962 participants (mean age 58.3 years; SD: 13.8).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A significant association was observed between obesity and the proportion of teeth with probing pocket depth (PPD)\u2009\u2265\u20094\u00a0mm (ratio of means [RM]: 1.25, 95% confidence interval [CI]: 1.14, 1.37;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), whereas the high-income group exhibited a significantly lower proportion of teeth with PPD\u2009\u2265\u20094\u00a0mm (RM: 0.84, 95% CI: 0.71, 0.998;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.047). Interaction analysis also revealed a significant interaction between obesity and the high-income group regarding the proportion of teeth with PPD\u2009\u2265\u20094\u00a0mm (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.020). The subgroup analysis demonstrated that the RM of obesity for the proportion of teeth with PPD\u2009\u2265\u20094\u00a0mm was higher in females than in males.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Income-related inequalities are associated with the relationship between obesity and periodontal disease. Among obese adults, those with low- and middle-income levels may have a higher risk of periodontal disease than those with high income.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical relevance<\/jats:title>\n                    <jats:p>Comprehensive care and oral health education may be enhanced for obese individuals in low-income populations to mitigate their elevated risk of periodontal disease.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00784-025-06638-1","type":"journal-article","created":{"date-parts":[[2025,11,15]],"date-time":"2025-11-15T06:53:37Z","timestamp":1763189617000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Income-related inequalities in the association of obesity and periodontal disease: a register-based cross-sectional analysis in the Tokyo metropolitan districts"],"prefix":"10.1007","volume":"29","author":[{"given":"Natsumi","family":"Saito","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1398-0450","authenticated-orcid":false,"given":"Risako","family":"Mikami","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koji","family":"Mizutani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norio","family":"Aoyama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takanori","family":"Matsuura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomonari","family":"Suda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kohei","family":"Takeda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Aida","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuichi","family":"Izumi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takanori","family":"Iwata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,11,15]]},"reference":[{"issue":"13","key":"6638_CR1","doi-asserted-by":"publisher","first-page":"1581","DOI":"10.1001\/archinte.161.13.1581","volume":"161","author":"AE Field","year":"2001","unstructured":"Field AE, Coakley EH, Must A et al (2001) Impact of overweight on the risk of developing common chronic diseases during a 10-year period. 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