Exploring the relationship between climate-related exposures and oral health outcomes in Pakistan: A community-based cross-sectional study

Kawish Syed, Syed Midhat Batool, Rabia Khatoon, Hafiz Muhammad Owais Nasim, Abid Rahim, Kaisar Khan, Farhad Ali Khattak, Muhammad Ilyas and Sofia Shehzad

PLOS Global Public Health, 2026, vol. 6, issue 3, 1-13

Abstract: Climate change is increasingly recognized as a contextual determinant of health in low- and middle-income countries (LMICs). Climate-related stressors such as water scarcity and food insecurity may influence oral health indirectly by disrupting hygiene practices, dietary patterns, and access to care. However, epidemiological evidence examining these relationships remains limited, particularly in resource-limited settings. This study aimed to examine the association between selected climate-related exposures and oral health outcomes among adults residing in climate-vulnerable districts of Pakistan. A cross-sectional analytical study was conducted among 422 adults residing in Charsadda and Peshawar districts of Khyber Pakhtunkhwa, Pakistan. Climate-related exposures assessed over the preceding 12 months included water scarcity, food insecurity, heat stress, and climate-related displacement. Oral health outcomes were evaluated using standardized clinical measures: the Decayed, Missing, and Filled Teeth (DMFT) index and the Community Periodontal Index (CPI). Multivariable binary logistic regression models were used to examine associations between climate-related exposures and oral health outcomes after adjusting for socio-demographic and behavioral confounders. Principal component analysis was performed to explore clustering of environmental and behavioral risk factors. Among the 422 adults, 61.4% had high caries (DMFT ≥ 3) and 47.6% had periodontal disease (CPI ≥ 3). Water scarcity (49.8%) and food insecurity (45.5%) were frequently reported. In adjusted analysis, water scarcity (AOR 1.89;95% CI 1.23-2.9) and food insecurity (AOR 1.74; 95% CI 1.12-2.69) were independently associated with high caries. For periodontal disease, water scarcity (AOR 1.67; 95% CI 1.12-2.48) and food insecurity (AOR 1.59;95% CI 1.05-2.41) were independently associated. Principal component analysis identified clustering of environmental stressors with hygiene- and nutrition-related vulnerabilities. Water scarcity and food insecurity were associated with adverse oral health outcomes in climate-vulnerable districts of Khyber Pakhtunkhwa. Integrating climate resilience with preventive oral health strategies may help in the reduction of emerging environmental health inequalities.

Date: 2026
References: Add references at CitEc
Citations:

Downloads: (external link)
https://journals.plos.org/globalpublichealth/artic ... journal.pgph.0006190 (text/html)
https://journals.plos.org/globalpublichealth/artic ... 06190&type=printable (application/pdf)

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:plo:pgph00:0006190

DOI: 10.1371/journal.pgph.0006190

Access Statistics for this article

More articles in PLOS Global Public Health from Public Library of Science
Bibliographic data for series maintained by globalpubhealth ().