The hidden health equity crisis: readability assessment of online information regarding periodontitis-diabetes relationship.

BACKGROUND

Despite strong evidence linking periodontitis as a risk factor for diabetes, this association remains significantly underrepresented in online health information. Given that online resources serve as a primary source of health education, this study examines the content coverage and readability of diabetes-related websites from government and health organizations.

METHODS

A total of 154 health and diabetes-related websites were screened, with only 28 containing any reference to periodontitis-diabetes interrelationship. Readability analysis was specifically conducted on this subset of 28 sites using Flesch-Kincaid Grade Level (FKGL), Gunning Fog Index (GFI), Simple Measure of Gobbledygook (SMOG), Coleman-Liau Index (CLI), and Flesch Reading Ease (FRE) Score. Readability scores were then compared to the American Medical Association's recommended fifth-to-sixth-grade reading level (~10-12 years old).

RESULTS

Only 15 websites (9.7%) explicitly identified periodontitis as a risk factor for diabetes, highlighting a major gap in online health education. Readability analysis of sites that cover any part of the periodontitis-diabetes interrelationship (n = 28) showed that most content was written at a level too complex for general audiences. FKGL (mean = 12.0, p < 0.001), GFI (mean = 12.0, p < 0.001), SMOG scores (mean = 13.6, p < 0.001), CLI (mean = 13.6, p < 0.001), and FRE scores (mean = 43.9, p < 0.001) indicate that much of the material requires college-level reading proficiency (typically 18+ years old).

CONCLUSIONS

The overwhelming majority of online diabetes resources fail to acknowledge periodontitis as a risk factor for diabetes, despite well-established evidence supporting this link. Additionally, the readability of available materials is significantly above recommended levels for public comprehension. This accessibility gap may lead to a lack of awareness among patients and healthcare professionals, further contributing to health inequality. To enhance health literacy and encourage integrated care approaches, websites should prioritize both simplifying their content and ensuring the periodontitis-diabetes relationship is clearly communicated.