A pragmatic risk index evaluating the elderly with comorbidity for oral health event times

评估患有合并症的老年人口腔健康事件时间的实用风险指数

• 批准号: 10593634
• 负责人: Dipankar Bandyopadhyay
• 金额: $ 21.05万
• 依托单位: VIRGINIA COMMONWEALTH UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10593634
• 关键词: Accounting; Address; Adult; Affordable Care Act; Area; Award; Behavioral; Biological Markers; Categories; Centers for Disease Control and Prevention (U.S.); Characteristics; Childhood; Clinical; Clinical Trials; Complex; Computer software; Consensus; Data; Data Set; Data Storage and Retrieval; Databases; Dental; Dental Schools; Dental caries; Disease; Elderly; Electronic Health Record; Epidemiologist; Epidemiology; Evaluation; Event; Failure; Funding; Future; Generations; Goals; Government; Health; Health Services Accessibility; Healthcare; Internet; Intervention; Kentucky; Knowledge; Lead; Life; Literature; Longevity; Longitudinal Surveys; Methods; Midwestern United States; Modeling; Monoclonal Antibody R24; National Health and Nutrition Examination Survey; National Institute of Dental and Craniofacial Research; Nature; Non-Insulin-Dependent Diabetes Mellitus; Oral; Oral health; Outcome; PF4 Gene; Pattern; Performance; Periodontal Diseases; Persons; Plug-in; Population; Principal Component Analysis; Prognosis; Prognostic Factor; Public Health Dentistry; Records; Research Personnel; Residual state; Risk; Risk Assessment; Risk Factors; Sampling; Statistical Data Interpretation; Structure; Subgroup; Surveys; System; Time; Tooth Loss; Tooth structure; Translations; Uncertainty; Universities; Validation; Weight; analytical tool; baby boomer; clinical practice; clinical risk; comorbidity; cost; experience; health care availability; immunosuppressed; indexing; interest; longitudinal database; population based; response; social; tool; treatment planning; user friendly software; web app

With the rising cost of dental healthcare spending, future professional dental treatment plans will seek to utilize efficient prognosis to weigh the long-term outlook of tooth retention against the costs involved. This is in context when tooth loss (due to caries, or periodontal disease, or both) continues to remain a major oral health burden in the US, while the Affordable Care Act, although covering the pediatric population, is not mandated for the adults. Furthermore, elderly people with additional comorbidities, such as Type-2 diabetes (T2D) and disparities in oral health access to care, are often at an elevated risk of compromised oral health. With recent significant advances in data storage capabilities, huge oral health epidemiologic databases, such as those generated from the AxiUm and Epic management systems, or national surveys containing a wealth of risk information, oral health biomarkers, and associated time to event (TTE) information are at our disposal. However, their comprehensive exploration has mostly gone untapped, mainly due to the unique statistical complexities they pose that are often beyond the capabilities of existing statistical tools and software packages. These include, but not limited to (a) an extremely multi-level setup, (b) very high level of censoring patterns, (c) bottlenecks accommodating time- varying biomarkers, (d) informative sampling in national surveys, and (e) no consensus on the ‘effective’ and ‘clinically interpretable’ summary of the complex effects of predictors, and their confounders, on these TTE endpoints. The goals of this project are to address these complexities, and perform a comprehensive statistical analysis of available TTE endpoints from 3 rich databases comprising the U.S. Midwest and Southeast population, and a nationally-representative NHANES database. Our proposal has three broad aims of practical interest to oral epidemiologists and practitioners: (a) construct a pragmatic risk index for estimation and dynamic prediction of the median residual lifetime of a tooth for the T2D/Non-T2D elderly, (b) refine that index to estimate a tooth’s time to landmark events in NHANES, and (c) effective dissemination of these new tools to clinical practitioners. Specifically, we propose to develop a well-documented, free, web-application, where a user/clinician can plug-in values of a subject’s characteristics to calculate the corresponding index determining tooth TTEs. This proposal is expected to generate new knowledge on evaluating national-level risk assessments of tooth survival via this comprehensive and unique index. To the best of our knowledge, this idea of creating a tooth TTE index is the first of its kind, and will provide a set of data analytic tools that are readily generalizable. When ‘nationally-representative’ longitudinal databases are made available (from the ongoing NHANES studies), the proposed methods can be readily adapted to inform interventions and treatment decisions.

随着牙科医疗保健支出的上涨，未来的专业牙科治疗计划将寻求利用 有效的预后可以权衡牙齿保留的长期前景与所涉及的成本。这是在上下文中 当牙齿脱落（由于龋齿，牙周疾病或两者）继续仍然是主要的口腔健康伯恩 在美国，虽然《负担得起的护理法》虽然涵盖了儿科人口，但并未要求 成年人。此外，老年人患有其他合并症，例如2型糖尿病（T2D）和差异 在口腔健康获得护理方面，通常面临口腔健康损害的风险。具有最近的重要性 数据存储功能的进步，巨大的口腔健康流行病学数据库，例如从 Axium和Epic管理系统或包含大量风险信息的国家调查，口腔健康 生物标志物和相关事件的相关时间（TTE）信息可供我们使用。但是，他们的全面 探索大部分未开发，主要是由于它们构成的独特统计复杂性通常是 除了现有的统计工具和软件包的功能之外。这些包括但不限于（a） 非常多级的设置，（b）非常高的审查模式，（c）瓶颈可容纳时间 - 不同的生物标志物，（d）国家调查中的信息抽样，以及（e）对“有效”和 “临床上可解释的”摘要预测因子及其混杂因素对这些TTE的复杂作用 端点。该项目的目标是解决这些复杂性，并执行全面的统计数据 分析3个富裕数据库的可用TTE端点，完成了美国中西部和东南部 人口，以及全国代表性的NHANES数据库。我们的建议具有实用的三个广泛目标 口头流行病学家和从业者的兴趣：（a）构建务实的风险指数，以估算和动态 T2D/非T2D的牙齿中位残留寿命的预测，（b）完善该指数的估计指数 牙齿在NHANES中进行地标性活动的时间，以及（c）有效传播这些新工具到临床上 从业人员。特别是，我们建议开发一个有据可查的，免费的，网络应用程序，其中 用户/临床医生可以插入受试者特征的插入值，以计算确定相应的索引 牙齿。预计该建议将产生有关评估国家级别风险评估的新知识 通过这个全面而独特的指数的牙齿生存。据我们所知，这是创建一个的想法 牙齿TTE指数是同类产品中的第一个，它将提供一组易于推广的数据分析工具。 当提供“全国代表性的”纵向数据库时（来自正在进行的NHANES研究）时， 提出的方法可以很容易地适应干预措施和治疗决策。