Multilevel analyses of oral health conditions among older adults in the All of Us Research Program

“我们所有人研究计划”中老年人口腔健康状况的多层次分析

• 批准号: 10658463
• 负责人: Jane A Weintraub
• 金额: $ 12.82万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-15 至 2023-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10658463
• 关键词: Adult; Affect; Age; Aging; All of Us Research Program; American; Area; Behavioral; Cardiovascular Diseases; Chronic; Clinical; Code; Cognition; Communities; Data; Data Analyses; Data Set; Dental; Dental Care; Dental General Practice; Dental Records; Dental caries; Diabetes Mellitus; Digit structure; Edentulous Mouth; Elderly; Electronic Health Record; Enrollment; Ethnic Origin; Frequencies; Funding; Geographic Locations; Geography; Goals; Health; Health Status; Health and Retirement Study; Health behavior; Healthcare; Individual; Life; Life Style; Link; Longitudinal Studies; Medicaid; Medical; Medicare; Medicine; Modeling; National Institute of Dental and Craniofacial Research; Oral; Oral health; Outcome; Participant; Patient Self-Report; Periodontitis; Population; Primary Health Care; Psychosocial Factor; Quality of life; Retirement; Risk; Role; Sampling; Source; Strategic Planning; Stroke; Surveys; Systematized Nomenclature of Medicine; Systemic disease; Tooth Loss; Tooth structure; Underrepresented Populations; United States; United States National Institutes of Health; Variant; base; cohort; contextual factors; craniofacial; data ecosystem; data infrastructure; demographics; edentulism; education research; functional status; health care settings; health data; health inequalities; improved; insight; large datasets; multilevel analysis; negative affect; oral condition; parent grant; psychosocial; racial disparity; social; social health determinants; sociodemographic factors; socioeconomics; volunteer

Abstract The U.S. population is rapidly aging. Americans are living longer, with more chronic conditions, and retaining more teeth. Because of the relationships between oral and systemic conditions, there is a need for dental care to become better integrated with primary care. Oral health inequalities in access to dental care are prevalent among older adults. Routine dental care is not included in Medicare and large state-level variations exist in dental Medicaid benefits. The oral health of older adults in the US is understudied due to few national large- scale studies with longitudinal components that include medical dental, individual and community level data. With this supplement, secondary data analysis from the national NIH All of US (AoU) Research Project will expand information about adults age 51+ available from the longitudinal, nationally representative US Health and Retirement Study (HRS) currently being analyzed (NIDCR R03 DE030161-02). Our R03 goals are to study longitudinal changes in the oral health of older adults in relationship to changes in cognition, retirement, medical, contextual, psychosocial, behavioral and dental utilization data. Both HRS and AoU datasets provide information to link oral health status to medical conditions, demographics, lifestyle, psychosocial factors, and overall health. The HRS and AoU both include self-report survey data. Additionally, the AoU includes clinically- determined information from participants' electronic health records (EHR) obtained in healthcare settings. AoU seeks to enroll diverse, traditionally under-represented groups. The AoU Controlled Tier level data includes 3- digit ZIP code that provides access to geographical contextual information to explore social determinants of health using multilevel analyses. Poor oral health, partial tooth loss, and edentulism among older adults negatively affect their quality of life and functional status. An AoU analytical Controlled Tier dataset will be constructed with 3 groups having different oral conditions based on EHR data for comparison: 1) completely edentulous, 2) partially edentulous, and 3) evidence of being dentate (e.g., dental caries, periodontitis). The specific aims are: AIM 1a) Tabulate the means (SD) and frequency distribution of socio-demographic factors in Controlled Tier AoU data and medical, cognition, and social/lifestyle risk indicators from survey and EHR data associated with these 3 dental status groups (above). Aim 1b) Develop multivariable models using these 3 dental status groups and dental utilization to determine their influence on self-rated health, cognition, and other medical conditions (e.g., diabetes, cardiovascular disease, stroke). Aim 1c) Develop multilevel models including contextual variables using zip code data to represent geographic regions where participants reside to examine individual and area variations in outcomes. AIM 2: Compare AoU findings with 2018 HRS data and assess population differences in self-rated health, cognition, and medical outcomes. HRS and AoU are both large-scale, landmark studies with different key features. By analyzing both datasets, we will be able to take advantage of the best features of each one to further our understanding of the oral health of older adults.

抽象的 美国人口正在迅速老龄化。美国人的寿命更长，患有更多慢性病，并且保留 更多牙齿。由于口腔和全身疾病之间的关系，需要进行牙齿护理 更好地融入初级保健。获得牙科护理方面的口腔健康不平等现象普遍存在 在老年人中。常规牙科护理不包括在医疗保险中，并且各州之间存在较大差异 牙科医疗补助福利。由于很少有全国性的大型研究，美国老年人的口腔健康尚未得到充分研究。 具有纵向成分的规模研究，包括医学牙科、个人和社区层面的数据。 通过此补充，来自国家 NIH 全美国 (AoU) 研究项目的二次数据分析将 扩展可从具有全国代表性的美国健康纵向数据中获得的有关 51 岁以上成年人的信息 目前正在分析退休研究 (HRS) (NIDCR R03 DE030161-02)。我们的 R03 目标是 研究老年人口腔健康的纵向变化与认知、退休、 医疗、背景、心理、行为和牙科使用数据。 HRS 和 AoU 数据集都提供 将口腔健康状况与医疗状况、人口统计、生活方式、心理社会因素和 整体健康。 HRS 和 AoU 均包含自我报告调查数据。此外，AoU 还包括临床- 从在医疗保健环境中获得的参与者的电子健康记录 (EHR) 中确定信息。奥乌 力求招收多元化、传统上代表性不足的群体。 AoU 受控层级数据包括 3- 数字邮政编码，提供对地理背景信息的访问，以探索社会决定因素 使用多层次分析来评估健康状况。老年人口腔健康状况不佳、部分牙齿缺失和无牙颌 对他们的生活质量和功能状态产生负面影响。 AoU 分析受控层数据集将是 根据 EHR 数据构建 3 个具有不同口腔状况的组进行比较：1）完全 无牙，2) 部分无牙，3) 有齿的证据（例如，龋齿、牙周炎）。这 具体目标是： AIM 1a) 将社会人口因素的平均值 (SD) 和频率分布制成表格 来自调查和 EHR 的受控 Tier AoU 数据以及医疗、认知和社会/生活方式风险指标 与这 3 个牙齿状况组相关的数据（上图）。目标 1b) 使用这些开发多变量模型 3 牙齿状况组和牙齿使用情况，以确定其对自评健康、认知和健康的影响 其他医疗状况（例如糖尿病、心血管疾病、中风）。目标 1c) 开发多层次模型 包括使用邮政编码数据来表示参与者居住的地理区域的上下文变量 检查结果的个体和地区差异。目标 2：将 AoU 调查结果与 2018 年 HRS 数据进行比较 评估自评健康、认知和医疗结果方面的人群差异。 HRS 和 AoU 都是 具有不同关键特征的大规模、里程碑式的研究。通过分析这两个数据集，我们将能够 利用每一种的最佳功能来进一步了解老年人的口腔健康。