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成本的不断上升，未来的专业牙科治疗计划将寻求利用 有效的预后来权衡牙齿保留的长期前景和所涉及的成本。 当牙齿脱落（由于龋齿或牙周病或两者兼而有之）仍然是主要的口腔健康负担时 在美国，《平价医疗法案》虽然涵盖了儿科人群，但并未强制规定 此外，患有其他合并症的老年人，例如 2 型糖尿病 (T2D) 和差异。 在口腔健康方面，获得护理的人往往面临口腔健康受损的风险较高。 数据存储能力的进步，庞大的口腔健康流行病学数据库，例如由 AxiUm 和 Epic 管理系统，或包含大量风险信息、口腔健康的国家调查 我们可以使用生物标志物和相关的事件发生时间 (TTE) 信息，但它们的综合性较高。 探索大部分尚未开发，主要是由于它们所带来的独特的统计复杂性，而这些复杂性往往是 超出现有统计工具和软件包的能力，其中包括但不限于 (a) 一个极其多层次的设置，（b）非常高水平的审查模式，（c）适应时间的瓶颈 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“有效”没有达成共识 预测因素及其混杂因素对这些 TTE 的复杂影响的“临床可解释”总结 该项目的目标是解决这些复杂性，并进行全面的统计。 对来自美国中西部和东南部 3 个丰富数据库的可用 TTE 端点进行分析 我们的建议具有三个广泛的实际目标。 口腔流行病学家和从业者的兴趣：(a) 构建一个实用的风险指数，用于估计和动态 预测 T2D/非 T2D 老年人牙齿的中位剩余寿命，(b) 细化该指数以进行估计 NHANES 中具有里程碑意义的事件只需一颗牙齿的时间，以及 (c) 将这些新工具有效传播到临床 具体来说，我们建议开发一个文档齐全的免费网络应用程序，其中 用户/临床医生可以插入受试者特征的值来计算相应的指标确定 该提案预计将产生评估国家级风险评估的新知识。 据我们所知，这个想法是通过这个全面而独特的指数来评估牙齿的存活率。 牙齿 TTE 索引是同类中的第一个，并将提供一组易于推广的数据分析工具。 当“全国代表性”纵向数据库可用时（来自正在进行的 NHANES 研究）， 所提出的方法可以很容易地进行调整，为干预措施和治疗决策提供信息。