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Identifying heterogeneity in the risk factors of dental caries status in Chinese adolescents using Poisson mixture regression.

ABSTRACT: OBJECTIVE:The purpose of this study was to cluster individuals into groups with different dental health characteristics and make statistical inferences on the effect differences among different groups simultaneously to identify the heterogeneity of risk factors in Chinese adolescents by analysing the data from the 4th Chinese National Oral Health Survey. METHODS:For decayed, missing and filled permanent teeth (DMFT), mean values were statistically analysed for their relationships with different categories of all involved variables. As DMFT scores only have discrete values, Poisson mixture regression was adopted to model the heterogeneity and complex patterns in the association and to detect the subgroup. The Bayesian information criterion (BIC) was used to determine the optimal number of subgroups. A series of Wald tests were used to explore the relationship between risk factors including the interaction effects and the number of DMFT. RESULTS:A total of 100?986 individuals aged 12-15?years old were analysed. The model clustered different individuals into three subgroups and built three submodels for detailed statistical inference simultaneously. The number of individuals in the three subgroups were 52?576 (52.1%), 41?969 (41.5%) and 6441 (6.4%), respectively. The mean (SD) of DMFT of the three subgroups was 0.50 (1.05), 0.99 (1.21), 5.59 (2.50). The model fitting results indicated that the effects of all risk factors on DMFT appear to be different in three subgroups. Controlling the confounding effects, our analysis implied that the regional inequality was the main contributing factor to dental caries among adolescents in Chinese mainland. CONCLUSIONS:The risk factors of dental caries exhibited heterogeneity in groups with different characteristics. The Poisson mixture regression model could cluster individuals into groups and identify the heterogeneous effects of risk factors among different groups. The findings support the need for different targeted interventions and prevention measures in groups with different dental health characteristics.

SUBMITTER: Yuan C

PROVIDER: S-EPMC7592291 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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Identifying heterogeneity in the risk factors of dental caries status in Chinese adolescents using Poisson mixture regression.

Yuan Chao C He Jie J Sun Xiangyu X Kang Jian J Zheng Shuguo S

BMJ open 20201026 10

<h4>Objective</h4>The purpose of this study was to cluster individuals into groups with different dental health characteristics and make statistical inferences on the effect differences among different groups simultaneously to identify the heterogeneity of risk factors in Chinese adolescents by analysing the data from the 4th Chinese National Oral Health Survey.<h4>Methods</h4>For decayed, missing and filled permanent teeth (DMFT), mean values were statistically analysed for their relationships ...[more]

PMID: 33109671

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Project description:Introduction:Obesity and dental caries are global public health problems. There are conflicting reports about the relationship between caries and obesity. Therefore, the study aimed to investigate the association between obesity and dental caries among male adolescents. Materials and Methods:This cross-sectional study included a sample of 258 male students' aged 12 to 15 years from schools in Dammam/Al-Khobar, Saudi Arabia. The study involved measuring caries prevalence and DMFT estimates, assessing body mass index (BMI), and administering a self-completion questionnaire. Independent samples Student's t-test, one-way ANOVA test, Pearson's correlation test, and bivariate and multivariate logistic regression analyses were performed. Results:Caries prevalence of the sample was 79.8%, and the mean score of DMFT was 3.55?±?2.94. The mean BMI of participants was 23.42?±?6.82 and 18% were obese (BMI?>?30). The obese participants had a higher mean DMFT score (4.46?±?3.54) than nonobese participants (3.35?±?2.77) (P=0.021). Similarly, the mean untreated caries was higher in obese (4.17?±?3.22) than in nonobese participants (3.01?±?2.66) (P=0.010). In the logistic regression analysis, after controlling for father's education, family history of obesity, meals per day, fast food per week, and physical activity in the final model, the participants with high caries experience (DMFT?=?5-15) were 2.21 times more likely to have obesity than those with low caries experience (DMFT?=?0-4) (P=0.04). No/school education of father (odds ratio 3.54, P=0.011), family history of obesity (odds ratio 3.27, P=0.002), and not performing physical activity (odds ratio 4.37, P=0.002) were significantly associated with an increased likelihood of obesity. Conclusion:The prevalence of caries and obesity was high in male adolescents in Saudi Arabia. Obesity was significantly associated with untreated caries and caries experience. Children with high caries experience were more likely to have obesity than children with low caries experience. Preventive programs and policies should address public health issues related to caries and obesity in male teenagers.

Project description:Fluoridation of America's drinking water was among the great public health achievements of the 20th century. Yet there is a paucity of studies from the past 3 decades investigating its dental health benefits in the U.S. POPULATION:This cross-sectional study sought to evaluate associations between availability of community water fluoridation (CWF) and dental caries experience in the U.S. child and adolescent population. County-level estimates of the percentage of population served by CWF (% CWF) from the Centers for Disease Control and Prevention's Water Fluoridation Reporting System were merged with dental examination data from 10 y of National Health and Nutrition Examination Surveys (1999 to 2004 and 2011 to 2014). Dental caries experience in the primary dentition (decayed and filled tooth surfaces [dfs]) was calculated for 7,000 children aged 2 to 8 y and in the permanent dentition (decayed, missing, and filled tooth surfaces [DMFS]) for 12,604 children and adolescents aged 6 to 17 y. Linear regression models estimated associations between % CWF and dental caries experience with adjustment for sociodemographic characteristics: age, sex, race/ethnicity, rural-urban location, head-of-household education, and period since last dental visit. Sensitivity analysis excluded counties fluoridated after 1998. In unadjusted analysis, caries experience in the primary dentition was lower in counties with ?75% CWF (mean dfs = 3.3; 95% confidence limit [CL] = 2.8, 3.7) than in counties with <75% CWF (mean dfs = 4.6; 95% CL = 3.9, 5.4), a prevented fraction of 30% (95% CL = 11, 48). The difference was also statistically significant, although less pronounced, in the permanent dentition: mean DMFS (95% CL) was 2.2 (2.0, 2.4) and 1.9 (1.8, 2.1), respectively, representing a prevented fraction of 12% (95% CL = 1, 23). Statistically significant associations likewise were seen when % CWF was modeled as a continuum, and differences tended to increase in covariate-adjusted analysis and in sensitivity analysis. These findings confirm a substantial caries-preventive benefit of CWF for U.S. children and that the benefit is most pronounced in primary teeth.

Project description:BackgroundVitamin D is crucial for mineralized tissue formation and immunological functions. The purpose of this study was to evaluate the association between vitamin D status and dental status in healthy children with vitamin D supplementation in infancy and at 6 years of age.MethodEight-year-old children who had participated in a vitamin D intervention project when they were 6 years old were invited to participate in a dental follow-up study. They had fair or darker skin complexion and represented two geographically distant parts of Sweden. 25-hydroxy vitamin D in serum had been measured at 6 years of age and after a 3-month intervention with 25, 10 or 2 (placebo) μg of vitamin D3 per day. Two years later, caries and enamel defects were scored, self-reported information on e.g., oral behavior, dietary habits and intake of vitamin D supplements was collected, and innate immunity peptide LL37 levels in saliva and cariogenic mutant streptococci in tooth biofilm were analyzed. The outcome variables were caries and tooth enamel defects.ResultsDental status was evaluated in 85 of the 206 children in the basic intervention study. Low vitamin D levels were found in 28% at baseline compared to 11% after the intervention, and 34% reported continued intake of vitamin D supplements. Logistic regression supported a weak inverse association between vitamin D status at 6 years of age and caries 2 years later (odds ratio 0.96; p = 0.024) with minor attenuation after an adjustment for potential confounders. Multivariate projection regression confirmed that insufficient vitamin D levels correlated with caries and higher vitamin D levels correlated with being caries-free. Vitamin D status at 6 years of age was unrelated to enamel defects but was positively associated with saliva LL37 levels.ConclusionAn association between vitamin D status and caries was supported, but it was not completely consistent. Vitamin D status at 6 years of age was unrelated to enamel defects but was positively associated with LL37 expression.Trial registrationThe basic intervention study was registered at ClinicalTrials.gov with register number NCT01741324 www.clinicaltrials.gov/ct2/show/NCT02347293 on November 26, 2012.

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Identifying heterogeneity in the risk factors of dental caries status in Chinese adolescents using Poisson mixture regression.

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Identifying heterogeneity in the risk factors of dental caries status in Chinese adolescents using Poisson mixture regression.

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