Periodontal treatment and subsequent clinical outcomes and medical care costs: A retrospective cohort study.
Periodontal treatment and subsequent clinical outcomes and medical care costs: A retrospective cohort study.
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DOI：
10.1371/journal.pone.0290028
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发表时间：
2023
期刊：
影响因子：
3.7
通讯作者：
中科院分区：
文献类型：
--
作者：
牙周炎是一种常见的口腔疾病，与冠心病(CAD)、脑血管疾病(CBVD)和2型糖尿病(T2D)相关。我们研究了牙周炎治疗是否改善了CAD、CBVD或T2D患者的临床结果并降低了医疗成本。我们使用医疗保健系统的临床记录和索赔数据来识别牙周炎和CAD、CBVD或T2D患者，并评估牙周治疗、住院治疗、医疗费用(总费用、住院费用、门诊费用、药房费用)、糖化血红蛋白、心血管事件和并发疾病诊断后的死亡。我们根据随访期接受牙周治疗和/或维持护理的情况比较临床结果，并根据并发疾病诊断后一年内的治疗状况比较护理费用，同时调整协变量。对2019-21年的数据进行了分析。我们确定了9,503人，其中4,057人在CAD队列中，3,247人在CBVD队列中，4,879人在T2D队列中。选择接受治疗和维持护理的患者住院的可能性低于未接受治疗的患者(CAD：OR=0.71(95%CI：0.55，0.92)；CBVD：OR=0.73(0.56，0.94)；T2D：OR=0.80(0.64，0.99))。选择治疗和/或维持护理与心血管事件、死亡率或糖化血红蛋白变化没有显著相关性。治疗组和未治疗组之间的总护理费用在4年内没有显著差异。接受治疗的患者住院费用较低，但药房费用较高。被选择接受牙周治疗或维持护理的牙周炎和CAD、CBVD或T2D患者的住院率较低，但在临床结果或总医疗费用方面与未接受治疗的患者没有显著差异。
Periodontitis is a common oral disease associated with coronary artery disease (CAD), cerebrovascular disease (CBVD) and type 2 diabetes (T2D). We studied if periodontitis treatment improves clinical outcomes and reduces medical care costs in patients with CAD, CBVD or T2D. We used clinic records and claims data from a health care system to identify patients with periodontitis and CAD, CBVD or T2D, and to assess periodontal treatments, hospitalizations, medical costs (total, inpatient, outpatient, pharmacy), glycated hemoglobin, cardiovascular events, and death following concurrent disease diagnoses. We compared clinical outcomes according to receipt of periodontal treatment and/or maintenance care in the follow-up period, and care costs according to treatment status within one year following concurrent disease diagnoses, while adjusting for covariates. The data were analyzed in 2019–21. We identified 9,503 individuals, 4,057 of whom were in the CAD cohort; 3,247 in the CBVD cohort; and 4,879 in the T2D cohort. Patients who were selected and elected to receive treatment and maintenance care were less likely to be hospitalized than untreated individuals (CAD: OR = 0.71 (95% CI: 0.55, 0.92); CBVD: OR = 0.73 (0.56, 0.94); T2D: OR = 0.80 (0.64, 0.99)). Selection to treatment and/or maintenance care was not significantly associated with cardiovascular events, mortality, or glycated hemoglobin change. Total care costs did not differ significantly between treated and untreated groups over 4 years. Treated patients experienced lower inpatient costs but higher pharmacy costs. Patients with periodontitis and CAD, CBVD or T2D who were selected and elected to undergo periodontal treatment or maintenance care had lower rates of hospitalizations, but did not differ significantly from untreated individuals in terms of clinical outcomes or total medical care costs.
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