Multivariable Modeling of Phenotypic Risk Factors for First-Onset TMD: The OPPERA Prospective Cohort Study
Multivariable Modeling of Phenotypic Risk Factors for First-Onset TMD: The OPPERA Prospective Cohort Study
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DOI：
10.1016/j.jpain.2013.09.003
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发表时间：
2013-12-01
期刊：
影响因子：
4
通讯作者：
Slade, Gary D.
中科院分区：
文献类型：
--
作者：
Bair, Eric;Ohrbach, Richard;Slade, Gary D.
采用多变量模型预测颞下颌关节紊乱病（TMD）的发病率，该模型使用从口面疼痛：前瞻性评价和风险评估（OPPERA）研究中最初无TMD的个体收集的假定风险因素。202个基线风险因素包括社会人口统计学和临床特征、一般健康状况指标、实验性疼痛敏感性、自主神经功能和心理困扰。研究参与者（n = 2，737）随后进行了中位2.8年的前瞻性随访，以确定首发TMD病例。Lasso回归和随机森林模型被用来预测使用所有上述措施的首发TMD的发病率。变量重要性分数确定了最重要的危险因素，并使用偏相关图以图形方式说明了它们与TMD发病率的关系。TMD发病率升高的两个最重要的危险因素是更多的共病疼痛状况和更大程度的非特异性口面症状。其他重要的基线风险因素是预先存在的身体疼痛，身体意识增强，以及检查者对头部，颈部和身体的触诊反应更大程度的疼痛。即使在调整其他OPPERA变量后，一些人口统计学变量仍然是危险因素，这表明OPPERA中未测量的环境变量也可能导致首发TMD。(C)2013年美国疼痛协会American Pain Society
Incidence of temporomandibular disorder (TMD) was predicted with multivariable models that used putative risk factors collected from initially TMD-free individuals in the Orofacial Pain: Prospective Evaluation and Risk Assessment (OPPERA) study. The 202 baseline risk factors included sociodemographic and clinical characteristics, measures of general health status, experimental pain sensitivity, autonomic function, and psychological distress. Study participants (n = 2,737) were then followed prospectively for a median of 2.8 years to ascertain cases of first-onset TMD. Lasso regression and random forest models were used to predict incidence of first-onset TMD using all of the aforementioned measures. Variable importance scores identified the most important risk factors, and their relationship with TMD incidence was illustrated graphically using partial dependence plots. Two of the most important risk factors for elevated TMD incidence were greater numbers of comorbid pain conditions and greater extent of nonspecific orofacial symptoms. Other important baseline risk factors were preexisting bodily pain, heightened somatic awareness, and greater extent of pain in response to examiners' palpation of the head, neck, and body. Several demographic variables persisted as risk factors even after adjusting for other OPPERA variables, suggesting that environmental variables not measured in OPPERA may also contribute to first-onset TMD. (C) 2013 by the American Pain Society