Age cohort changes in oral conditions and life transitions in the United States Health and Retirement Study

摘要 关于老年人生活变化的纵向信息（例如，认知能力下降，退休，医疗 条件和残疾）影响他们的口腔健康和牙科使用稀少。然而，需要纵向数据 评估因果关系。婴儿潮一代和其他几代人有不同的生活环境，影响良好- 存在与衰老为了规划他们的口腔健康需求和预防保健，统计模型应考虑到 不同的出生队列。这种二次数据分析将使用全面的、纵向的、全国性的 美国健康与退休研究（HRS）HRS队列为51岁以上的患者及其配偶 2006 - 2018年参加CORE两年期HRS波的患者（n ≥ 15，960/波）;社会心理 子样本A（任何波中n = 12，631），以及2008年（n = 1，300）和2018年HRS牙科模块（两者中n = 612） 模块）。并非所有变量都是每两年收集一次; 10年和12年的变化指的是2008 - 2018年， 2006-2018.就以人口为基础的分析而言，调查回归将采用适当的抽样权重 反映美国人群的分析;适当的协变量、潜在混杂因素和队列/数据子集 采用具体目标是：目标1）通过以下方式确定2018年口腔健康状况和口腔健康差异： HRS定义的传统社会人口统计学因素和较少研究的心理社会和就业因素 同伙自评口腔健康、牙齿状态（有和无功能性牙列、无牙）和口腔健康- 将评估相关的生活质量。目的2a）按出生队列比较2008 - 2018年牙科使用趋势 调整口腔健康状况;目的2b）确定预测10年或12年恶化发生率的因素 口腔健康状况（偶发性缺牙、偶发性牙齿脱落、自评口腔健康恶化）。目标3）评估 受试者内变化和与认知的双向关系（通过电话访谈评估 每两年收集一次的认知状态（TICS）和成年人的口腔健康状况。认知障碍很常见 在老年。了解口腔健康下降对认知的影响是很重要的，因为大部分的口腔疾病都是由口腔疾病引起的。 对受影响的个人、家庭成员和照顾者的社会影响。先前的研究表明， 口腔健康与认知的关系。目标3a。确定2008年基线口腔健康状况是否 预测未来十年认知能力下降目标3b。确定基线认知状态和10/12年认知功能 下降预示着10/12年的口腔健康恶化。目标4侧重于纵向变化的影响 在HRS中测量的心理社会因素，如生活满意度和孤独感。目标4a）比较模式 心理社会因素、出生队列和其他因素对牙科使用的影响。目标4b）确定基线是否 心理社会因素和12年的变化预测了无牙症事件和2018年的口腔健康结果。 目标2b、3b和4b将使用自助交叉验证来评估预测准确性。成果将克服差距 了解不同世代的老年人如何随着时间的推移而发展，并为卫生政策提供信息 决定（即，将牙科保险纳入医疗保险和成人医疗补助计划）。

Abstract Longitudinal information of how changes in the lives of older adults (e.g., cognitive decline, retirement, medical conditions and disability) affect their oral health and dental utilization is sparse. Yet, longitudinal data are needed to assess causality. Baby Boomers and other generations have had different life circumstances that affect well- being and aging. To plan for their oral health needs and preventive care, statistical models should account for different birth cohorts. This secondary data analysis will use the comprehensive, longitudinal, nationally representative US Health and Retirement Study (HRS). HRS cohorts were 51+ year olds and their spouses who participated in the CORE biennial HRS waves from 2006-2018 (n≥15,960 per wave); Psychosocial subsample A (n=12,631 in any wave), and in the 2008 (n=1,300) and 2018 HRS dental modules (n=612 in both modules). Not all variables were collected biennially; 10-year and 12-year changes refer to 2008-2018 and 2006-2018. For population-based analysis, appropriate sampling weights will be applied in survey regression analysis to reflect the US population; appropriate covariates, potential confounders, and cohort/data subsets used. The specific aims are to: Aim 1) Determine 2018 oral health conditions and oral health disparities by traditional socio-demographic and less studied psychosocial and employment factors by HRS defined birth cohorts. Self-rated oral health, dentate status (with and without functional dentition, edentulous), and oral health- related quality of life will be assessed. Aim 2a) Compare 2008-2018 trends in dental utilization by birth cohort adjusting for oral health conditions; Aim 2b) Identify factors predictive of 10 or 12-year incidence of worsening oral health conditions (incident edentulism, incident tooth loss, worsening self-rated oral health). Aim 3) Evaluate within-subject changes and the bidirectional relationship with cognition (assessed via the Telephone Interviews for Cognitive Status(TICS) collected biennially) and adults' oral health status. Cognitive impairment is common in old age. It is important to understand the effects of decrements in oral health on cognition because of the large societal impact on the affected individuals, family members and caregivers. Prior studies have shown different relationships between oral health and cognition. Aim 3a. Determine if 2008 baseline oral health conditions are predictive of 10-year cognitive decline. Aim 3b. Determine if baseline cognitive status and 10/12-year cognitive decline are predictive of 10/12-year worsening oral health. Aim 4 focuses on the effects of longitudinal changes in psychosocial factors such as life satisfaction and loneliness measured in the HRS. Aim 4a) Compare patterns of dental utilization by psychosocial factors, birth cohorts and other factors. Aim 4b) Determine if baseline psychosocial factors and 12-year changes are predictive of incident edentulism and 2018 oral health outcomes. Aims 2b, 3b and 4b will use bootstrap cross-validation to assess prediction accuracy. Results will overcome gaps in knowledge about how different generations of older adults are faring over time and inform health policy decisions (i.e., inclusion of dental coverage in Medicare and adult Medicaid programs).