Causal Mediation Analysis of Dental Caries in VLBW and BPD Adolescents

VLBW和BPD青少年龋齿的因果中介分析

• 批准号: 7799135
• 负责人: JEFFREY M ALBERT
• 金额: $ 15.54万
• 依托单位: CASE WESTERN RESERVE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-04-05 至 2012-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7799135
• 关键词: 14 year old; Address; Adolescence; Adolescent; Affect; Age-Years; Behavior; Behavioral; Behavioral Mechanisms; Biological; Birth; Bronchopulmonary Dysplasia; Characteristics; Child; Clinical; Clinical Data; Cognitive; Cohort Studies; Complex; Confidence Intervals; Data; Data Analyses; Defect; Dental; Dental Enamel; Dental caries; Development; Disease; Future; Goals; Health; Health behavior; Incidence; Individual; Intervention; Knowledge; Learning; Linear Models; Longitudinal Studies; Low Birth Weight Infant; Measures; Mediating; Mediation; Medical; Methodology; Methods; Minority; Minority Groups; Modeling; Mouth Diseases; NIH Program Announcements; National Institute of Dental and Craniofacial Research; Oral; Oral health; Outcome; Pathway interactions; Psychosocial Factor; Relative (related person); Research Project Grants; Risk; Risk Factors; Specific qualifier value; Staging; Statistical Data Interpretation; Statistical Methods; System; Time; Translating; Very Low Birth Weight Infant; cohort; design; effective intervention; flexibility; health disparity; improved; interest; intervention program; novel; novel strategies; psychosocial; public health relevance; response; simulation

DESCRIPTION (provided by applicant): Very low birth weight (VLBW) and bronchopulmonary dysplasia (BPD) are significant health issues which are also risk factors for oral health disease, including dental caries. In addition, VLBW/BPD is associated both with enamel defects, a biological risk factor for caries, and reduced cognitive development which may hinder the acquisition of healthy oral health behavior. Furthermore, both VLBW and BPD disproportionately affect minorities and those with low SES. The relative contributions or `mediating effects' of the various biologic, cognitive/behavior and psychosocial factors to the incidence and progression of oral disease in VLBW/BPD individuals is poorly understood. We propose to develop a new approach to mediation analysis and to analyze data from a unique cohort study to help illuminate the relationship between VLBW/BPD and dental caries. Our data are from a study which collected dental caries, enamel defects and oral health behavior information on a cohort of 302 adolescents previously assessed on medical, cognitive, and psychosocial outcomes at birth and at eight years of age. We propose a flexible new statistical method which translates and elaborates a proposed causal diagram into a system of easily fitted generalized linear models. This general context will allow us to incorporate specialized models, such as the zero-inflated Poisson, for the DMFT/S and other dental caries outcomes. We use a potential outcomes framework to develop mediation measures which may be expressed as functions of parameters from our general model. An additional aim of our project is to conduct simulation studies to examine the bias and efficiency of our mediation effect estimators, with a focus on robustness to model departures. Our development and study of methods for mediation analysis will facilitate their broad applicability for dental health and other studies. By helping to illuminate causal mechanisms in the relationship between VLBW/BPD and adolescent dental caries, we also hope to contribute to the development of effective new intervention programs for these special needs children. PUBLIC HEALTH RELEVANCE: This project seeks to learn about the reasons (whether they are biologic, oral health behavioral, or both) for the increased risk of dental caries among adolescents with very low birth weight (VLBW) and/or bronchopulmonary dysplasia (BPD). Our specific goals are to develop new statistical methods to handle complex causal models and to use these methods to analyze data from a cohort of adolescents followed from birth. By understanding the mechanisms leading to dental caries in VLBW/BPD children, we can more effectively intervene to improve the oral and general health of these special needs children.

描述(申请人提供)：极低出生体重(VLBW)和支气管肺发育不良(BPD)是重要的健康问题，也是口腔健康疾病的风险因素，包括龋齿。此外，VLBW/BPD与釉质缺陷和认知发育降低有关，釉质缺陷是龋病的生物危险因素，认知发育降低可能阻碍获得健康的口腔健康行为。此外，VLBW和BPD对少数群体和社会经济地位低的人的影响都不成比例。各种生物、认知/行为和心理社会因素对VLBW/BPD患者口腔疾病的发生和发展的相对贡献或“中介作用”尚不清楚。我们建议开发一种新的中介分析方法，并分析来自一项独特的队列研究的数据，以帮助阐明VLBW/BPD与龋齿的关系。我们的数据来自一项研究，该研究收集了302名青少年的龋齿、釉质缺陷和口腔健康行为信息，这些信息之前对出生时和8岁时的医疗、认知和心理社会结果进行了评估。我们提出了一种灵活的新统计方法，它将所提出的因果图转化为易于拟合的广义线性模型系统并加以阐述。在这一大背景下，我们将能够纳入专门的模型，如零膨胀泊松模型，用于DMFT/S和其他龋齿结果。我们使用一个潜在的结果框架来制定调解措施，这些措施可以表达为我们一般模型中参数的函数。我们项目的另一个目标是进行模拟研究，以检验我们的中介效应估计器的偏差和效率，重点是对模型偏离的稳健性。我们对中介分析方法的开发和研究将促进它们在牙科健康和其他研究中的广泛应用。通过帮助阐明VLBW/BPD与青少年龋齿之间的关系，我们也希望为这些特殊需要的儿童制定有效的新的干预计划做出贡献。 公共卫生相关性：该项目旨在了解极低出生体重(VLBW)和/或支气管肺发育不良(BPD)青少年患龋齿风险增加的原因(无论是生物原因、口腔健康行为原因，还是两者兼有)。我们的具体目标是开发新的统计方法来处理复杂的因果模型，并使用这些方法来分析从出生起跟踪的一组青少年的数据。通过了解导致VLBW/BPD儿童龋齿的机制，我们可以更有效地进行干预，以改善这些特殊需要儿童的口腔和一般健康。