Multilevel analyses of oral health conditions among older adults in the All of Us Research Program

摘要

Abstract The U.S. population is rapidly aging. Americans are living longer, with more chronic conditions, and retaining more teeth. Because of the relationships between oral and systemic conditions, there is a need for dental care to become better integrated with primary care. Oral health inequalities in access to dental care are prevalent among older adults. Routine dental care is not included in Medicare and large state-level variations exist in dental Medicaid benefits. The oral health of older adults in the US is understudied due to few national large- scale studies with longitudinal components that include medical dental, individual and community level data. With this supplement, secondary data analysis from the national NIH All of US (AoU) Research Project will expand information about adults age 51+ available from the longitudinal, nationally representative US Health and Retirement Study (HRS) currently being analyzed (NIDCR R03 DE030161-02). Our R03 goals are to study longitudinal changes in the oral health of older adults in relationship to changes in cognition, retirement, medical, contextual, psychosocial, behavioral and dental utilization data. Both HRS and AoU datasets provide information to link oral health status to medical conditions, demographics, lifestyle, psychosocial factors, and overall health. The HRS and AoU both include self-report survey data. Additionally, the AoU includes clinically- determined information from participants' electronic health records (EHR) obtained in healthcare settings. AoU seeks to enroll diverse, traditionally under-represented groups. The AoU Controlled Tier level data includes 3- digit ZIP code that provides access to geographical contextual information to explore social determinants of health using multilevel analyses. Poor oral health, partial tooth loss, and edentulism among older adults negatively affect their quality of life and functional status. An AoU analytical Controlled Tier dataset will be constructed with 3 groups having different oral conditions based on EHR data for comparison: 1) completely edentulous, 2) partially edentulous, and 3) evidence of being dentate (e.g., dental caries, periodontitis). The specific aims are: AIM 1a) Tabulate the means (SD) and frequency distribution of socio-demographic factors in Controlled Tier AoU data and medical, cognition, and social/lifestyle risk indicators from survey and EHR data associated with these 3 dental status groups (above). Aim 1b) Develop multivariable models using these 3 dental status groups and dental utilization to determine their influence on self-rated health, cognition, and other medical conditions (e.g., diabetes, cardiovascular disease, stroke). Aim 1c) Develop multilevel models including contextual variables using zip code data to represent geographic regions where participants reside to examine individual and area variations in outcomes. AIM 2: Compare AoU findings with 2018 HRS data and assess population differences in self-rated health, cognition, and medical outcomes. HRS and AoU are both large-scale, landmark studies with different key features. By analyzing both datasets, we will be able to take advantage of the best features of each one to further our understanding of the oral health of older adults.