A pragmatic risk index evaluating the elderly with comorbidity for oral health event times

随着牙科保健支出成本的上升，未来的专业牙科治疗计划将寻求利用 有效的预后来衡量牙齿保留的长期前景与所涉及的成本。这是有背景的 当牙齿脱落（由于龋齿或牙周病，或两者）仍然是主要的口腔健康负担时 在美国，虽然《平价医疗法案》（Affordable Care Act）涵盖了儿科人群，但并不强制要求 成年人了此外，患有其他合并症的老年人，如2型糖尿病（T2 D）和差异 在口腔健康获得护理方面，经常面临口腔健康受损的高风险。随着最近重大 数据存储能力的进步，巨大的口腔健康流行病学数据库，如从 AxiUm和Epic管理系统，或包含大量风险信息的国家调查，口腔健康 生物标志物和相关的事件发生时间（TTE）信息可供我们使用。然而，其综合 勘探大部分尚未开发，主要是由于它们所构成的独特的统计复杂性， 超越现有统计工具和软件包的能力。这些措施包括但不限于（a） 一个非常多层次的设置，（B）非常高水平的审查模式，（c）瓶颈适应时间- 不同的生物标志物，（d）国家调查中的信息性抽样，以及（e）对“有效”和 预测因子及其混杂因素对这些TTE的复杂影响的“临床可解释”总结 端点。该项目的目标是解决这些复杂性，并执行全面的统计 分析来自3个丰富数据库（包括美国中西部和东南部）的可用TTE终点 一个全国性的NHANES数据库。我们的建议有三个广泛的目标， 口腔流行病学家和从业人员感兴趣：（a）构建一个实用的风险指数， 预测T2 D/非T2 D老年人牙齿的中值剩余寿命，（B）改进该指数以估计 一颗牙齿的时间，以标志性的事件，在NHANES，和（c）有效传播这些新的工具，以临床 从业者具体来说，我们建议开发一个文档齐全的、免费的Web应用程序， 用户/临床医生可以插入受试者特征的值以计算相应的指数 牙齿TTE。预计这一提议将产生关于评价国家一级风险评估的新知识 通过这个全面而独特的指数来评估牙齿的存活率。据我们所知，这种创造一个 牙齿TTE指数是同类指数中的第一个，它将提供一套易于推广的数据分析工具。 当“全国代表性”纵向数据库可用时（来自正在进行的NHANES研究）， 所提出的方法可以很容易地调整，以告知干预和治疗决定。

With the rising cost of dental healthcare spending, future professional dental treatment plans will seek to utilize efficient prognosis to weigh the long-term outlook of tooth retention against the costs involved. This is in context when tooth loss (due to caries, or periodontal disease, or both) continues to remain a major oral health burden in the US, while the Affordable Care Act, although covering the pediatric population, is not mandated for the adults. Furthermore, elderly people with additional comorbidities, such as Type-2 diabetes (T2D) and disparities in oral health access to care, are often at an elevated risk of compromised oral health. With recent significant advances in data storage capabilities, huge oral health epidemiologic databases, such as those generated from the AxiUm and Epic management systems, or national surveys containing a wealth of risk information, oral health biomarkers, and associated time to event (TTE) information are at our disposal. However, their comprehensive exploration has mostly gone untapped, mainly due to the unique statistical complexities they pose that are often beyond the capabilities of existing statistical tools and software packages. These include, but not limited to (a) an extremely multi-level setup, (b) very high level of censoring patterns, (c) bottlenecks accommodating time- varying biomarkers, (d) informative sampling in national surveys, and (e) no consensus on the ‘effective’ and ‘clinically interpretable’ summary of the complex effects of predictors, and their confounders, on these TTE endpoints. The goals of this project are to address these complexities, and perform a comprehensive statistical analysis of available TTE endpoints from 3 rich databases comprising the U.S. Midwest and Southeast population, and a nationally-representative NHANES database. Our proposal has three broad aims of practical interest to oral epidemiologists and practitioners: (a) construct a pragmatic risk index for estimation and dynamic prediction of the median residual lifetime of a tooth for the T2D/Non-T2D elderly, (b) refine that index to estimate a tooth’s time to landmark events in NHANES, and (c) effective dissemination of these new tools to clinical practitioners. Specifically, we propose to develop a well-documented, free, web-application, where a user/clinician can plug-in values of a subject’s characteristics to calculate the corresponding index determining tooth TTEs. This proposal is expected to generate new knowledge on evaluating national-level risk assessments of tooth survival via this comprehensive and unique index. To the best of our knowledge, this idea of creating a tooth TTE index is the first of its kind, and will provide a set of data analytic tools that are readily generalizable. When ‘nationally-representative’ longitudinal databases are made available (from the ongoing NHANES studies), the proposed methods can be readily adapted to inform interventions and treatment decisions.