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 有效的预测，权衡牙齿固位的长期前景和涉及的成本。这是在上下文中 当牙齿脱落(由于龋齿或牙周病，或两者兼而有之)仍然是口腔健康的主要负担时 在美国，虽然《平价医疗法案》涵盖了儿科人口，但并未强制要求 成年人。此外，患有其他合并症的老年人，如2型糖尿病(T2D)和差异 在口腔健康方面，获得护理的人往往处于损害口腔健康的较高风险中。随着最近的重大事件 数据存储能力的进步，巨大的口腔健康流行病学数据库，如由 AXIUm和EPIC管理系统，或包含丰富风险信息的国家调查，口腔健康 生物标记物和相关的事件间隔时间(TTE)信息可由我们处理。然而，他们的全面 勘探大多尚未开发，主要是因为它们通常呈现出独特的统计复杂性 超出现有统计工具和软件包的能力。这些措施包括但不限于(A) 非常多层次的设置，(B)非常高水平的审查模式，(C)容纳时间的瓶颈- 不同的生物标志物，(D)国家调查中的信息性抽样，以及(E)关于“有效”和 对预测因素及其混杂因素对这些TTE的复杂影响的“临床可解释”总结 终端。该项目的目标是解决这些复杂性，并执行全面的统计 从包括美国中西部和东南部的3个丰富数据库中分析可用的TTE终端 人口，以及具有全国代表性的NHANES数据库。我们的建议有三个广泛的实际目标 口腔流行病学家和从业者的兴趣：(A)为估计和动态建立实用的风险指数 预测T2D/非T2D老年人牙齿的中位剩余寿命，(B)改进该指数以进行估计 一颗牙齿的时间在NHANES中具有里程碑意义，以及(C)这些新工具在临床上的有效传播 从业者。具体地说，我们建议开发一个文档齐全、免费的Web应用程序，其中 用户/临床医生可以插入受试者的特征值来计算相应的指标确定 牙齿刺痛。这项提议预计将产生关于评估国家级风险评估的新知识。 通过这一全面而独特的指数来评估牙齿存活率。据我们所知，创建一个 牙齿TTE指数是此类指数中的第一个，并将提供一套易于推广的数据分析工具。 当提供具有全国代表性的纵向数据库时(来自正在进行的NHANES研究)， 建议的方法可以很容易地适用于为干预和治疗决定提供信息。

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.