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

摘要 老年人生活变化的纵向信息(例如，认知衰退、退休、医疗 健康状况和残疾)会影响他们的口腔健康，而牙齿的利用很少。然而，需要纵向数据 来评估因果关系。婴儿潮一代和其他几代人经历了不同的生活环境，这对他们产生了良好的影响。 生存和衰老。为了规划他们的口腔健康需求和预防护理，统计模型应该考虑到 不同的出生队列。这项二级数据分析将使用全面的、纵向的、全国性的 具有代表性的美国健康和退休研究(HRS)。HRS队列是51岁以上的人及其配偶 世卫组织参加了2006年至2018年两年一次的核心人权报告浪潮(n≥15,960次/浪潮)；心理社会 亚样本A(任意波中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)。并非所有变量每两年收集一次；10年和12年的变化指的是2008-2018年和 2006-2018年。对于以总体为基础的分析，将在调查回归中应用适当的抽样权重 分析以反映美国人口；适当的协变量、潜在的混杂因素和队列/数据子集 使用。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距 HRS定义出生的传统社会人口学和较少研究的心理社会和就业因素 一群人。自评口腔健康、牙齿状况(有无功能性牙列、无牙)和口腔健康- 相关的生活质量将被评估。目标2a)按出生队列比较2008-2018年间牙齿利用的趋势 调整口腔健康状况；目标2b)确定预测10年或12年恶化发生率的因素 口腔健康状况(牙齿缺失、牙齿脱落、口腔健康状况恶化)。目标3)评估 受试者内部变化与认知的双向关系(通过电话访谈进行评估 每两年收集一次的认知状况(TICS)和成年人的口腔健康状况。认知障碍很常见 垂暮之年。了解口腔健康下降对认知的影响是很重要的，因为 对受影响的个人、家庭成员和照顾者的社会影响。先前的研究表明不同的是 口腔健康与认知之间的关系。目标3a。确定2008年的基线口腔健康状况是否 预示着10年的认知衰退。目标3b。确定基线认知状态和10/12年认知 下降预示着10/12年来口腔健康的恶化。目标4侧重于纵向变化的影响 在心理社会因素方面，如HRS测量的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齿利用的影响。目标4b)确定基线是否 心理社会因素和12年的变化可以预测牙齿缺失事件和2018年的口腔健康结果。 目标2b、3b和4b将使用自举交叉验证来评估预测准确性。成果将弥合差距 了解不同世代的老年人随着时间的推移情况如何，并为卫生政策提供信息 决定(即，将牙科保险纳入联邦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).