Birth Certificate Linkage To Growth & Health Measures

本项目使用第三次全国健康和营养检查调查（NHANES III, 1988-84）的数据，与2-83个月样本儿童的出生证明相关联（由Overpeck博士通过与NCHS/CDC的机构间协议协调），以探索宫内生长对健康的影响。今年完成的分析主要集中在围产期因素对儿童早期龋齿的影响。随着极早产婴儿存活率的提高，关于是否对儿童牙齿发育有影响的问题已经出现，特别是早产是否与ECC风险增加有关。从第三次全国健康和营养检查调查（1988-1994年）中提取了3,273名3-5岁儿童的人口特征（种族/民族、家庭收入）、营养（婴儿喂养、儿童饮食、补品）、接触氟化水和龋齿状况的信息。这些数据与出生证明相关联，以获得出生体重并确定早产程度（非常早产<33周，早产33-36周，早产37周以上）；2.2%非常早产，7.2%早产。主要结局变量为ECC，定义为无龋、中度（1-7颗牙齿受影响）和重度（8+颗牙齿受影响）。与龋齿有关的主要环境因素，即接触符合保护作用水平（0.6 ppm）的氟化水（公共水源）的可能性，是根据区域和居住县的规模估算的。正如预期的那样，接触氟化水与患龋齿的乳牙数量减少有关（-1.3颗牙齿受影响/接触概率增加10%，p<.001）。调整氟化水暴露和其他混杂因素后，早产儿童的ECC风险仅略有增加。然而，早产儿发生中度ECC的风险增加了两倍（AOR=2.04, 95% CI=0.73-5.67），严重ECC的风险显著增加（AOR=11.94, 95% CI 1.16-123.07）。因此，由于牙釉质形成的破坏或与出生后重症监护相关的因素，早产儿童的初级牙列可能容易发生ECC。

This project uses data from the Third National Health and Nutrition Examination Survey (NHANES III, 1988-84), linked to birth certificates for sample children ages 2-83 mo (coordinated by Dr. Overpeck through an interagency agreement with NCHS/CDC) to explore the health consequences of intrauterine growth. Completed analyses in this year focused on the effects of perinatal factors on early childhood caries (ECC). With improved survival of infants born very preterm, questions have arisen as to whether there are consequences for childhood dental development, particularly whether preterm delivery is associated with an increased risk of ECC. Information on demographic characteristics (race/ethnicity, family income), nutrition (infant feeding, childhood diet, supplements), exposure to fluoridated water, and caries status was extracted for 3,273 children, ages 3-5 years, from the Third National Health and Nutrition Examination Survey (1988-1994). These were linked to birth certificates to acquire birth weight and define degree of prematurity (very preterm <33 wk, preterm 33-36 wk, term 37+ wk); 2.2% were born very preterm, and 7.2% preterm. The main outcome variable was ECC, defined as no caries, moderate (1-7 teeth affected) and severe (8+ teeth affected). The major environmental factor related to caries, the probability of exposure to fluoridated water (public sources) at levels consistent with a protective effect (> 0.6 ppm), was estimated based on region and residential county size. As expected, exposure to fluoridated water was associated with a decrease in number of primary teeth affected with caries (-1.3 teeth affected/10% increase in probability of exposure, p<.001). Adjusting for fluoridated water exposure and other confounding, children born preterm had only a modest increased risk of ECC. However, children born very preterm had a twofold increased risk of moderate ECC (AOR=2.04, 95% CI=0.73-5.67), and a dramatically increased risk of severe ECC (AOR=11.94, 95% CI 1.16-123.07). Thus, the primary dentition of children born very preterm may be susceptible to ECC because of disruptions in tooth enamel formation or factors associated with their postnatal intensive care.