Oral Health Disparities in Children with Special Needs

描述(由申请人提供)：有特殊健康护理需要(CSHCN)的儿童约占美国18岁以下儿童的1250万或18%，但根据使用的定义，患病率估计在4%至32%之间。根据1994-1995年全国残疾人健康访谈调查的数据，牙科护理是CSHCN最普遍的未得到满足的卫生保健需求。关于这一未得到充分服务的群体的口腔健康状况的大部分信息来自小样本、不具代表性的样本、地方或地区报告或对成年人的研究。现有信息表明，这一群体存在严重的口腔健康差距，包括口腔健康状况不佳和牙病得不到治疗。 该项目将分析1988-94年第三次全国健康和营养检查调查(NHANES III)的公开数据，以描述这一群体的口腔健康状况，并比较全国2-17岁CSHCN儿童和没有特殊需求的类似年龄儿童的龋齿、牙周状况、牙齿脱落和门牙创伤的患病率和严重程度。我们还将比较CSHCN中未得到满足的牙科需求和获得护理的机会与没有特殊需求的同龄人。由于这是一个多样化的群体，分析策略旨在比较先天假设的儿童患龋齿的高风险，因为慢性病对他们的口腔健康产生负面影响，药物使用对口腔产生不利影响，或者影响自我护理实践的功能限制(身体和认知)。 将使用联邦妇幼保健局对CSHCN的定义以及其他定义。参加NHANES III的近10,300名2-17岁儿童的数据将使用SAS和SUDAAN进行分析，以说明在这个具有全国代表性的样本中的复杂调查设计，并说明潜在的混杂因素和影响因素。这些分析的结果将指导我们制定研究假设和适当的干预措施，以便在未来的CSHCN研究中进行检验。

DESCRIPTION (provided by applicant): Children with special health care needs (CSHCN) comprise about 12.5 million or 18% of US children under age 18, though prevalence estimates range from 4%-32% depending on the definition used. Based on data from the 1994-95 National Health Interview Survey on Disability, dental care is the most prevalent unmet health care need of CSHCN. Most of the information about the oral health status of this underserved group comes from small, unrepresentative samples, local or regional reports, or studies of adults. Available information indicates that this group surfers from severe oral health disparities including poor oral health and untreated dental disease. This project will analyze publicly available data from the third National Health and Nutrition Examination Survey, 1988-94 (NHANES III) to describe the oral health status of this group, and to compare the national prevalence and severity of dental caries, periodontal conditions, tooth loss and incisor trauma in CSHCN ages 2-17 years to similarly aged children without special needs. We will also compare unmet dental needs and access to care in CSHCN to that of their peers without special needs. Because this is a diverse group, analytical strategies are designed to compare children hypothesized a priori to be at high risk for caries because of chronic illness that negatively impacts their oral health, medication use with adverse effects on the ora cavity, or functional limitations (physical and cognitive) that affect self-care practices. The federal Maternal and Child Health Bureau definition of CSHCN will be used as well as others. Data from nearly 10,300 children ages 2-17 years participating in NHANES III will be analyzed using SAS arid SUDAAN to account for the complex survey design in this nationally representative sample, and account for potential confounders and effect modifiers. The result of these analyses will direct our formulation of research hypotheses and appropriate interventions for testing in future studies of CSHCN.