Causal Mediation Analysis of Dental Caries in VLBW and BPD Adolescents

描述（由申请人提供）：极低出生体重（VLBW）和支气管肺发育不良（BPD）是重要的健康问题，也是口腔健康疾病（包括龋齿）的危险因素。此外，VLBW/BPD与牙釉质缺陷（龋齿的生物学危险因素）和认知发育减少（可能阻碍健康口腔健康行为的习得）有关。此外，VLBW和BPD对少数民族和社会经济地位低的人的影响不成比例。各种生物学、认知/行为和社会心理因素对VLBW/BPD患者口腔疾病的发生和进展的相对贡献或“中介作用”尚不清楚。我们建议发展一种新的中介分析方法，并从一项独特的队列研究中分析数据，以帮助阐明VLBW/BPD与龋齿之间的关系。我们的数据来自一项研究，该研究收集了302名青少年的龋齿、牙釉质缺陷和口腔健康行为信息，这些青少年在出生时和8岁时进行了医学、认知和社会心理方面的评估。我们提出了一种灵活的新统计方法，将所提出的因果图转化为易于拟合的广义线性模型系统。这种一般的背景将允许我们纳入专门的模型，如零膨胀泊松，为DMFT/S和其他龋齿的结果。我们使用潜在结果框架来开发中介措施，这些措施可以表示为我们一般模型中参数的函数。我们项目的另一个目标是进行模拟研究，以检查我们的中介效应估计器的偏差和效率，重点是对模型偏离的鲁棒性。我们对中介分析方法的开发和研究将促进其在牙齿健康和其他研究中的广泛适用性。通过帮助阐明VLBW/BPD与青少年龋齿之间关系的因果机制，我们也希望为这些特殊需要儿童制定有效的新干预方案做出贡献。

DESCRIPTION (provided by applicant): Very low birth weight (VLBW) and bronchopulmonary dysplasia (BPD) are significant health issues which are also risk factors for oral health disease, including dental caries. In addition, VLBW/BPD is associated both with enamel defects, a biological risk factor for caries, and reduced cognitive development which may hinder the acquisition of healthy oral health behavior. Furthermore, both VLBW and BPD disproportionately affect minorities and those with low SES. The relative contributions or `mediating effects' of the various biologic, cognitive/behavior and psychosocial factors to the incidence and progression of oral disease in VLBW/BPD individuals is poorly understood. We propose to develop a new approach to mediation analysis and to analyze data from a unique cohort study to help illuminate the relationship between VLBW/BPD and dental caries. Our data are from a study which collected dental caries, enamel defects and oral health behavior information on a cohort of 302 adolescents previously assessed on medical, cognitive, and psychosocial outcomes at birth and at eight years of age. We propose a flexible new statistical method which translates and elaborates a proposed causal diagram into a system of easily fitted generalized linear models. This general context will allow us to incorporate specialized models, such as the zero-inflated Poisson, for the DMFT/S and other dental caries outcomes. We use a potential outcomes framework to develop mediation measures which may be expressed as functions of parameters from our general model. An additional aim of our project is to conduct simulation studies to examine the bias and efficiency of our mediation effect estimators, with a focus on robustness to model departures. Our development and study of methods for mediation analysis will facilitate their broad applicability for dental health and other studies. By helping to illuminate causal mechanisms in the relationship between VLBW/BPD and adolescent dental caries, we also hope to contribute to the development of effective new intervention programs for these special needs children. PUBLIC HEALTH RELEVANCE: This project seeks to learn about the reasons (whether they are biologic, oral health behavioral, or both) for the increased risk of dental caries among adolescents with very low birth weight (VLBW) and/or bronchopulmonary dysplasia (BPD). Our specific goals are to develop new statistical methods to handle complex causal models and to use these methods to analyze data from a cohort of adolescents followed from birth. By understanding the mechanisms leading to dental caries in VLBW/BPD children, we can more effectively intervene to improve the oral and general health of these special needs children.