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）的风险因素。此外，VLBW/BPD与釉质缺陷（龋齿的生物学风险因素）和认知发育降低（可能阻碍健康口腔健康行为的获得）相关。此外，极低出生体重儿和贫困人口过多地影响少数群体和社会经济地位低的人。各种生物学、认知/行为和心理社会因素对VLBW/BPD个体口腔疾病发病率和进展的相对贡献或“介导作用”知之甚少。我们建议开发一种新的方法来调解分析和分析数据，从一个独特的队列研究，以帮助阐明VLBW/BPD和龋齿之间的关系。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岁时对医疗，认知和心理社会结果进行了评估。我们提出了一个灵活的新的统计方法，翻译和阐述了一个系统的易于拟合的广义线性模型的因果关系图。这个一般的背景将使我们能够将专门的模型，如零膨胀泊松，DMFT/S和其他龋齿的结果。我们使用一个潜在的结果框架来制定调解措施，这些措施可以表示为我们的一般模型中参数的函数。我们项目的另一个目的是进行模拟研究，以检查我们的中介效应估计的偏差和效率，重点是对模型偏离的鲁棒性。我们的开发和研究的调解分析方法将促进其广泛适用于牙齿健康和其他研究。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。 公共卫生相关性：该项目旨在了解极低出生体重（VLBW）和/或支气管肺发育不良（BPD）青少年患龋齿风险增加的原因（无论是生物学原因，口腔健康行为原因，还是两者兼而有之）。我们的具体目标是开发新的统计方法来处理复杂的因果模型，并使用这些方法来分析从出生后的青少年队列的数据。通过了解导致极低出生体重/BPD儿童龋齿的机制，我们可以更有效地干预，以改善这些特殊需要儿童的口腔和整体健康。

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.