Analysis of Complex Caries Life Course Data in Inner City African-American Childr

描述(申请人提供)：尽管累积的证据表明龋齿在口腔内的易感性不同，但口腔内疾病的生命过程仍然相对较少被研究。众所周知，龋病的易感性在上颌之间不同，在单个牙齿及其表面上也是不同的，但人们对这些口腔内特征的发生时间和疾病转移知之甚少。由密歇根大学安娜堡分校牙科学院开展的底特律口腔健康项目(DDHP)是一个独特的数据库，它为龋齿生命过程的研究提供了详细的口腔内信息。这是一项纵向研究，旨在了解居住在密歇根州底特律的低收入非裔美国儿童(0-5岁)及其主要照顾者(14岁以上)的口腔健康状况。在其他信息中，这项研究包括涉及牙齿水平和牙齿表面水平的龋齿生命过程信息的纵向调查，这些调查可以为一些重要的研究问题提供答案，例如：哪些牙齿或牙齿表面从声音病变到非空洞病变并最终过渡到空洞病变的速度更快？哪些牙齿或牙齿表面更有可能从非空洞病变反向过渡到健康？口腔中是否存在(左-右或上-下)关于龋齿转移时间的对称性？男孩的磨牙比男性更有可能更快地过渡到更高的疾病阶段 女孩们？从DDHP研究中分析龋齿生命过程数据本质上是复杂的，因为间隔审查的观察、分级的口腔内相关性和多种龋齿状态 损伤。在统计文献中有几部研究相关问题和复杂性的著作，但这些著作通常只包含其中的一到两个复杂性。据我们所知，我们不知道有任何统计模型可以同时解决所有这些复杂问题。该项目的具体目的是为牙齿和牙齿表面水平的集群间隔删失龋齿历史数据开发半参数多状态模型；并应用所开发的模型来广泛分析DDHP研究的数据。从技术上讲，该方法将建立在区间删失观测的多状态模型的可能性和惩罚似然估计的基础上。随着这个项目的完成，我们希望大幅提高我们对低收入内城非裔美国儿童儿童早期龋病的了解。最重要的是，所获得的知识可能有助于今后在这些服务不足的人群中预防和治疗龋齿。

DESCRIPTION (provided by applicant): Despite accumulated evidence that caries susceptibility varies within the oral cavity, the intra-oral life course of the disease remains relatively understudied. It is well known that caries susceptibility differs between the maxilla an mandible and also across individual teeth and their surfaces, but little is known about the timing and disease transition for these intra-oral characteristics. A unique database that provides detailed longitudinal intra-oral information for the study of caries life course is the Detroit Denal Health Project (DDHP) conducted by the University of Michigan School of Dentistry at Ann Arbor, Michigan. This is a longitudinal study designed to understand the oral health of low-income African-American children (0-5 years) and their main caregivers (14+ years) residing in the city of Detroit, Michigan. Among other information, this study comprises longitudinal investigations involving tooth-level and tooth-surface level information on caries life course which can provide answers to important research questions such as: which teeth or tooth surfaces transition faster from sound to noncavitated lesions and ultimately to cavitated lesions? Which teeth or tooth surfaces are more likely to transition reversely from noncavitated lesions to sound? Are there (left-right or upper-lower) symmetries in the mouth with respect to caries transition times? Are molars more likely to transition faster to higher disease stages in boys than girls? Analyzing caries life course data from the DDHP study is inherently complex because of interval-censored observations, a hierarchical intra-oral correlation and multiple states of caries lesions. There have been several works in the statistical literature which examine related issues and complications, but these works often accommodate only one or two of these complications. To our best knowledge, we are not aware of any statistical model that addresses all these complications simultaneously. This project specifically aims at developing semiparametric multi-state models for clustered interval-censored caries history data at both tooth and tooth-surface levels; and applying the developed models to extensively analyze the data from the DDHP study. Technically, the methodology will be built from the likelihood of multi- state models for interval-censored observations coupled with penalized likelihood estimation. Following the completion of this project, we hope to substantially improve our understanding of early childhood caries in low income inner city African-American children. Most importantly, the acquired knowledge may then facilitate future prevention and treatment of dental caries in these underserved populations.