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

描述（由申请人提供）：尽管积累的证据表明龋病的易感性在口腔内是不同的，但对该疾病的口腔内生命过程的研究仍然相对不足。众所周知，龋齿的易感性在上颌和下颌骨之间以及单个牙齿及其表面之间是不同的，但对这些口腔内特征的时间和疾病转变知之甚少。密歇根州安阿伯市密歇根大学牙科学院实施的底特律口腔健康项目（dhp）是一个独特的数据库，为龋齿生命过程的研究提供了详细的纵向口腔内信息。这是一项纵向研究，旨在了解居住在密歇根州底特律市的低收入非洲裔美国儿童（0-5岁）及其主要照顾者（14岁以上）的口腔健康状况。除其他信息外，本研究包括牙齿水平和牙齿表面水平的龋齿生命过程的纵向调查，可以为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的转变更快，最终到空洞病变？哪些牙齿或牙齿表面更容易从非空化病变转变为声音？龋齿过渡时间是否（左右或上下）对称？男孩的磨牙是否比男孩更容易更快地过渡到更高的疾病阶段

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.