Analysis of longitudinal data from a school-based comprehensive caries prevention program

 描述（由申请人提供）：本项目的目标是评估以学校为基础的龋齿预防计划。为了实现这一点，我们将分析一个为期六年的纵向数据集的9260名儿童就读于标题1学校谁参加了以学校为基础的龋齿预防计划。这将使我们能够识别和量化临床和以患者为中心的变量，这些变量可以增强龋齿预防的实施和有效性，并预测高危儿童的龋齿进展。龋齿是最常见的可预防的儿童疾病。在5至17岁的儿童中，龋齿的发病率是哮喘的5倍多，口腔健康状况不佳与呼吸系统疾病、心血管疾病和糖尿病有关。未经治疗的龋齿影响了28%的美国学龄儿童（超过1000万），以及近50%的少数民族，服务不足和医疗补助接受者。来自联邦和州政府、健康基金会和临床组织的指导都建议以学校为基础的龋齿预防作为增加获得和改善健康的有效手段。令人遗憾的是，疾病控制和预防中心目前的数据表明，只有14%的儿童获得有效的预防性牙科服务。学校预防龋齿的传播和实施有三个主要障碍：（1）虽然有效性试验证明了龋齿控制的成功，但在大型实用研究中几乎没有有效性的证据;（2）对不同年龄学生的预防效果随着时间的推移而累积的知之甚少，因此很难优化;和（3）以前对预防项目纵向数据的研究没有研究最需要护理的学生群体。我们在这个项目中的目标是使用二级数据分析，以确定优化以学校为基础的龋齿预防计划的关键标准。特别是，我们将量化：（1）对儿童、牙齿和牙齿表面未经治疗的龋齿的发病率和患病率的影响;（2）随着时间的推移，个体内的变化和预防的因果效应;以及（3）预测龋齿发展的概率，以优化护理，重点关注交付时间、高危人群的目标护理以及临床相关的预防方法。我们将使用新的统计方法来正确解释复杂的研究设计，控制相关的观察到的和未测量的混杂因素，并利用所有可用的数据来确保足够的统计功效。这项研究是有意义的，它将是第一个系统地分析全面的龋齿预防在纵向数据集的学生参加标题1学校。研究结果有可能为国家实施有效的以学校为基础的龋齿预防计划提供基础信息。

 DESCRIPTION (provided by applicant): The goal of this project is to evaluate school-based caries prevention programs. To accomplish this we will analyze a six-year longitudinal data set of 9260 children attending Title 1 schools who participated in a school- based caries prevention program. This will allow us to identify and quantify clinical and patient-centered variables that enhance the delivery and effectiveness of caries prevention and predict caries progression in high-risk children. Dental caries is the most common preventable childhood disease. Caries is over five times more common than asthma among children aged 5 to 17, and poor oral health has been associated with respiratory disease, cardiovascular disease, and diabetes. Untreated caries affects 28% of U.S. school-age children (more than 10 million), and almost 50% of minority, underserved, and Medicaid recipients. Guidance from federal and state governments, health foundations, and clinical organizations all recommend school- based caries prevention as an effective means of increasing access to and improving health. Sadly, current data from the Centers for Disease Control and Prevention indicate that only 14% of children receive effective preventive dental services. There are three primary barriers to the dissemination and implementation of school- based caries prevention: (1) while efficacy trials demonstrate success in caries control, there is little evidence of effectiveness in large pragmatic studies; (2) littleis known of the cumulative effects of prevention over time for students of varying age, so optimization is difficult; and (3) previous studies of longitudinal data from prevention programs did not examine student cohorts who most needed care. Our goal in this project is to use secondary data analysis to identify key criteria for optimizing school-based caries prevention programs. In particular, we will quantify: (1) impact on the incidence and prevalence rate of untreated caries across children, teeth, and tooth surfaces; (2) intra-individual change and the causal effects of prevention over time; and (3) predicted probabilities of decay development to optimize care, focusing on delivery time, targeted care for high- risk groups, and clinically relevant prevention methods. We will use novel statistical methods to properly account for the complex research design, control for relevant observed and unmeasured confounders, and utilize all available data to ensure adequate statistical power. This research is significant in tht it will be the first to systematically analyze comprehensive caries prevention in a longitudinal dataset of students attending Title 1 schools. The outcomes have the potential to provide foundational information for national implementation of effective school-based caries prevention programs.