Dye Bruce A, Selwitz Robert H
Centers for Disease Control and Prevention/National Center for Health Statistics, Hyattsville, MD 20782, USA.
J Clin Periodontol. 2005 Jul;32(7):798-808. doi: 10.1111/j.1600-051X.2005.00742.x.
To assess differences between selected periodontal measures by demographic and behavioural factors in a nationally representative sample of the United States.
Data for 11,347 person's ages 20-79 years from the third National Health and Nutrition Examination Survey (NHANES III) were used. Indices and measures constructed from NHANES III data used for this study were: derived community periodontal index (dCPI), attachment loss extent index (ALEI), attachment loss (AL) scores, and a Periodontal Status Measure (PSM) developed for this study.
The influence of demographic and behavioural factors varied across the four indices examined in multivariate cumulative logistic models. Moreover, there was significant effect modification by cigarette smoking with age in the ALEI and AL models. The odds ratio (OR) of increasing periodontal disease status among 20-39 year olds as measured by AL or ALEI for current smokers compared with non-smokers were OR=6.2 (95% confidence interval (CI)=4.1, 8.7) and OR=5.6 (95% CI=3.7, 8.7), respectively. In a similar comparison, the OR for dCPI was 2.6 (95% CI=1.7, 3.8). Furthermore, Mexican American ethnicity was generally not significant in any models using dCPI, PSM, AL, or ALEI and prior dental visit was more likely to be significant only in the dCPI and PSM models.
Among the well-known demographic and behavioural influences on periodontal health status, some, such as race/ethnicity and prior dental visit status have different relationships with differing periodontal measures employed to assess periodontal status. Moreover, potential interactions among cofactors also are dependent upon the measure selected. Periodontal research findings may be influenced significantly by periodontal measure selection and its affect on measurement validity. This may have particular relevance to issues concerning disease surveillance and assessing reduction of disparities in oral health. Consequently, a renewed approach to developing appropriate measures for periodontal epidemiology is needed.
在美国具有全国代表性的样本中，评估按人口统计学和行为因素划分的选定牙周测量指标之间的差异。
使用了来自第三次全国健康和营养检查调查（NHANES III）的11347名年龄在20 - 79岁之间的人员的数据。本研究使用NHANES III数据构建的指标和测量值包括：衍生社区牙周指数（dCPI）、附着丧失程度指数（ALEI）、附着丧失（AL）评分以及为本研究开发的牙周状况测量指标（PSM）。
在多变量累积逻辑模型中，人口统计学和行为因素的影响在四个检查指标中各不相同。此外，在ALEI和AL模型中，吸烟与年龄之间存在显著的效应修正。与非吸烟者相比，20 - 39岁当前吸烟者按AL或ALEI测量的牙周疾病状况增加的优势比（OR）分别为OR = 6.2（95%置信区间（CI）= 4.1, 8.7）和OR = 5.6（95% CI = 3.7, 8.7）。在类似的比较中，dCPI的OR为2.6（95% CI = 1.7, 3.8）。此外，在使用dCPI、PSM、AL或ALEI的任何模型中墨西哥裔美国人种族一般不显著，而之前的牙科就诊仅在dCPI和PSM模型中更可能显著。
在对牙周健康状况的著名人口统计学和行为影响因素中，一些因素，如种族/民族和之前的牙科就诊状况，与用于评估牙周状况的不同牙周测量指标有不同的关系。此外，协变量之间的潜在相互作用也取决于所选的测量指标。牙周研究结果可能会受到牙周测量指标选择及其对测量效度的影响的显著影响。这可能与疾病监测和评估口腔健康差距缩小的问题特别相关。因此，需要一种新的方法来为牙周流行病学制定合适的测量指标。
