抑郁和焦虑与口腔健康服务的使用及牙齿缺失的关系。

The association between depression and anxiety and use of oral health services and tooth loss.

机构信息

Division of Behavioral Surveillance, Public Health Surveillance Program Office, Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.

出版信息

Community Dent Oral Epidemiol. 2012 Apr;40(2):134-44. doi: 10.1111/j.1600-0528.2011.00637.x. Epub 2011 Aug 25.

DOI:10.1111/j.1600-0528.2011.00637.x

PMID:21883356

Abstract

OBJECTIVE

The purpose of this study is to examine the associations among depression, anxiety, use of oral health services, and tooth loss.

METHODS

Data were analysed for 80 486 noninstitutionalized adults in 16 states who participated in the 2008 Behavioral Risk Factor Surveillance System. Binomial and multinomial logistic regression analyses were used to estimate predicted marginals, adjusted prevalence ratios, adjusted odds ratios (AOR) and their 95% confidence intervals (CI).

RESULTS

The unadjusted prevalence for use of oral health services in the past year was 73.1% [standard error (SE), 0.3%]. The unadjusted prevalence by level of tooth loss was 56.1% (SE, 0.4%) for no tooth loss, 29.6% (SE, 0.3%) for 1-5 missing teeth, 9.7% (SE, 0.2%) for 6-31 missing teeth and 4.6% (SE, 0.1%) for total tooth loss. Adults with current depression had a significantly higher prevalence of nonuse of oral health services in the past year than those without this disorder (P < 0.001), after adjustment for age, sex, race/ethnicity, education, marital status, employment status, adverse health behaviours, chronic conditions, body mass index, assistive technology use and perceived social support. In logistic regression analyses employing tooth loss as a dichotomous outcome (0 versus ≥1) and as a nominal outcome (0 versus 1-5, 6-31, or all), adults with depression and anxiety were more likely to have tooth loss. Adults with current depression, lifetime diagnosed depression and lifetime diagnosed anxiety were significantly more likely to have had at least one tooth removed than those without each of these disorders (P < 0.001 for all), after fully adjusting for evaluated confounders (including use of oral health services). The adjusted odds of being in the 1-5 teeth removed, 6-31 teeth removed, or all teeth removed categories versus 0 teeth removed category were increased for adults with current depression versus those without (AOR = 1.35; 95% CI = 1.14-1.59; AOR = 1.83; 95% CI = 1.51-2.22; and AOR = 1.44; 95% CI = 1.11-1.86, respectively). The adjusted odds of being in the 1-5 teeth removed and 6-31 teeth removed categories versus 0 teeth removed category were also increased for adults with lifetime diagnosed depression or anxiety versus those without each of these disorders.

CONCLUSIONS

Use of oral health services and tooth loss was associated with depression and anxiety after controlling for multiple confounders.

摘要

目的

本研究旨在探讨抑郁、焦虑、口腔卫生服务利用与牙齿缺失之间的关系。

方法

对 16 个州的 80486 名非住院成年人进行数据分析，这些成年人参与了 2008 年行为风险因素监测系统。采用二项式和多项逻辑回归分析来估计预测边缘值、调整后患病率比、调整后比值比（AOR）及其 95%置信区间（CI）。

结果

过去一年口腔卫生服务的未调整患病率为 73.1%（标准误差[SE]，0.3%）。未调整的牙齿缺失水平患病率为：无牙齿缺失为 56.1%（SE，0.4%），缺失 1-5 颗牙齿为 29.6%（SE，0.3%），缺失 6-31 颗牙齿为 9.7%（SE，0.2%），全部牙齿缺失为 4.6%（SE，0.1%）。当前患有抑郁症的成年人过去一年未使用口腔卫生服务的比例显著高于无此疾病的成年人（P < 0.001），调整了年龄、性别、种族/民族、教育程度、婚姻状况、就业状况、不良健康行为、慢性疾病、体重指数、辅助技术使用和感知社会支持等因素后。在将牙齿缺失作为二分类结果（0 与≥1）和名义结果（0 与 1-5、6-31 或全部）进行逻辑回归分析时，患有抑郁症和焦虑症的成年人更有可能出现牙齿缺失。当前患有抑郁症、终生诊断为抑郁症和终生诊断为焦虑症的成年人与无这些疾病的成年人相比，更有可能至少有一颗牙齿被拔掉（所有 P < 0.001），在充分调整了评估混杂因素（包括口腔卫生服务的使用）后。与无当前抑郁症的成年人相比，当前患有抑郁症的成年人在 1-5 颗牙齿被拔掉、6-31 颗牙齿被拔掉或全部牙齿被拔掉的类别中，其处于上述类别中的可能性增加（AOR = 1.35；95%CI = 1.14-1.59；AOR = 1.83；95%CI = 1.51-2.22；AOR = 1.44；95%CI = 1.11-1.86）。与无终生诊断为抑郁症或焦虑症的成年人相比，终生诊断为抑郁症或焦虑症的成年人在 1-5 颗牙齿被拔掉和 6-31 颗牙齿被拔掉的类别中，其处于上述类别中的可能性也增加。