Washington Dental Service, 9706 Fourth Avenue NE, Seattle, WA 98115, USA.
BMC Oral Health. 2012 Jul 9;12:20. doi: 10.1186/1472-6831-12-20.
About one-third of adults with diabetes have severe oral complications. However, limited previous research has investigated dental care utilization associated with diabetes. This project had two purposes: to develop a methodology to estimate dental care utilization using claims data and to use this methodology to compare utilization of dental care between adults with and without diabetes.
Data included secondary enrollment and demographic data from Washington Dental Service (WDS) and Group Health Cooperative (GH), clinical data from GH, and dental-utilization data from WDS claims during 2002-2006. Dental and medical records from WDS and GH were linked for enrollees continuously and dually insured during the study. We employed hurdle models in a quasi-experimental setting to assess differences between adults with and without diabetes in 5-year cumulative utilization of dental services. Propensity score matching adjusted for differences in baseline covariates between the two groups.
We found that adults with diabetes had lower odds of visiting a dentist (OR = 0.74, p < 0.001). Among those with a dental visit, diabetes patients had lower odds of receiving prophylaxis (OR = 0.77), fillings (OR = 0.80) and crowns (OR = 0.84) (p < 0.005 for all) and higher odds of receiving periodontal maintenance (OR = 1.24), non-surgical periodontal procedures (OR = 1.30), extractions (OR = 1.38) and removable prosthetics (OR = 1.36) (p < 0.001 for all).
Patients with diabetes are less likely to use dental services. Those who do are less likely to use preventive care and more likely to receive periodontal care and tooth-extractions. Future research should address the possible effectiveness of additional prevention in reducing subsequent severe oral disease in patients with diabetes.
约有三分之一的成年糖尿病患者有严重的口腔并发症。然而，先前的研究很少调查与糖尿病相关的牙科保健利用情况。本项目有两个目的：一是开发一种使用索赔数据估算牙科保健利用情况的方法，二是使用该方法比较有和无糖尿病患者的牙科保健利用情况。
数据包括华盛顿牙科服务（WDS）和团体健康合作组织（GH）的二次入组和人口统计学数据、GH 的临床数据以及 2002-2006 年 WDS 索赔的牙科利用数据。WDS 和 GH 的医疗和牙科记录为研究期间连续和双重保险的参保者进行了链接。我们在准实验环境中使用障碍模型评估了有和无糖尿病患者在 5 年内牙科服务累计利用情况方面的差异。采用倾向评分匹配调整了两组间基线协变量的差异。
我们发现，糖尿病患者看牙医的可能性较低（OR = 0.74，p < 0.001）。在有牙科就诊的患者中，糖尿病患者接受预防治疗（OR = 0.77）、补牙（OR = 0.80）和牙冠（OR = 0.84）的可能性较低（所有 p < 0.005），接受牙周维护（OR = 1.24）、非手术牙周治疗（OR = 1.30）、拔牙（OR = 1.38）和可摘义齿（OR = 1.36）的可能性较高（所有 p < 0.001）。
糖尿病患者使用牙科服务的可能性较低。那些使用牙科服务的患者更不可能接受预防治疗，而更有可能接受牙周治疗和拔牙。未来的研究应该解决在减少糖尿病患者后续严重口腔疾病方面增加预防措施的可能效果。
