Eke Paul I, Wei Liang, Thornton-Evans Gina O, Borrell Luisa N, Borgnakke Wenche S, Dye Bruce, Genco Robert J
Division of Population Health, Centers for Disease Control and Prevention, Atlanta, GA.
DB Consulting Group, Atlanta, GA.
J Periodontol. 2016 Oct;87(10):1174-85. doi: 10.1902/jop.2016.160013. Epub 2016 Jul 1.
Through the use of optimal surveillance measures and standard case definitions, it is now possible to more accurately determine population-average risk profiles for severe (SP) and non-severe periodontitis (NSP) in adults (aged 30 years and older) in the United States.
Data from the 2009 to 2012 National Health and Nutrition Examination Survey were used, which, for the first time, used the "gold standard" full-mouth periodontitis surveillance protocol to classify severity of periodontitis following suggested Centers for Disease Control/American Academy of Periodontology case definitions. Probabilities of periodontitis by: 1) sociodemographics, 2) behavioral factors, and 3) comorbid conditions were assessed using prevalence ratios (PRs) estimated by predicted marginal probability from multivariable generalized logistic regression models. Analyses were further stratified by sex for each classification of periodontitis.
Likelihood of total periodontitis (TP) increased with age for overall and NSP relative to non-periodontitis. Compared with non-Hispanic whites, TP was more likely in Hispanics (adjusted [a]PR = 1.38; 95% confidence interval 95% CI: 1.26 to 1.52) and non-Hispanic blacks (aPR = 1.35; 95% CI: 1.22 to 1.50), whereas SP was most likely in non-Hispanic blacks (aPR = 1.82; 95% CI: 1.44 to 2.31). There was at least a 50% greater likelihood of TP in current smokers compared with non-smokers. In males, likelihood of TP in adults aged 65 years and older was greater (aPR = 2.07; 95% CI: 1.76 to 2.43) than adults aged 30 to 44 years. This probability was even greater in women (aPR = 3.15; 95% CI: 2.63 to 3.77). Likelihood of TP was higher in current smokers relative to non-smokers regardless of sex and periodontitis classification. TP was more likely in men with uncontrolled diabetes mellitus (DM) compared with adults without DM.
Assessment of risk profiles for periodontitis in adults in the United States based on gold standard periodontal measures show important differences by severity of disease and sex. Cigarette smoking, specifically current smoking, remains an important modifiable risk for all levels of periodontitis severity. Higher likelihood of TP in older adults and in males with uncontrolled DM is noteworthy. These findings could improve identification of target populations for effective public health interventions to improve periodontal health of adults in the United States.
通过采用最佳监测措施和标准病例定义，现在有可能更准确地确定美国30岁及以上成年人中重度牙周炎（SP）和非重度牙周炎（NSP）的人群平均风险概况。
使用了2009年至2012年国家健康和营养检查调查的数据，该调查首次采用“金标准”全口牙周炎监测方案，按照疾病控制中心/美国牙周病学会建议的病例定义对牙周炎的严重程度进行分类。通过以下方面评估牙周炎的概率：1）社会人口统计学因素，2）行为因素，3）合并症，使用多变量广义逻辑回归模型预测边际概率估计的患病率比（PRs）。对于每种牙周炎分类，分析进一步按性别分层。
总体而言，相对于非牙周炎，全口牙周炎（TP）的可能性随年龄增长而增加，NSP也是如此。与非西班牙裔白人相比，西班牙裔患TP的可能性更高（调整后[a]PR = 1.38；95%置信区间95%CI：1.26至1.52），非西班牙裔黑人也是如此（aPR = 1.35；95%CI：1.22至1.50），而SP在非西班牙裔黑人中最常见（aPR = 1.82；95%CI：1.44至2.31）。与不吸烟者相比，当前吸烟者患TP的可能性至少高出50%。在男性中，65岁及以上成年人患TP的可能性（aPR = 2.07；95%CI：1.76至2.43）高于30至44岁的成年人。在女性中，这种可能性更大（aPR = 3.15；95%CI：2.63至3.77）。无论性别和牙周炎分类如何，当前吸烟者患TP的可能性相对于不吸烟者更高。与无糖尿病（DM）的成年人相比，患有未控制糖尿病的男性患TP的可能性更大。
基于金标准牙周测量方法对美国成年人牙周炎风险概况的评估显示，疾病严重程度和性别存在重要差异。吸烟，特别是当前吸烟，仍然是所有牙周炎严重程度水平的一个重要可改变风险因素。老年人以及患有未控制糖尿病的男性患TP的可能性更高，这一点值得注意。这些发现有助于更精准地识别目标人群，从而有效地开展公共卫生干预措施，改善美国成年人的牙周健康状况。
