1 Department of Global Health Promotion, Tokyo Medical and Dental University (TMDU), Bunkyo-ku, Japan.
2 Japan Society for the Promotion of Science, Chiyoda-ku, Japan.
J Dent Res. 2019 May;98(5):510-516. doi: 10.1177/0022034519833353. Epub 2019 Mar 8.
Comparing the burden of dental conditions to other health outcomes provides useful insight for public policy. We aimed to estimate quality-adjusted life expectancy (QALE) loss due to dental conditions in the US adult population. Social inequalities in QALE loss by dental conditions were also examined. Data from 3 cross-sectional waves of the National Health and Nutrition Examination Survey (NHANES waves 2001 to 2002, 2003 to 2004, and 2011 to 2012) were pooled and analyzed. The average age of study participants ( n = 9,445) was 48.4 y. Disutility scores were derived from self-rated health and the numbers of physically unhealthy days, mentally unhealthy days, and days with activity limitation, employing a previously published algorithm. The associations between the disutility scores and the numbers of decayed teeth, missing teeth, and periodontitis were examined by multiple linear regression stratified by age groups (20-39, 40-59, and ≥60 y), adjusted for other covariates (age, sex, wave fixed effect, educational attainment, smoking, and diabetes). The QALE loss due to dental conditions at the age of 20 was estimated using life tables. Decayed and missing teeth, but not periodontitis, were associated with a larger disutility score. The coefficient for decayed teeth was larger among the older population, whereas that of missing teeth was smaller among them. The estimated QALE loss was 0.43 y (95% confidence interval [CI], 0.28-0.59), which reached 5.3% of QALE loss (8.15 y; 95% CI, 8.03-8.27) due to overall morbidity. There were clear social gradients in QALE loss by dental conditions across the life course, and people with high school or less education had 0.32 y larger QALE loss in total compared with people with college or more education. This study suggests that improvements in people's dental health may yield substantial gains in population health and well-being. The necessity of more comprehensive public health strategies is highlighted.
将牙齿状况的负担与其他健康结果进行比较，可以为公共政策提供有用的见解。我们旨在估计美国成年人群体因牙齿状况导致的调整后质量预期寿命 (QALE) 损失。还检查了牙齿状况造成的 QALE 损失的社会不平等。对来自国家健康和营养检查调查 (NHANES 波 2001 年至 2002 年、2003 年至 2004 年和 2011 年至 2012 年) 的 3 个横截面波的数据进行了汇总和分析。研究参与者的平均年龄（n=9445）为 48.4 岁。采用先前发表的算法，从自我报告的健康状况以及身体不健康天数、心理健康天数和活动受限天数中得出不良健康评分。通过多元线性回归，根据年龄组（20-39 岁、40-59 岁和≥60 岁）检查不良健康评分与龋齿、缺牙和牙周炎数量之间的关联，调整了其他协变量（年龄、性别、波固定效应、教育程度、吸烟和糖尿病）。根据寿命表估算了 20 岁时因牙齿状况导致的 QALE 损失。龋齿和缺牙与更大的不良健康评分相关，但牙周炎没有。在老年人群中，龋齿的系数更大，而在其中，缺牙的系数更小。估计的 QALE 损失为 0.43 年（95%置信区间[CI]，0.28-0.59），占总发病率导致的 QALE 损失的 5.3%（8.15 年；95%CI，8.03-8.27）。在整个生命周期中，牙齿状况造成的 QALE 损失存在明显的社会梯度，与接受过高中或以下教育的人相比，接受过高中或以上教育的人总 QALE 损失高出 0.32 年。本研究表明，改善人们的牙齿健康状况可能会给人口健康和福祉带来实质性的收益。突出了更全面的公共卫生策略的必要性。
