Australian Research Centre for Population Oral Health (ARCPOH), Adelaide Dental School, The University of Adelaide, Adelaide, Australia.
SA Aboriginal Chronic Disease Consortium, Wardliparingga, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia.
Community Dent Oral Epidemiol. 2022 Oct;50(5):445-452. doi: 10.1111/cdoe.12699. Epub 2021 Sep 24.
This study aims to investigate the mediating pathways of oral health literacy (OHL) and oral health-related behaviours on the relationship between education and self-reported tooth loss among Australian adults.
Data used for studying the effects of mediating pathways are from the National Dental Telephone Interview Survey 2013, a random sample survey of Australian adults aged 18+ years. To study the mediating effects, we use counterfactual-based analysis. To decompose the effect of multiple mediator's alternate, to natural effect, methods such as interventional effects have been proposed. In this paper, we use these approaches to decompose the effect between education, OHL and oral health-related behaviours on self-reported tooth loss. Sensitivity analysis was performed for unmeasured confounding with multiple mediators.
Data were available for 2936 Australian adults. The prevalence of persons with ≥12 self-reported tooth loss was approximately 15%. The average total causal effect from the low education group was nearly 150%, and the interventional indirect effect through OHL and the dependence of oral health-related behaviours on OHL to more than 12 missing teeth were 20% and 120%, respectively, higher than in the high education group. Sensitivity analysis indicated if the difference in the prevalence of unmeasured confounder is as big as 6% the direct effect and the indirect effect remains as observed.
An additional two-fifths reduction on having more than 12 missing teeth for Australian adults with lower education level could be achieved if the proportion of lower OHL was decreased and optimal dental behaviours were increased.
本研究旨在探讨口腔健康素养（OHL）和口腔健康相关行为在教育与澳大利亚成年人自我报告牙齿缺失之间的关系中的中介途径。
用于研究中介途径影响的数据来自于 2013 年全国牙科电话访谈调查，这是对 18 岁及以上澳大利亚成年人的随机抽样调查。为了研究中介效应，我们使用基于反事实的分析。为了解释多个中介变量的替代效应，提出了干预效应等方法。在本文中，我们使用这些方法来分解教育、OHL 和口腔健康相关行为对自我报告牙齿缺失的影响。对于具有多个中介变量的未测量混杂因素，进行了敏感性分析。
本研究的数据可用于 2936 名澳大利亚成年人。有≥12 颗自我报告牙齿缺失的人的患病率约为 15%。低教育组的平均总因果效应接近 150%，而通过 OHL 的干预间接效应以及口腔健康相关行为对超过 12 颗缺牙的依赖性分别为 20%和 120%，均高于高教育组。敏感性分析表明，如果未测量混杂因素的流行率差异高达 6%，则直接效应和间接效应仍与观察结果一致。
如果降低低 OHL 的比例并增加最佳的口腔护理行为，澳大利亚低教育水平成年人中超过 12 颗缺牙的比例可能会减少五分之二。
