Department of Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China.
Department of Medical Administration, Peking University School and Hospital of Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China.
Front Public Health. 2022 Aug 12;10:916878. doi: 10.3389/fpubh.2022.916878. eCollection 2022.
The goal of this study was to identify potentially important factors for the dental health though heterogeneous effects of risk factors within Chinese adolescent populations with different characteristics by analyzing the repeated cross-sectional data collected in the 3rd (2005) and 4th (2015) National Oral Health Survey.
We studied the relationships between the decayed, missing and filled permanent teeth (DMFT) score, which was a discrete value, with the caries risk factors (region, census type, gender, only child or not, parents' education level, tooth bushing, dentist visit history, knowledge score, sugar intake, and pit-and-fissure sealants status), though the Poisson mixture regression model, which could identify subgroups among the full population and estimate the heterogeneous effects of risk factors simultaneously. We performed a series of tests and trend analysis based on the model fitting results to explore the primary causes for the dental caries issue clearly and intuitively.
A total of 39,049 teenagers aged 12 years were involved in the analysis. The Poisson mixture regression model clustered all individuals into three subgroups, where the mean values (standard deviations) of DMFT were 0.18 (0.56), 1.31 (1.49), and 2.91 (1.89), respectively. Model fitting results indicated that the heterogeneous effects of the involved risk factors were significant. In addition, we also found significant differences in the distributions and trends of DMFT within different categories of selected risk factors (region, census type, gender and dentist visiting history) from the projection analysis results. The estimated and projected proportions showed that the proportion of high caries risk population in the southwestern region increased by 31.8%, and will become even more severe as it will be the major component of high caries risk population in 2025.
We found that the trends for the developments and changes of dental caries within populations with different characteristics were inequality. The regional difference is the primary factor for diversified changes in DMFT. The findings in this study provide support for intervention and prevention policies for the deterioration of dental caries risk within different adolescent populations.
本研究旨在通过分析 2005 年和 2015 年第三次（2005 年）和第四次（2015 年）全国口腔健康调查中收集的重复横断面数据，确定不同特征的中国青少年人群中具有异质效应的危险因素，以确定潜在的重要因素。
我们通过泊松混合回归模型研究了龋病危险因素（地区、普查类型、性别、独生子女与否、父母受教育程度、牙套管、看牙医的历史、知识得分、糖摄入量和窝沟封闭剂状况）与恒磨牙龋失补（DMFT）评分（离散值）之间的关系，该模型可以识别总体人群中的亚组，并同时估计危险因素的异质效应。我们根据模型拟合结果进行了一系列检验和趋势分析，以清晰直观地探讨导致龋齿问题的主要原因。
共纳入 39049 名 12 岁青少年。泊松混合回归模型将所有个体聚类为三个亚组，DMFT 的平均值（标准差）分别为 0.18（0.56）、1.31（1.49）和 2.91（1.89）。模型拟合结果表明，所涉及危险因素的异质效应具有统计学意义。此外，我们还从投影分析结果中发现，在选定危险因素（地区、普查类型、性别和看牙医的历史）的不同类别中，DMFT 的分布和趋势存在显著差异。估计和预测的比例表明，西南地区高龋风险人群的比例增加了 31.8%，并且随着该地区成为高龋风险人群的主要组成部分，2025 年情况将更加严重。
我们发现，不同特征人群中龋齿发展和变化的趋势存在不平等。地区差异是 DMFT 多样化变化的主要因素。本研究结果为不同青少年人群龋病风险恶化的干预和预防政策提供了支持。
