Department of Healthcare Administration and Medical Informatics, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan.
Division of Medical Statistics and Bioinformatics, Department of Medical Research, Kaohsiung Medical University, Kaohsiung, Taiwan.
Front Public Health. 2023 Sep 6;11:1241150. doi: 10.3389/fpubh.2023.1241150. eCollection 2023.
Diabetes threatens population health, especially in rural areas. Diabetes and periodontal diseases have a bidirectional relationship. A persistence of rural-urban disparities in diabetes may indicate a rural-urban difference in periodontal disease among patients with diabetes; however, the evidence is lacking. This retrospective study aimed to investigate rural-urban discrepancies in the incidence and treatment intensity of periodontal disease among patients who were newly diagnosed with type 2 diabetes in the year 2010.
The present study was a retrospective cohort design, with two study samples: patients with type 2 diabetes and those who were further diagnosed with periodontal disease. The data sources included the 2010 Diabetes Mellitus Health Database at the patient level, the National Geographic Information Standardization Platform and the Department of Statistics, Ministry of Health and Welfare in Taiwan at the township level. Two dependent variables were a time-to-event outcome for periodontal disease among patients with type 2 diabetes and the treatment intensity measured for patients who were further diagnosed with periodontal disease. The key independent variables are two dummy variables, representing rural and suburban areas, with urban areas as the reference group. The Cox and Poisson regression models were applied for analyses.
Of 68,365 qualified patients, 49% of them had periodontal disease within 10 years after patients were diagnosed with diabetes. Compared to urban patients with diabetes, rural (HR = 0.83, 95% CI: 0.75-0.91) and suburban patients (HR = 0.86, 95% CI: 0.83-0.89) had a lower incidence of periodontal disease. Among 33,612 patients with periodontal disease, rural patients received less treatment intensity of dental care (Rural: RR = 0.87, 95% CI: 0.83, 0.92; suburban: RR = 0.93, 95% CI: 0.92, 0.95) than urban patients.
Given the underutilization of dental care among rural patients with diabetes, a low incidence of periodontal disease indicates potentially undiagnosed periodontal disease, and low treatment intensity signals potentially unmet dental needs. Our findings provide a potential explanation for the persistence of rural-urban disparities in poor diabetes outcomes. Policy interventions to enhance the likelihood of identifying periodontal disease at the early stage for proper treatment would ease the burden of diabetes care and narrow rural-urban discrepancies in diabetes outcomes.
糖尿病威胁着人口健康，尤其是在农村地区。糖尿病和牙周病之间存在双向关系。如果糖尿病患者的城乡间糖尿病发病率持续存在差异，可能表明城乡间牙周病存在差异；然而，目前这方面的证据还很缺乏。本回顾性研究旨在调查 2010 年新诊断为 2 型糖尿病患者中牙周病发病率和治疗强度的城乡差异。
本研究采用回顾性队列设计，有两个研究样本：患有 2 型糖尿病的患者和进一步被诊断为牙周病的患者。数据来源包括患者层面的 2010 年糖尿病健康数据库、国家地理信息标准化平台以及台湾卫生福利部统计处。两个因变量是 2 型糖尿病患者牙周病的时间事件结局和进一步被诊断为牙周病患者的治疗强度。关键的自变量是两个代表农村和郊区的虚拟变量，以城市地区为参照组。采用 Cox 和 Poisson 回归模型进行分析。
在 68365 名合格患者中，有 49%的患者在被诊断为糖尿病后 10 年内患有牙周病。与城市糖尿病患者相比，农村（HR=0.83，95%CI：0.75-0.91）和郊区（HR=0.86，95%CI：0.83-0.89）患者牙周病的发病率较低。在 33612 名患有牙周病的患者中，农村患者接受的牙科护理治疗强度较低（农村：RR=0.87，95%CI：0.83，0.92；郊区：RR=0.93，95%CI：0.92，0.95）。
鉴于农村糖尿病患者牙科护理利用率较低，牙周病发病率较低表明可能存在未确诊的牙周病，治疗强度较低表明可能存在未满足的牙科需求。我们的研究结果为糖尿病不良结局的城乡差异持续存在提供了一个潜在的解释。加强早期识别牙周病并进行适当治疗的政策干预措施将减轻糖尿病护理负担，并缩小城乡间糖尿病结局的差异。
