Dentistry, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
JDR Clin Trans Res. 2024 Oct;9(1_suppl):13S-22S. doi: 10.1177/23800844241273760.
Emerging studies on the links between suboptimal oral health and multimorbidity (MM), or the co-existence of multiple chronic conditions, have raised controversy as to whether enhancing access to dental care may mitigate MM in those with suboptimal oral health. In this study, we aim to assess the extent of the association between suboptimal oral health and MM and whether access to dental care can modify this association.
We conducted a cross-sectional analysis using data from the Canadian Longitudinal Study on Aging (CLSA) (N = 44,815, 45 to 84 y old). Edentulism, self-reported oral health (SROH), and other oral health problems (e.g., toothache, bleeding gums) were used as indicators of suboptimal oral health. MM was defined according to the Public Health Agency of Canada as having 2 or more of the following chronic conditions: cancer, cardiovascular diseases, chronic respiratory diseases, diabetes, and mental illnesses. For robustness, we also used a cutoff of having 3 or more of these chronic conditions. Variables for access to dental care included (1) dental visits within the past year, (2) availability of dental insurance, and (3) cost barriers to dental care. We constructed robust Poisson regression models to estimate the association between suboptimal oral health and MM and then assessed the effect measure modification by indicators of access to dental care on a multiplicative scale. We also calculated the relative excess risk due to interaction for prevalence ratio (PR) on an additive scale.
Indicators of suboptimal oral health were significantly associated with MM (edentulism PR 1.17, 95% confidence interval [CI] 1.08, 1.27; poor SROH PR 1.44, 95% CI 1.33, 1.54; other oral health problems PR 1.52, 95% CI 1.44, 1.78). The magnitude of this association was higher in individuals who reported fewer dental visits within the past year, lacked dental insurance, and avoided dental care due to costs.
The association between suboptimal oral health and MM may be exacerbated by barriers to accessing dental care. Policies aiming to enhance access to dental care may help mitigate MM in middle-aged and older Canadians with suboptimal oral health.
This study offers insights into the connection among suboptimal oral health, multimorbidity, and access to dental care factors in middle-aged and older Canadians. The findings can be of value for clinicians and policy makers aiming to enhance medical-dental integration and improve accessibility to dental care and to patients seeking information about the connections between oral health and chronic conditions. Implementation has the potential to enhance individual well-being and drive systemic improvements in health care.
关于口腔健康不佳与多种合并症（MM）之间关联的新研究，即多种慢性疾病同时存在，引起了争议，即改善口腔保健的可及性是否可以减轻口腔健康不佳者的 MM。本研究旨在评估口腔健康不佳与 MM 之间关联的程度，以及口腔保健的可及性是否可以改变这种关联。
我们使用加拿大老龄化纵向研究（CLSA）（N=44815，45-84 岁）的数据进行了横断面分析。无牙（edentulism）、自我报告的口腔健康（SROH）和其他口腔健康问题（如牙痛、牙龈出血）被用作口腔健康不佳的指标。MM 根据加拿大公共卫生署的定义，定义为患有 2 种或以上以下慢性疾病：癌症、心血管疾病、慢性呼吸道疾病、糖尿病和精神疾病。为了稳健性，我们还使用了患有 3 种或以上这些慢性疾病的标准。口腔保健可及性的变量包括（1）过去一年的牙科就诊次数，（2）牙科保险的可用性，以及（3）牙科保健的费用障碍。我们构建了稳健的泊松回归模型来估计口腔健康不佳与 MM 之间的关联，然后评估了口腔保健可及性指标对乘法尺度的效应修正。我们还计算了在加性尺度上的比值比（PR）的交互超额风险。
口腔健康不佳的指标与 MM 显著相关（无牙 PR1.17，95%置信区间[CI]1.08，1.27；SROH 差 PR1.44，95%CI1.33，1.54；其他口腔健康问题 PR1.52，95%CI1.44，1.78）。在过去一年就诊次数较少、没有牙科保险和因费用而避免看牙的人群中，这种关联的程度更高。
口腔保健可及性障碍可能会加剧口腔健康不佳与 MM 之间的关联。旨在提高口腔保健可及性的政策可能有助于减轻加拿大中年和老年人中口腔健康不佳与 MM。
本研究提供了关于加拿大中年和老年人中口腔健康不佳、多种合并症和口腔保健可及性因素之间联系的见解。研究结果对于旨在加强医学-牙科整合和改善口腔保健可及性的临床医生和政策制定者以及寻求有关口腔健康与慢性疾病之间联系信息的患者可能具有价值。实施有可能提高个人的幸福感，并推动医疗保健系统的改善。
