Gift H C, Atchison K A, Dayton C M
National Institutes of Health, Bethesda, MD 20892-6401, USA.
Soc Sci Med. 1997 Mar;44(5):601-8. doi: 10.1016/s0277-9536(96)00211-0.
This investigation considers oral health from a health-related quality of life perspective using a multidimensional concept representing a combination of impairment, function, perceptions, and/or opportunity. A subset of dentate individuals aged 18 and older from a national probability sample of the U.S. was selected for the reported analysis with data available from personal interviews, self-administered questionnaires, and oral examinations. Impairment was represented by clinically assessed active diseases and sequelae of diseases and self-reported acute symptoms. Other domains are represented by self-reported problems with function, perception of control over oral health, satisfaction with teeth, value attributed to oral health, and opportunity to obtain dental care. Principal components analysis with varimax rotation provided a structure to interpret four factors: accumulated oral neglect, self-perceived symptoms and problems, reparable oral diseases, and oral health values and priorities. Approximately 50% of the variance was explained by these four factors. Factor-based scores, envisioned as an index or summary measure representing the combination of variables identified in each factor, were used to assess potential validity. Whites had lower levels of accumulated oral neglect, fewer symptoms, and less reparable oral disease, but similar oral health values, than non-whites. Level of formal education was associated with each of the four factor-based scores. Age was directly associated with accumulated oral neglect, but the youngest age group had significantly more reparable oral diseases. Individuals with a dental visit in the past two years had considerably less accumulated oral neglect, fewer self-perceived problems, less reparable oral disease, and higher values of oral health than those without a dental visit in the past two years. Ordinary least square regressions were performed on each of the four factor-based scores using eight sociodemographic and economic variables. All four regression models were significant, with only the education variable being significant across all models. These analyses provide no evidence for one unique factor representing oral health. Rather, a conceptual framework for oral health appears to be represented by a set of reasonably independent components, including two groups of clinically assessed oral health, which together more fully represent oral health than any one single variable. Conceptualizing and measuring oral health multidimensionally leads us closer to examining it as part of general health.
本研究从与健康相关的生活质量角度考量口腔健康，采用了一个多维概念，该概念代表了损伤、功能、认知和/或机会的综合情况。从美国全国概率样本中选取了一部分18岁及以上的有牙个体进行报告分析，数据来自个人访谈、自填问卷和口腔检查。损伤由临床评估的活动性疾病、疾病后遗症和自我报告的急性症状来体现。其他维度则由自我报告的功能问题、对口腔健康的控制感、对牙齿的满意度、赋予口腔健康的价值以及获得牙科护理的机会来体现。采用方差最大化旋转的主成分分析提供了一种结构来解释四个因素：累积口腔忽视、自我感知的症状和问题、可修复的口腔疾病以及口腔健康价值观和优先事项。这四个因素解释了约50%的方差。基于因素的分数被设想为一个指数或汇总指标，代表每个因素中确定的变量的组合，用于评估潜在的有效性。与非白人相比，白人的累积口腔忽视水平较低，症状较少，可修复的口腔疾病也较少，但口腔健康价值观相似。正规教育水平与基于四个因素的分数均相关。年龄与累积口腔忽视直接相关，但最年轻的年龄组有明显更多的可修复口腔疾病。过去两年内看过牙医的个体比过去两年内未看过牙医的个体累积口腔忽视程度明显更低，自我感知的问题更少，可修复的口腔疾病更少，口腔健康价值更高。使用八个社会人口统计学和经济变量对基于四个因素的分数分别进行普通最小二乘法回归。所有四个回归模型均具有显著性，只有教育变量在所有模型中均具有显著性。这些分析没有为代表口腔健康的单一独特因素提供证据。相反，口腔健康的概念框架似乎由一组合理独立的成分来代表，包括两组临床评估的口腔健康，它们共同比任何一个单一变量更全面地代表口腔健康。从多维角度对口腔健康进行概念化和测量，使我们更接近于将其作为整体健康的一部分来进行审视。
