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Peng J, Gorham TJ, Meyer BD. Predicting Dental General Anesthesia Use among Children with Behavioral Health Conditions. JDR Clin Trans Res 2024:23800844241252817. [PMID: 38877718 DOI: 10.1177/23800844241252817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2024] Open
Abstract
OBJECTIVES To evaluate how different data sources affect the performance of machine learning algorithms that predict dental general anesthesia use among children with behavioral health conditions. STUDY DESIGN Observational study using claims data. METHODS Using Medicaid claims from Partners For Kids (2013-2019), electronic medical record data, and the Ohio Child Opportunity Index, we conducted a retrospective cohort study of 12,410 children with behavioral health diagnoses. Four lasso-regularized logistic regression models were developed to predict dental general anesthesia use, each incorporating different data sources. Lift scores, or the ratio of positive predictive value to base case prevalence, were used to compare models, and a lift score of 2.5 was considered minimally acceptable for risk prediction. RESULTS Dental general anesthesia use ranged from 3.2% to 3.9% across models, which made it difficult for the machine learning models to achieve high positive predictive value. Model performance was best when either the electronic medical record (lift = 2.59) or Ohio Child Opportunity Index (lift = 2.56), but not both (lift = 2.34) or neither (lift = 1.87), was used. CONCLUSIONS Incorporating additional data sources improved machine learning model performance, and 2 models achieved satisfactory performance. The model using electronic medical record data could be applied in hospital-based settings, and the model using the Ohio Child Opportunity Index could be more valuable in community-based settings. KNOWLEDGE TRANSFER STATEMENT Machine learning was applied to satisfactorily predict which children with behavioral health diagnoses would require dental treatment under general anesthesia. Incorporating electronic medical record data or area-level social determinants of health data, but not both, improved the performance of the machine learning predictions. The 2 highest performing models could be applied by hospitals using medical record data or by organizations using area-level social determinants of health data to risk stratify the pediatric behavioral health population.
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Affiliation(s)
- J Peng
- IT Research & Innovation, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - T J Gorham
- IT Research & Innovation, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - B D Meyer
- Division of Pediatric Dentistry, The Ohio State University and Nationwide Children's Hospital, Columbus, OH, USA
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Peng J, Townsend J, Casamassimo P, Coury DL, Gowda C, Meyer B. Dental Care Differences Among the Behavioral Health Population in an Accountable Care Organization: A Retrospective Cohort. Acad Pediatr 2022; 23:839-845. [PMID: 36055449 DOI: 10.1016/j.acap.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 08/15/2022] [Accepted: 08/23/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare dental utilization and expenditures between children with and without behavioral health (BH) diagnoses in an accountable care organization. METHODS This retrospective cohort study used enrollment and claims data of Medicaid-enrolled children in Ohio. Children with 7 years of continuous enrollment from 2013 to 2019 were included. We calculated 5 dental utilization outcomes: 1) Diagnostic only visits, 2) Preventive visits, 3) Treatment visits, 4) Treatment visits under general anesthesia (GA), and 5) Orthodontic visits. Total 7-year cumulative expenditures were calculated for each outcome. Multivariable logistic regression models were run for each outcome adjusting for demographics and medical comorbidities. RESULTS Among 77,962 children, 23% had ≥1 BH diagnosis. No utilization differences were noted between children with and without BH for diagnostic only visits, treatment visits, and orthodontic visits. BH status modified the likelihood of having a preventive visit and dental GA visits based on medical comorbidity. For example, children with BH diagnoses had significantly lower odds of a preventive visit (eg, non-complex chronic comorbidity: odds ratio [OR] = 0.87, 95% confidence interval [CI]: 0.85-0.89), and significantly higher odds of a dental treatment under general anesthesia visit (eg, non-chronic comorbidity: OR = 3.69, 95% CI: 3.26-4.18). The total cumulative dental expenditures were $10.5M greater for children with BH. CONCLUSIONS Children with BH diagnoses were significantly less likely to have preventive visits and more likely to have dental GA visits, which was expensive. Early identification and intervention could alter treatment approaches, improve care, reduce risk of harm, and achieve cost-savings within a pediatric accountable care organization.
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Affiliation(s)
- Jin Peng
- Information Technology Research and Innovation (J Peng), The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio; Department of Dentistry (J Peng, J Townsend, P Casamassimo, and B Meyer), Nationwide Children's Hospital; Columbus, Ohio
| | - Janice Townsend
- Department of Dentistry (J Peng, J Townsend, P Casamassimo, and B Meyer), Nationwide Children's Hospital; Columbus, Ohio; Division of Pediatric Dentistry (J Townsend and B Meyer), The Ohio State University, College of Dentistry; Columbus, Ohio
| | - Paul Casamassimo
- Department of Dentistry (J Peng, J Townsend, P Casamassimo, and B Meyer), Nationwide Children's Hospital; Columbus, Ohio
| | - Daniel L Coury
- Department of Developmental and Behavioral Pediatrics (DL Coury), Nationwide Children's Hospital; Columbus, Ohio
| | - Charitha Gowda
- Department of Infectious Diseases (C Gowda), Nationwide Children's Hospital; Columbus, Ohio; Partner's For Kids (C Gowda), Columbus, Ohio
| | - Beau Meyer
- Department of Dentistry (J Peng, J Townsend, P Casamassimo, and B Meyer), Nationwide Children's Hospital; Columbus, Ohio; Division of Pediatric Dentistry (J Townsend and B Meyer), The Ohio State University, College of Dentistry; Columbus, Ohio.
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Hussein H, Abbas M, Albaaj FO, Mahmood A. Importance of preventive dentistry in the elderly: A personal approach. Dent Res J (Isfahan) 2022; 19:11. [PMID: 35308457 PMCID: PMC8927949 DOI: 10.4103/1735-3327.338774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 09/04/2021] [Accepted: 09/30/2021] [Indexed: 11/04/2022] Open
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Azar R, Doucet S, Horsman AR, Charlton P, Luke A, Nagel DA, Hyndman N, Montelpare WJ. A concept analysis of children with complex health conditions: implications for research and practice. BMC Pediatr 2020; 20:251. [PMID: 32456672 PMCID: PMC7248453 DOI: 10.1186/s12887-020-02161-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 05/20/2020] [Indexed: 11/10/2022] Open
Abstract
Background This concept analysis aimed to clarify the meaning of “children with complex health conditions” and endorse a definition to inform future research, policy, and practice. Methods Using Walker and Avant’s (2011)‘s approach, we refined the search strategy with input from our team, including family representatives. We reviewed the published and grey literature. We also interviewed 84 health, social, and educational stakeholders involved in the care of children with complex health conditions about their use/understanding of the concept. Results We provided model, borderline, related, and contrary cases for clarification purposes. We identified defining attributes that nuance the concept: (1) conditions and needs’ breadth; (2) uniqueness of each child/condition; (3) varying extent of severity over time; 4) developmental age; and (5) uniqueness of each family/context. Antecedents were chronic physical, mental, developmental, and/or behavioural condition(s). There were individual, family, and system consequences, including fragmented services. Conclusions Building on previous definitions, we proposed an iteration that acknowledges the conditions’ changing trajectories as involving one or more chronic condition(s), regardless of type(s), whose trajectories can change over time, requiring services across sectors/settings, oftentimes resulting in a lower quality of life. A strength of this paper is the integration of the stakeholders’/family’s voices into the development of the definition.
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Affiliation(s)
- Rima Azar
- Psychobiology of Stress and Health Lab, Psychology Department, Mount Allison University, 49A York Street, Sackville, NB, E4L 1C7, Canada. .,NaviCare/SoinsNavi, Sackville, Canada.
| | - Shelley Doucet
- Department of Nursing and Health Sciences, University of New Brunswick, PO Box 5050, Saint John, NB, E2L 4L5, Canada
| | - Amanda Rose Horsman
- Interdisciplinary Studies, School of Graduate Studies, University of New Brunswick, 100 Tucker Park Rd, Box 5050, Saint John, NB, E2L 4L5, Canada
| | - Patricia Charlton
- Faculty of Nursing, University of Prince Edward Island, 550 University Avenue, Charlottetown, Prince Edward Island, C1A 4P3, Canada
| | - Alison Luke
- Department of Nursing and Health Sciences, University of New Brunswick, PO Box 5050, Saint John, NB, E2L 4L5, Canada
| | - Daniel A Nagel
- Department of Nursing and Health Sciences, University of New Brunswick, PO Box 5050, Saint John, NB, E2L 4L5, Canada
| | - Nicky Hyndman
- Veterans Affairs Canada, PO Box 7700, Charlottetown, PE, C1A 8M9, Canada
| | - William J Montelpare
- Faculty of Science, University of Prince Edward Island, 550 University Avenue, Charlottetown, Prince Edward Island, C1A 4P3, Canada
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Johhnson B, Serban N, Griffin PM, Tomar SL. Projecting the economic impact of silver diamine fluoride on caries treatment expenditures and outcomes in young U.S. children. J Public Health Dent 2019; 79:215-221. [PMID: 30741498 DOI: 10.1111/jphd.12312] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 01/07/2019] [Accepted: 01/17/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To quantify the economic impact of using silver diamine fluoride (SDF) to arrest the progression of dental caries in Medicaid-enrolled children (aged 1-5 years) relative to the standard restorative treatment from the Medicaid programs' perspective. METHODS We used Monte Carlo simulation to estimate averted restorative visits and associated expenditures for varying SDF effectiveness and intervention penetration levels. We compared the current standard of care for treating caries to applying SDF. We estimated expenditures from the 2010-2012 Medicaid Analytic Extract files for seven US states and the incremental cost effectiveness ratio for SDF application on averted restorative visits. RESULTS Across the seven states, averted restorative visits ranged from 2,049 (Vermont) to 60,542 (North Carolina), assuming an SDF penetration level of 50%. Averted per-restorative visit costs ranged from $100 to $350 per-visit. There were higher averted per-restorative visit costs in nonmetropolitan counties than metropolitan counties. CONCLUSIONS Providing SDF as a caries management strategy can reduce Medicaid program dental care expenditures by averting expensive caries treatment options. It could also prevent stressful restorative procedures. State Medicaid programs should consider reimbursing for SDF to arrest the progression of dental caries in young children.
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Affiliation(s)
- Ben Johhnson
- School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Nicoleta Serban
- School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Paul M Griffin
- Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, IN, USA
| | - Scott L Tomar
- Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, USA
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Amiresmaili M, Amini S, Shahravan A, Goudarzi R, Anari SHS, Anbari Z, Ghanbarnejad M. Relation between Socioeconomic Indicators and Children Dental Caries in Iran: A Systematic Review and Meta-analysis. Int J Prev Med 2018; 9:71. [PMID: 30167101 PMCID: PMC6106133 DOI: 10.4103/ijpvm.ijpvm_435_17] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 10/30/2017] [Indexed: 12/02/2022] Open
Abstract
The relationship between households’ socioeconomic situation (SES) and children dental caries has been assessed in many Iranian studies to evaluate the effect of public dental care programs supporting the poor. Hence, this study through systematic review and meta-analysis has presented a conclusion in this regard. Domestic and foreign databases were searched using keywords designed by concept map. Time limit to search the databases included articles published from 1994 to 2017. Twenty-five articles were entered to the final step of the study, in which 49 relationships between SES and dental caries were assessed. Heterogeneity between studies was assessed using I2. Publication bias has been assessed using funnel plot and Egger's test. The data were assessed by STATA 13.1. Odds ratio and mean difference of children dental caries in high SES households in comparison with low SES households were 0.41 (confidence interval [CI]: 0.30, 0.52) and −0.49 (CI: −0.85, −0.13), respectively. The CI in both cases did not include “null or no effect line,” so there was a significant inverse relation between SES and dental caries. Despite the emphasis on upstream documents on equity in access to dental health services, there was high difference between SES groups in this regard. It is necessary to revise dental health programs at the country level to decrease these differences.
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Affiliation(s)
- Mohammadreza Amiresmaili
- Department of Health Management, Policy and Economics, Faculty of Management and Medical Informatics, Kerman University of Medical Sciences, Kerman, Iran
| | - Saeed Amini
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Arash Shahravan
- Endodontology Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Reza Goudarzi
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Seyed Hossein Saberi Anari
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Zohre Anbari
- Educational Development Center, Arak University of Medical Sciences, Arak, Iran
| | - Mahtab Ghanbarnejad
- Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Čuković-Bagić I, Hrvatin S, Jeličić J, Negovetić Vranić D, Kujundžić Tiljak M, Pezo H, Marks L. General dentists' awareness of how to cope with medical emergencies in paediatric dental patients. Int Dent J 2017; 67:238-243. [PMID: 28422288 DOI: 10.1111/idj.12286] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND General dentists (GDs) should be aware of the symptoms, signs, diagnoses and treatment of medical emergencies in paediatric patients. AIM To evaluate the knowledge of GDs in coping with medical emergencies, and to identify whether they are confident to diagnose and treat medical emergencies in paediatric patients. DESIGN The questionnaire was conducted immediately before the beginning of national dental meetings and continuing education seminars in Croatia, attended by the GDs, in order to obtain a representative sample. RESULTS Of a total of 498 GDs who returned the questionnaire with valid data, 51.2% reported that a medical history was regularly taken. A high proportion (81.3%) of the GDs had never received any basic life support (BLS) training and education for paediatric patients during their undergraduate studies. After graduation, this value rose to 86.1% of GDs. However, more than two-thirds (68.7%) had experienced some emergency situation in their practice. The most frequent emergency was vasovagal syncope (83.6%) and the most rare was cardiac arrest (8.2%). One-fifth (20.5%) of GDs experienced some emergency but could not make a diagnosis. The more BLS training undergone by a GD, the more self-confident s/he felt in an emergency situation. CONCLUSIONS Most GDs have a lack of knowledge to cope with medical emergencies in paediatric patients, and do not feel confident to diagnose and treat emergency situations in children. It is suggested that adequate training and education should be provided for all GDs to address this shortcoming.
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Affiliation(s)
- Ivana Čuković-Bagić
- Department of Paediatric and Preventive Dentistry, School of Dental Medicine, University of Zagreb, Zagreb, Croatia.,Department of Dental Medicine, University Hospital Center Zagreb, Zagreb, Croatia
| | - Sandra Hrvatin
- Department of Paediatric Dentistry, School of Medicine, University of Rijeka, Rijeka, Croatia
| | | | - Dubravka Negovetić Vranić
- Department of Paediatric and Preventive Dentistry, School of Dental Medicine, University of Zagreb, Zagreb, Croatia.,Department of Dental Medicine, University Hospital Center Zagreb, Zagreb, Croatia
| | - Mirjana Kujundžić Tiljak
- Department of Medical Statistics, Epidemiology and Medical Informatics, Andrija Stampar School of Public Health, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Hrvoje Pezo
- Croatian Chamber of Dental Medicine, Zagreb, Croatia
| | - Luc Marks
- Centre of Special Care in Dentistry, PaeCoMeDiS, Ghent University Hospital, Gent, Belgium
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Bruen BK, Steinmetz E, Bysshe T, Glassman P, Ku L. Potentially preventable dental care in operating rooms for children enrolled in Medicaid. J Am Dent Assoc 2016; 147:702-8. [PMID: 27158078 DOI: 10.1016/j.adaj.2016.03.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 03/16/2016] [Accepted: 03/23/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND In this study, the authors examined the prevalence and cost of care for children enrolled in Medicaid for potentially preventable dental conditions who receive surgical care in hospital operating rooms (ORs) or ambulatory surgery centers (ASCs). METHODS The authors analyzed Medicaid data from 8 states to find cases in which children aged 1 to 20 years received surgical care in ORs or ASCs in 2010 and 2011 for potentially preventable diagnoses, as defined with diagnostic codes. RESULTS For 6 states with complete data, there were 26,373 cases in 2011 in which children received OR or ASC surgical care for potentially preventable conditions. These cases represent approximately 0.5% of all children enrolled in Medicaid in these states and approximately 1% of children enrolled in Medicaid who received any dental care. There were $68 million in total Medicaid payments for these cases, with an average of $2,581 per case. Diagnostic codes indicated that 98% of cases were related to treatment of dental caries. More than two-thirds of the cases (71%) were children aged 1 to 5 years. CONCLUSIONS Extrapolation to the United States suggests that approximately $450 million in additional expenditures occurred in 2011 because of OR or ASC surgical care for potentially preventable pediatric dental conditions, primarily related to early childhood caries. PRACTICAL IMPLICATIONS Strategies to improve prevention of early childhood caries, including community- and family-based education, and to increase access to timely and early dental care for low-income children could reduce the burdens and costs of these dental problems.
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Non-traumatic Dental Condition-Related Emergency Department Visits and Associated Costs for Children and Adults with Autism Spectrum Disorders. J Autism Dev Disord 2015; 45:1396-407. [PMID: 25374135 DOI: 10.1007/s10803-014-2298-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We analyzed 2010 US National Emergency Department Sample data and ran regression models to test the hypotheses that individuals with ASD are more likely to have non-traumatic dental condition (NTDC)-related emergency department (ED) visits and to incur greater costs for these visits than those without ASD. There were nearly 2.3 million NTDC-related ED visits in 2010. Less than 1.0% (children) and 2.1% (adults) of all ED visits were for NTDC. There was no significant difference in NTDC-related ED visits or costs for children by ASD status. Adults with ASD had significantly lower odds of NTDC-related ED visits (OR 0.39; 95% CI 0.29, 0.52; p < 0.001) but incurred significantly greater mean costs for NTDC-related ED visits (p < 0.006) than did adults without ASD.
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Chi DL, Hopkins S, O'Brien D, Mancl L, Orr E, Lenaker D. Association between added sugar intake and dental caries in Yup'ik children using a novel hair biomarker. BMC Oral Health 2015; 15:121. [PMID: 26452647 PMCID: PMC4600323 DOI: 10.1186/s12903-015-0101-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 10/01/2015] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Dental caries (tooth decay) is a significant public health problem in Alaska Native children. Dietary added sugars are considered one of the main risk factors. In this cross-sectional pilot study, we used a validated hair-based biomarker to measure added sugar intake in Alaska Native Yup'ik children ages 6-17 years (N = 51). We hypothesized that added sugar intake would be positively associated with tooth decay. METHODS A 66-item parent survey was administered, a hair sample was collected from each child, and a dental exam was conducted. Added sugar intake (grams/day) was measured from hair samples using a linear combination of carbon and nitrogen ratios. We used linear and log-linear regression models with robust standard errors to test our hypothesis that children with higher added sugar intake would have a higher proportion of carious tooth surfaces. RESULTS The mean proportion of carious tooth surfaces was 30.8 % (standard deviation: 23.2 %). Hair biomarker-based added sugar intake was associated with absolute (6.4 %; 95 % CI: 1.2 %, 11.6 %; P = .02) and relative increases in the proportion of carious tooth surfaces (24.2 %; 95 % CI: 10.6 %, 39.4 %; P < .01). There were no associations between self-reported measures of sugar-sweetened food and beverage intake and tooth decay. CONCLUSIONS Added sugar intake as assessed by hair biomarker was significantly and positively associated with tooth decay in our sample of Yup'ik children. Self-reported dietary measures were not associated tooth decay. Most added sugars were from sugar-sweetened fruit drinks consumed at home. Future dietary interventions aimed at improving the oral health of Alaska Native children should consider use of objective biomarkers to assess and measure changes in home-based added sugar intake, particularly sugar-sweetened fruit drinks.
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Affiliation(s)
- Donald L Chi
- Department of Oral Health Sciences, University of Washington School of Dentistry, Box 357475, Seattle, WA, 98195, USA.
| | - Scarlett Hopkins
- University of Alaska Fairbanks, Center for Alaska Native Health Research, Fairbanks, AK, USA.
| | - Diane O'Brien
- University of Alaska Fairbanks, Center for Alaska Native Health Research, Fairbanks, AK, USA.
| | - Lloyd Mancl
- Department of Oral Health Sciences, University of Washington School of Dentistry, Box 357475, Seattle, WA, 98195, USA.
| | - Eliza Orr
- University of Alaska Fairbanks, Center for Alaska Native Health Research, Fairbanks, AK, USA.
| | - Dane Lenaker
- Yukon Kuskokwim Health Corporation, Dentistry Department, Bethel, AK, USA.
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Darling BG, Singhal A, Kanellis MJ. Emergency department visits and revisits for nontraumatic dental conditions in Iowa. J Public Health Dent 2015; 76:122-8. [DOI: 10.1111/jphd.12120] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 07/31/2015] [Indexed: 11/26/2022]
Affiliation(s)
| | - Astha Singhal
- Henry M. Goldman School of Dentistry; Boston University; Boston MA USA
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12
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Dietary Research to Reduce Children's Oral Health Disparities: An Exploratory Cross-Sectional Analysis of Socioeconomic Status, Food Insecurity, and Fast-Food Consumption. J Acad Nutr Diet 2015; 115:1599-604. [PMID: 25840937 DOI: 10.1016/j.jand.2015.02.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 02/04/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Tooth decay is the most common childhood disease and it disproportionately affects low-income children. The dietary risk factors associated with socioeconomic status (SES), such as food insecurity and fast-food consumption, are poorly understood. OBJECTIVE To better understand how upstream social factors are related to dietary behaviors by testing the hypothesis that food insecurity mediates the SES-fast-food consumption relationship. DESIGN A 36-item survey was administered to caregivers of children younger than age 18 years (n=212). The predictor variable was SES, measured by whether the child was insured by Medicaid (no/yes). Food insecurity, the potential dietary mediator, was measured using the six-item US Department of Agriculture Household Food Security Survey (food secure/food insecure without hunger/food insecure with hunger). The outcome variable was whether the household reported eating at a fast-food restaurant ≥2 times a week (no/yes). We used logistic structural equation and mediation models to test our hypothesis. RESULTS About 63% of children were classified as low SES. Thirty percent of caregivers reported food insecurity (with or without hunger) and 18.6% of households consumed fast food ≥2 times per week. Lower SES was significantly associated with food insecurity (odds ratio [OR] 3.03, 95% CI 1.51 to 6.04; P=0.002), but SES was not related to fast-food consumption (OR 1.94, 95% CI 0.86 to 4.36; P=0.11). Food insecurity was not associated with fast-food consumption (OR 1.76, 95% CI 0.86 to 3.62; P=0.12). The mediation analyses suggest food insecurity does not mediate the relationship between SES and fast-food consumption. However, there are important potential differences in fast-food consumption by SES and food insecurity status. CONCLUSIONS Future dietary research focusing on tooth decay prevention in vulnerable children may need to account for the differential effects of SES on food insecurity and dietary behaviors like fast-food consumption. Studies are needed to further elucidate the mechanisms linking SES, dietary behaviors, and tooth decay in children.
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Chi DL. Medical care transition planning and dental care use for youth with special health care needs during the transition from adolescence to young adulthood: a preliminary explanatory model. Matern Child Health J 2014; 18:778-88. [PMID: 23812799 DOI: 10.1007/s10995-013-1322-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The aims of the study were to test the hypotheses that youth with special health care needs (YSHCN) with a medical care transition plan are more likely to use dental care during the transition from adolescence to young adulthood and that different factors are associated with dental utilization for YSHCN with and YSHCN without functional limitations. National Survey of CSHCN (2001) and Survey of Adult Transition and Health (2007) data were analyzed (N = 1,746). The main predictor variable was having a medical care transition plan, defined as having discussed with a doctor how health care needs might change with age and having developed a transition plan. The outcome variable was dental care use in 2001 (adolescence) and 2007 (young adulthood). Multiple variable Poisson regression models with robust standard errors were used to estimate covariate-adjusted relative risks (RR). About 63 % of YSHCN had a medical care transition plan and 73.5 % utilized dental care. YSHCN with a medical care transition plan had a 9 % greater RR of utilizing dental care than YSHCN without a medical care transition plan (RR 1.09; 95 % CI 1.03-1.16). In the models stratified by functional limitation status, having a medical care transition plan was significantly associated with dental care use, but only for YSHCN without functional limitations (RR 1.11; 95 % CI 1.04-1.18). Having a medical care transition plan is significantly associated with dental care use, but only for YSHCN with no functional limitation. Dental care should be an integral part of the comprehensive health care transition planning process for all YSHCN.
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Affiliation(s)
- Donald L Chi
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Box 357475, Seattle, WA, 98195, USA,
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14
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Allareddy V, Rampa S, Nalliah RP, Allareddy V. Longitudinal discharge trends and outcomes after hospitalization for mouth cellulitis and Ludwig angina. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 118:524-31. [PMID: 25216950 DOI: 10.1016/j.oooo.2014.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 05/06/2014] [Accepted: 06/03/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Objective is to provide longitudinal discharge trends and hospitalization outcomes in patients hospitalized because of mouth cellulitis or Ludwig angina. METHODS Nationwide Inpatient Sample for years 2004 to 2010 was used. All hospitalizations with primary diagnosis of cellulitis or Ludwig angina were selected. Discharge trends were examined. RESULTS A total of 29,228 hospitalizations occurred as a result of mouth cellulitis/Ludwig angina; 55% of all hospitalizations were male patients; 68% were aged 21 to 60 years. Non-whites comprised close to 40%. The uninsured comprised 22.3%. Ninety-nine patients died in hospitals. The total hospitalization charges across the entire United States over the study period was $772.57 million. Factors associated with increased hospitalization charges included, age, co-morbid burden, insurance status, race, teaching status of hospital, and geographic location. CONCLUSIONS Uninsured non-whites, those with high co-morbid burden, and those aged 21 to 60 years tended to be hospitalized consistently over the study period.
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Affiliation(s)
- Veerasathpurush Allareddy
- Associate Professor, Department of Orthodontics, College of Dentistry, The University of Iowa, Iowa City, IA.
| | - Sankeerth Rampa
- Graduate student, Texas A and M University Health Science Center School of Rural Public Health, College Station, TX
| | - Romesh P Nalliah
- Instructor, Department of Global Health, Harvard School of Dental Medicine, Boston, MA
| | - Veerajalandhar Allareddy
- Assistant Professor, Department of Pediatric Critical Care, Case Western Reserve University School of Medicine, Cleveland, OH
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Chi DL, Masterson EE, Wong JJ. U.S. emergency department admissions for nontraumatic dental conditions for individuals with intellectual and developmental disabilities. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2014; 52:193-204. [PMID: 24937745 PMCID: PMC4097187 DOI: 10.1352/1934-9556-52.3.193] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The authors hypothesized that individuals with intellectual and developmental disabilities (IDDs) are more likely to have an emergency department (ED) admission for nontraumatic dental conditions (NTDCs). The authors analyzed 2009 U.S. National Emergency Department Sample data and ran logistic regression models for children ages 3-17 years and adults age 18 years or older. The prevalence of NTDC-related ED admissions was 0.8% for children and 2.0% for adults. Children with IDDs were at increased odds of NTDC-related ED admission, but this difference was not statistically significant (odds ratio [OR] = 1.06; 95% confidence interval [CI] = 0.91, 1.23). Adults with IDDs had significantly lower odds of an ED admission for NTDCs (OR = 0.49; 95% CI = 0.44, 0.54). Children with IDDs are not at increased odds of NTDC-related ED admissions, whereas adults with IDDs are at significantly reduced odds.
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Chi DL, Masterson EE, Carle AC, Mancl LA, Coldwell SE. Socioeconomic status, food security, and dental caries in US children: mediation analyses of data from the National Health and Nutrition Examination Survey, 2007-2008. Am J Public Health 2014; 104:860-4. [PMID: 24625141 DOI: 10.2105/ajph.2013.301699] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES We examined associations of household socioeconomic status (SES) and food security with children's oral health outcomes. METHODS We analyzed 2007 and 2008 US National Health and Nutrition Examination Survey data for children aged 5 to 17 years (n = 2206) to examine the relationship between food security and untreated dental caries and to assess whether food security mediates the SES-caries relationship. RESULTS About 20.1% of children had untreated caries. Most households had full food security (62%); 13% had marginal, 17% had low, and 8% had very low food security. Higher SES was associated with significantly lower caries prevalence (prevalence ratio [PR] = 0.77; 95% confidence interval = 0.63, 0.94; P = .01). Children from households with low or very low food security had significantly higher caries prevalence (PR = 2.00 and PR = 1.70, respectively) than did children living in fully food-secure households. Caries prevalence did not differ among children from fully and marginally food-secure households (P = .17). Food insecurity did not appear to mediate the SES-caries relationship. CONCLUSIONS Interventions and policies to ensure food security may help address the US pediatric caries epidemic.
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Affiliation(s)
- Donald L Chi
- Donald L. Chi, Erin E. Masterson, Lloyd A. Mancl, and Susan E. Coldwell are with the Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle. Adam C. Carle is with the Department of Pediatrics, School of Medicine, and the Department of Psychology, College of Arts and Sciences, University of Cincinnati, Cincinnati, OH
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