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Chronic kidney disease and use of dental services in a United States public healthcare system: a retrospective cohort study.

Grubbs V, Plantinga LC, Tuot DS, Powe NR - BMC Nephrol (2012)

Bottom Line: Those with CKD had a 25% lower likelihood of having a dental visit [HR = 0.75, 95% CI (0.64-0.88)] than those without CKD after adjustment for confounders.Dental visits, but not eye visits, in a US public healthcare setting are extremely low, particularly among patients with CKD.Given the emerging association between oral health and CKD, addressing factors that impede dental access may be important for reducing the disparate burden of CKD in this population.

View Article: PubMed Central - HTML - PubMed

Affiliation: San Francisco General Hospital, Division of Nephrology, University of California, San Francisco, USA. grubbsv@medsfgh.ucsf.edu

ABSTRACT

Background: As several studies have shown an association between periodontal disease and chronic kidney disease (CKD), regular dental care may be an important strategy for reducing the burden of CKD. Access to dental care may be limited in the US public health system.

Methods: In this retrospective cohort study of 6,498 adult patients with (n = 2,235) and without (n = 4,263) CKD and at least 12 months of follow-up within the San Francisco Department of Public Health Community Health Network clinical databases, we examined the likelihood of having a dental visit within the observation period (2005-2010) using Cox proportional hazards models. To determine whether dental visits reflected a uniform approach to preventive service use in this setting, we similarly examined the likelihood of having an eye visit among those with diabetes, for whom regular retinopathy screening is recommended. We defined CKD status by average estimated glomerular filtration rate based on two or more creatinine measurements ≥ 3 months apart (no CKD, ≥ 60 ml/min/1.73 m2; CKD, < 60 ml/min/1.73 m2).

Results: Only 11.0% and 17.4% of patients with and without CKD, respectively, had at least one dental visit. Those with CKD had a 25% lower likelihood of having a dental visit [HR = 0.75, 95% CI (0.64-0.88)] than those without CKD after adjustment for confounders. Among the subgroup of patients with diabetes, 11.8% vs. 17.2% of those with and without CKD had a dental visit, while 58.8% vs. 57.8% had an eye visit.

Conclusions: Dental visits, but not eye visits, in a US public healthcare setting are extremely low, particularly among patients with CKD. Given the emerging association between oral health and CKD, addressing factors that impede dental access may be important for reducing the disparate burden of CKD in this population.

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Cumulative incidence of time to eye visit among those with diabetes.
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Figure 3: Cumulative incidence of time to eye visit among those with diabetes.

Mentions: While the percentage of patients with a dental visit was similar between those with and without diabetes (14.7% vs. 15.5%, p = 0.368), significantly more patients with diabetes had an eye visit than those without diabetes (58.3% vs. 26.8, p < 0.001). The percentages of patients with diabetes with a dental or eye visit by CKD status are shown in Figure 1. Among the 1,392 patients with diabetes but no CKD, 239 (17.2%) had a dental visit while 805 (57.8%) had an eye visit over the entire study period. Among the 1,183 patients with diabetes and CKD, 139 (11.8%) had a dental visit and 696 (58.8%) had an eye visit. Similar to the entire study population, patients with diabetes and CKD had a 20% lower likelihood of having a dental visit than those without CKD in the fully adjusted Cox model [0.80, (0.64-1.00)]. However, there was no difference in likelihood of having an eye visit by CKD status [fully adjusted model, 1.07, (0.96-1.19)]. As depicted in Figure 2, the cumulative incidence of time to dental visit by CKD status is not substantially different in the entire study population versus the population restricted to those with diabetes by CKD status. Figure 3 depicts an essentially overlapping cumulative incidence by CKD status of time to eye visit among the subpopulation with diabetes.


Chronic kidney disease and use of dental services in a United States public healthcare system: a retrospective cohort study.

Grubbs V, Plantinga LC, Tuot DS, Powe NR - BMC Nephrol (2012)

Cumulative incidence of time to eye visit among those with diabetes.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3368751&req=5

Figure 3: Cumulative incidence of time to eye visit among those with diabetes.
Mentions: While the percentage of patients with a dental visit was similar between those with and without diabetes (14.7% vs. 15.5%, p = 0.368), significantly more patients with diabetes had an eye visit than those without diabetes (58.3% vs. 26.8, p < 0.001). The percentages of patients with diabetes with a dental or eye visit by CKD status are shown in Figure 1. Among the 1,392 patients with diabetes but no CKD, 239 (17.2%) had a dental visit while 805 (57.8%) had an eye visit over the entire study period. Among the 1,183 patients with diabetes and CKD, 139 (11.8%) had a dental visit and 696 (58.8%) had an eye visit. Similar to the entire study population, patients with diabetes and CKD had a 20% lower likelihood of having a dental visit than those without CKD in the fully adjusted Cox model [0.80, (0.64-1.00)]. However, there was no difference in likelihood of having an eye visit by CKD status [fully adjusted model, 1.07, (0.96-1.19)]. As depicted in Figure 2, the cumulative incidence of time to dental visit by CKD status is not substantially different in the entire study population versus the population restricted to those with diabetes by CKD status. Figure 3 depicts an essentially overlapping cumulative incidence by CKD status of time to eye visit among the subpopulation with diabetes.

Bottom Line: Those with CKD had a 25% lower likelihood of having a dental visit [HR = 0.75, 95% CI (0.64-0.88)] than those without CKD after adjustment for confounders.Dental visits, but not eye visits, in a US public healthcare setting are extremely low, particularly among patients with CKD.Given the emerging association between oral health and CKD, addressing factors that impede dental access may be important for reducing the disparate burden of CKD in this population.

View Article: PubMed Central - HTML - PubMed

Affiliation: San Francisco General Hospital, Division of Nephrology, University of California, San Francisco, USA. grubbsv@medsfgh.ucsf.edu

ABSTRACT

Background: As several studies have shown an association between periodontal disease and chronic kidney disease (CKD), regular dental care may be an important strategy for reducing the burden of CKD. Access to dental care may be limited in the US public health system.

Methods: In this retrospective cohort study of 6,498 adult patients with (n = 2,235) and without (n = 4,263) CKD and at least 12 months of follow-up within the San Francisco Department of Public Health Community Health Network clinical databases, we examined the likelihood of having a dental visit within the observation period (2005-2010) using Cox proportional hazards models. To determine whether dental visits reflected a uniform approach to preventive service use in this setting, we similarly examined the likelihood of having an eye visit among those with diabetes, for whom regular retinopathy screening is recommended. We defined CKD status by average estimated glomerular filtration rate based on two or more creatinine measurements ≥ 3 months apart (no CKD, ≥ 60 ml/min/1.73 m2; CKD, < 60 ml/min/1.73 m2).

Results: Only 11.0% and 17.4% of patients with and without CKD, respectively, had at least one dental visit. Those with CKD had a 25% lower likelihood of having a dental visit [HR = 0.75, 95% CI (0.64-0.88)] than those without CKD after adjustment for confounders. Among the subgroup of patients with diabetes, 11.8% vs. 17.2% of those with and without CKD had a dental visit, while 58.8% vs. 57.8% had an eye visit.

Conclusions: Dental visits, but not eye visits, in a US public healthcare setting are extremely low, particularly among patients with CKD. Given the emerging association between oral health and CKD, addressing factors that impede dental access may be important for reducing the disparate burden of CKD in this population.

Show MeSH
Related in: MedlinePlus