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Bias in estimating the cross-sectional smoking, alcohol, obesity and diabetes associations with moderate-severe periodontitis in the Atherosclerosis Risk in Communities study: comparison of full versus partial-mouth estimates.

TitleBias in estimating the cross-sectional smoking, alcohol, obesity and diabetes associations with moderate-severe periodontitis in the Atherosclerosis Risk in Communities study: comparison of full versus partial-mouth estimates.
Publication TypeJournal Article
Year of Publication2015
AuthorsAkinkugbe AA, Saraiya VM, Preisser JS, Offenbacher S
Secondary AuthorsBeck JD
JournalJ Clin Periodontol
Volume42
Issue7
Pagination609-21
Date Published2015 Jul
ISSN1600-051X
KeywordsAfrican Americans, Alcohol Drinking, Atherosclerosis, Bias, Cohort Studies, Cross-Sectional Studies, Dental Care, Diabetes Complications, European Continental Ancestry Group, Female, Gingival Recession, Humans, Male, Middle Aged, Nutrition Surveys, Obesity, Periodontal Attachment Loss, Periodontal Index, Periodontal Pocket, Periodontitis, Prevalence, Prospective Studies, Risk Factors, Sensitivity and Specificity, Smoking, United States
Abstract

OBJECTIVE: To assess whether partial-mouth protocols (PRPs) result in biased estimates of the associations between smoking, alcohol, obesity and diabetes with periodontitis.

METHODS: Using a sample (n = 6129) of the 1996-1998 Atherosclerosis Risk in Communities study, we used measures of probing pocket depth and clinical attachment level to identify moderate-severe periodontitis. Adjusting for confounders, unconditional binary logistic regression estimated prevalence odds ratios (POR) and 95% confidence limits. Specifically, we compared POR for smoking, alcohol, obesity and diabetes with periodontitis derived from full-mouth to those derived from 4-PRPs (Ramfjörd, National Health and Nutrition Examination survey-III, modified-NHANES-IV and 42-site-Random-site selection-method). Finally, we conducted a simple sensitivity analysis of periodontitis misclassification by changing the case definition threshold for each PRP.

RESULTS: In comparison to full-mouth PORs, PRP PORs were biased in terms of magnitude and direction. Holding the full-mouth case definition at moderate-severe periodontitis and setting it at mild-moderate-severe for the PRPs did not consistently produce POR estimates that were either biased towards or away from the null in comparison to full-mouth estimates.

CONCLUSIONS: Partial-mouth protocols result in misclassification of periodontitis and may bias epidemiologic measures of association. The magnitude and direction of this bias depends on choice of PRP and case definition threshold used.

DOI10.1111/jcpe.12425
Alternate JournalJ Clin Periodontol
PubMed ID26076661
PubMed Central IDPMC4509916
Grant ListHHSN268201100012C / HL / NHLBI NIH HHS / United States
HHSN268201100009I / HL / NHLBI NIH HHS / United States
T90 DE021986 / DE / NIDCR NIH HHS / United States
HHSN268201100010C / HL / NHLBI NIH HHS / United States
HHSN268201100008C / HL / NHLBI NIH HHS / United States
5T90 DE021986 -04 / DE / NIDCR NIH HHS / United States
HHSN268201100005G / HL / NHLBI NIH HHS / United States
HHSN268201100008I / HL / NHLBI NIH HHS / United States
HHSN268201100007C / HL / NHLBI NIH HHS / United States
HHSN268201100011I / HL / NHLBI NIH HHS / United States
HHSN268201100011C / HL / NHLBI NIH HHS / United States
HHSN268201100006C / HL / NHLBI NIH HHS / United States
HHSN268201100005I / HL / NHLBI NIH HHS / United States
HHSN268201100009C / HL / NHLBI NIH HHS / United States
HHSN268201100005C / HL / NHLBI NIH HHS / United States
HHSN268201100007I / HL / NHLBI NIH HHS / United States