PMID- 21774138
OWN - NLM
STAT- MEDLINE
DCOM- 20110927
LR  - 20231110
IS  - 0022-4006 (Print)
IS  - 1752-7325 (Electronic)
IS  - 0022-4006 (Linking)
VI  - 71
IP  - 2
DP  - 2011 Spring
TI  - Health insurance status is associated with periodontal disease progression among 
      Gullah African-Americans with type 2 diabetes mellitus.
PG  - 143-51
AB  - OBJECTIVES: Assess periodontal disease progression among GullahAfrican Americans 
      with type 2 diabetes mellitus (T2DM) according to health insurance coverage. 
      METHODS: From an ongoing clinical trial among T2DM Gullah, we extracted a cohort 
      that was previously enrolled in a cross-sectional study (N=93). Comparing prior 
      exam to trial initiation, total tooth sites/person with periodontal disease 
      progression events [evaluated separately: 2+ mm of clinical attachment loss 
      (CAL), 2+ mm increased periodontal probing depths (PPD), bleeding on probing 
      (BOP) emergence] were evaluated according to health insurance coverage using 
      regression techniques appropriate for data with different counts of potential 
      events per subject (varying tooth sites available). We used negative binomial 
      regression techniques to account for overdispersion and fit multivariable models 
      that also included baseline glycemic control (poor: glycated hemoglobin > OR =7 
      percent, well: glycated hemoglobin <7 percent), history of established 
      periodontitis, age, gender, body mass index, annual income, and oral hygiene 
      behaviors. Final models included health insurance status, other significant 
      predictors, and any observed confounders. RESULTS: Privately insured were most 
      prevalent (41.94 percent), followed by uninsured (23.66 percent), Medicare (19.35 
      percent), and Medicaid (15.05 percent). Those with poor glycemic control (65.59 
      percent) were more prevalent than well-controlled (34.41 percent). CAL events 
      ranged from 0 to 58.8 percent tooth sites/ person (11.83 +/- 12.44 percent), 
      while PPD events ranged from 0 to 44.2 percent (8.66 +/- 10.97 percent) and BOP 
      events ranged from 0 to 95.8 percent (23.65 +/- 17.21 percent). Rates of CAL 
      events were increased among those who were uninsured [rate ratio (RR) = 1.75, P = 
      0.02], Medicare-insured (RR = 1.90, P = 0.03), and Medicaid-insured (RR = 1.89, P 
      = 0.06). CONCLUSIONS: Increased access to health care, including dental services, 
      may achieve reduction in chronic periodontal disease progression (as determined 
      by CAL) for this study population. These results are very timely given the March 
      2010 passing of the US healthcare reform bills.
FAU - Marlow, Nicole M
AU  - Marlow NM
AD  - Division of Biostatistics and Epidemiology, College of Medicine, Medical 
      University of South Carolina, Charleston, SC 29425, USA.
FAU - Slate, Elizabeth H
AU  - Slate EH
FAU - Bandyopadhyay, Dipankar
AU  - Bandyopadhyay D
FAU - Fernandes, Jyotika K
AU  - Fernandes JK
FAU - Leite, Renata S
AU  - Leite RS
LA  - eng
GR  - M01 RR001070/RR/NCRR NIH HHS/United States
GR  - P20 RR017696/RR/NCRR NIH HHS/United States
GR  - R03 DE020114/DE/NIDCR NIH HHS/United States
PT  - Clinical Trial
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - J Public Health Dent
JT  - Journal of public health dentistry
JID - 0014207
RN  - 0 (Glycated Hemoglobin A)
SB  - IM
MH  - Adult
MH  - Black or African American/*ethnology
MH  - Age Factors
MH  - Aged
MH  - Body Mass Index
MH  - Chronic Periodontitis/complications/physiopathology
MH  - Cohort Studies
MH  - Cross-Sectional Studies
MH  - Diabetes Mellitus, Type 2/blood/*complications
MH  - Disease Progression
MH  - Female
MH  - Gingival Hemorrhage/complications/physiopathology
MH  - Glycated Hemoglobin/analysis
MH  - Humans
MH  - Income
MH  - *Insurance Coverage
MH  - *Insurance, Health
MH  - Male
MH  - Medicaid
MH  - Medically Uninsured
MH  - Medicare
MH  - Middle Aged
MH  - Oral Hygiene
MH  - Periodontal Attachment Loss/complications/physiopathology
MH  - Periodontal Diseases/complications/*physiopathology
MH  - Periodontal Pocket/complications/physiopathology
MH  - Sex Factors
MH  - South Carolina
MH  - United States
PMC - PMC4234040
MID - NIHMS640575
EDAT- 2011/07/21 06:00
MHDA- 2011/09/29 06:00
PMCR- 2014/11/17
CRDT- 2011/07/21 06:00
PHST- 2011/07/21 06:00 [entrez]
PHST- 2011/07/21 06:00 [pubmed]
PHST- 2011/09/29 06:00 [medline]
PHST- 2014/11/17 00:00 [pmc-release]
AID - 10.1111/j.1752-7325.2011.00243.x [doi]
PST - ppublish
SO  - J Public Health Dent. 2011 Spring;71(2):143-51. doi: 
      10.1111/j.1752-7325.2011.00243.x.