Rural–urban disparities in the incidence and treatment intensity of periodontal disease among patients with diabetes

Bibliographic Data

ID22075567
AuthorsHsueh-Fen Chen (0000-0002-4066-6881, Kaohsiung Medical University), Huey-Er Lee (Yuan's General Hospital, corresponding author), I-Te Chen (0000-0002-8372-6557, Kaohsiung Medical University), Yu-Ting Huang (0009-0004-3212-3088, Kaohsiung Medical University), Pei‐Shan Ho (0000-0002-0860-1690, Kaohsiung Medical University), Pei-Shan Ho, Saleema A Karim (0000-0002-8946-9897, Virginia Commonwealth University)
Year2023
Volume11
Pages1241150-1241150
Publication date2023-09-06
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueFrontiers in Public Health (JOURNAL)
Journal identifiersISSN: 2296-2565 • E-ISSN: 2296-2565
PublisherFrontiers Media SA (PUBLISHER • CH)
DOI10.3389/fpubh.2023.1241150
PMID37736085
OpenAlexW4386483245
LanguageEN
Citations received1
References cited37

Background: Diabetes threatens population health, especially in rural areas. Diabetes and periodontal diseases have a bidirectional relationship. A persistence of rural-urban disparities in diabetes may indicate a rural-urban difference in periodontal disease among patients with diabetes; however, the evidence is lacking. This retrospective study aimed to investigate rural-urban discrepancies in the incidence and treatment intensity of periodontal disease among patients who were newly diagnosed with type 2 diabetes in the year 2010. Methods: The present study was a retrospective cohort design, with two study samples: patients with type 2 diabetes and those who were further diagnosed with periodontal disease. The data sources included the 2010 Diabetes Mellitus Health Database at the patient level, the National Geographic Information Standardization Platform and the Department of Statistics, Ministry of Health and Welfare in Taiwan at the township level. Two dependent variables were a time-to-event outcome for periodontal disease among patients with type 2 diabetes and the treatment intensity measured for patients who were further diagnosed with periodontal disease. The key independent variables are two dummy variables, representing rural and suburban areas, with urban areas as the reference group. The Cox and Poisson regression models were applied for analyses. Results: Of 68,365 qualified patients, 49% of them had periodontal disease within 10 years after patients were diagnosed with diabetes. Compared to urban patients with diabetes, rural (HR = 0.83, 95% CI: 0.75-0.91) and suburban patients (HR = 0.86, 95% CI: 0.83-0.89) had a lower incidence of periodontal disease. Among 33,612 patients with periodontal disease, rural patients received less treatment intensity of dental care (Rural: RR = 0.87, 95% CI: 0.83, 0.92; suburban: RR = 0.93, 95% CI: 0.92, 0.95) than urban patients. Conclusion: Given the underutilization of dental care among rural patients with diabetes, a low incidence of periodontal disease indicates potentially undiagnosed periodontal disease, and low treatment intensity signals potentially unmet dental needs. Our findings provide a potential explanation for the persistence of rural-urban disparities in poor diabetes outcomes. Policy interventions to enhance the likelihood of identifying periodontal disease at the early stage for proper treatment would ease the burden of diabetes care and narrow rural-urban discrepancies in diabetes outcomes

Diabetes mellitus · Disease · Environmental health · Pathology · Poisson regression · Population · Retrospective cohort study · Rural area · Dental Health and Care Utilization · Hyperglycemia and glycemic control in critically ill and hospitalized patients · Medicine · Oral microbiology and periodontitis research · Endocrinology · Internal Medicine

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