日本人の中高年集団における歯周病が医療費および歯科医療費に及ぼす影響：職場における縦断的研究

The effect of periodontal disease on medical and dental costs in a middle-aged Japanese population: a longitudinal worksite study.

抄録

背景:

歯周病は最も一般的な慢性疾患の一つであるが、歯周病が医療費の増加と関連しているかどうかは明らかではない。著者らは、歯周病が医療費および歯科医療費に及ぼす影響を3.5年間前向きに検討した。

BACKGROUND: Although periodontal disease is one of the most common chronic diseases, it is not clear whether periodontal disease is associated with increased health care costs. The authors examined the effect of periodontal disease on medical and dental costs and use for 3.5 years prospectively.

方法:

40～59歳の日本人公務員4,285人の健康診断と歯科検診、および健康保険請求からデータを得た。対象者は、病的ポケットなし、中等度歯周炎、重度歯周炎の3つのカテゴリーに分けられた。年齢、性別、喫煙、肥満度、高血圧は、肝臓病、心臓病、糖尿病の既往がある被験者を除外した後、多変量解析で調整した。

METHODS: The data were derived from health and dental examinations and health insurance claims of 4,285 Japanese civil officers aged 40 to 59 years. The subjects were divided into three categories: no pathological pocket, moderate periodontitis, and severe periodontitis. Age, gender, smoking, body mass index, and hypertension were adjusted in a multivariate analysis after excluding subjects with any history of liver disease, heart disease, or diabetes mellitus.

結果:

重度の歯周炎を有する被験者の累積費用は、病的ポケットのない被験者に比べて約21％高く、重度の歯周炎を有する被験者の入院率は最も高かった（男性：オッズ比[OR]=.34；95％信頼区間[CI]：1.00～1.80；女性：女性：0.75～2.20）。男性では、重度歯周炎患者の年間入院費は、病的ポケットのない患者よりも75％高かった。外来治療については、明確な傾向は認められなかった。重度の歯周炎患者の年間歯科受診率および費用は，男女ともに最も高かった．歯周病は糖尿病，消化器疾患，肝疾患の医療費を増加させる可能性がある．

RESULTS: The cumulative cost for subjects with severe periodontitis was approximately 21% higher than for subjects with no pathological pocket, and the hospital admission rates of subjects with severe periodontitis were highest (male: odds ratio [OR]=.34; 95% confidence interval [CI]: 1.00 to 1.80; female: OR=1.29; 95% CI: 0.75 to 2.20). In males, the annual hospital costs of subjects with severe periodontitis were 75% higher than for subjects with no pathological pocket. There was no clear trend identified for outpatient care. The annual dental visit rates and costs for subjects with severe periodontitis were highest in both genders. Periodontal disease might increase the medical care costs for diabetes mellitus, digestive disease, and liver disease.

結論:

歯周病は、中高年成人におけるわずか数年間の累積医療費の増加に重要な役割を果たしている可能性がある。

CONCLUSION: Periodontal disease may have played an important role in the cumulative health care cost increases in middle-aged adults over a period of only a few years.