東日本大震災被災者における歯周病と不眠症の関連：震災3ヵ月後に開始されたパネル研究

Periodontal Disease Is Associated with Insomnia among Victims of the Great East Japan Earthquake: A Panel Study Initiated Three Months after the Disaster.

抄録

2011年3月、東日本大震災（GEJE）は、壊滅的な津波に続き、日本の沿岸地域の社会および公衆衛生システムを破壊した。被災者の最大の問題である不眠症は、身体的・精神的健康に悪影響を及ぼす。歯周炎は慢性的な不快感や炎症を引き起こすが、不眠症への影響についてはほとんど知られていない。震災の3ヵ月後、2013年9月まで4回にわたって健康パネル調査が実施され、8,015人の成人に関する情報が収集・利用された。熱に関する質問票に加え、口腔疾患の自覚症状など他の変数も記録し、不眠の重症度を評価するためにアテネ不眠尺度を用いた。性，年齢，経済状態，併存疾患，肥満度，心的外傷後ストレス反応，習慣的喫煙・飲酒，Kessler Psychological Distress Scaleスコアで調整した後，パネルデータの多段階ロジスティックモデルを用いて，不眠症と歯周病との関連を検討した．GEJE被害者では不眠症の有病率が高いことに加え、すべての共変量で調整した後、不眠症と歯肉の問題（OR = 2.16、95％CI = 1.43-3.26）および咀嚼困難（OR = 2.22、95％CI = 1.40-3.51）との間に有意な関連が明らかになった。本研究により、GEJE被害者における不眠症と歯周病との間に有意な関連があることが明らかになった。このことから、被災者に対する統合的な口腔保健ケアは、口腔感染症の予防に貢献するだけでなく、このような有害な出来事によって引き起こされる他の問題の緩和にも役立つ可能性が示された。

In March 2011, the Great East Japan Earthquake (GEJE), which was followed by a devastating tsunami, destroyed the societal and the public hygiene systems in Japanese coastal areas. Insomnia, the greatest issue among disaster victims, has detrimental effects on both physical and psychological health. Periodontitis causes chronic discomfort and inflammation, and little is known about its impact on insomnia. Three months after the earthquake, a health panel survey was conducted over four surveys, till September 2013, in which information regarding 8,015 adults was collected and used. In addition to the heath-related questionnaire, other variables including subjective symptoms of oral diseases were recorded, and the Athens Insomnia Scale was used to evaluate the severity of insomnia. The association between insomnia and periodontal disease was examined using multilevel logistic models on the panel data, after adjusting for sex, age, economic status, comorbidities, body mass index, post-traumatic stress reactions, habitual smoking and alcohol drinking, and the Kessler Psychological Distress Scale score. In addition to the higher prevalence of insomnia among GEJE victims, significant association was revealed between insomnia and gum problems (OR = 2.16, 95% CI = 1.43-3.26), and difficulty chewing (OR = 2.22, 95% CI = 1.40-3.51), after adjusting for all covariates. The present study revealed significant association between insomnia and periodontal disease among GEJE victims. This indicated that together, integrated oral health care for disaster victims would contribute not only to prevention of oral infectious diseases, but may also help alleviate other problems caused by these harmful events.