子どもの口腔衛生関連行動と幼児期齲蝕。潜在的クラス分析

Children's oral health-related behaviours and early childhood caries: A latent class analysis.

抄録

目的:

本研究では、地域に密着した就学前児童の大規模サンプルを対象とした横断研究を行い、修正可能な幼児期の口腔保健関連行動（OHB）の明確なクラスターを特定し、幼児期の口腔保健の臨床的および親が報告した指標との関連を定量化することを目的とした。

OBJECTIVE: In this cross-sectional study in a large community-based sample of preschool-age children, we sought to identify distinct clusters of modifiable early childhood oral health-related behaviours (OHBs) and quantify their association with clinical and parent-reported measures of early childhood oral health.

方法:

METHODS: We relied upon a questionnaire (n = 8033; 11% in Spanish) and clinical oral health data (n = 6404; early childhood caries [ECC] prevalence = 54%] collected in the context of an epidemiologic study of early childhood oral health among 3- to 5-year-old children in North Carolina. Latent class analysis was used to identify clusters of modifiable OHBs based on parents' responses to 6 questionnaire items pertaining to their children's oral hygiene, diet and dental home. The optimal number of clusters was determined based on measures of model fit and interpretability. We examined associations of OHB clusters with clinical and parent-reported child oral health status (ie, ECC prevalence, severity and proportion with untreated disease) using bivariate association tests and multivariable regression modelling with marginal effects estimation accounting for clustered data. We used Mplus v.8.6 (Muthén & Muthén, Los Angeles, CA, USA) and Stata v.16.1 (StataCorp, College Station, TX, USA) for data analyses.

結果:

好ましいOHBクラスター（74％）と好ましくないOHBクラスター（26％）の2つのOHBクラスターを確認しました。好ましいOHBクラスターの子どもは、口腔衛生習慣（歯磨きの頻度とフッ素入り歯磨き粉の使用）が良好で、砂糖を含むスナックや飲料の摂取頻度が低く、夜間の哺乳歴を報告する頻度が低く、歯科医院に通っている可能性が高かった。好ましくないクラスターの子どもは、好ましいクラスターに比べて、ECC有病率（57％対53％）、う蝕負荷（平均dmfs＝9.3対7.6）、未治療疾患（43％対33％）が有意に高く、親が報告した口腔衛生状態も悪かった。

RESULTS: We identified 2 OHB clusters, a favourable (74%) and an unfavourable (26%) one. Children in the favourable OHB cluster had better oral hygiene practices (ie, tooth brushing frequency and fluoridated toothpaste use), lower consumption frequency of sugar-containing snacks and beverages, less frequent reports of night-time bottle-feeding history and a higher likelihood of a dental home. Children in the unfavourable cluster had significantly higher ECC prevalence (57% vs 53%), caries burden (mean dmfs = 9.3 vs 7.6), untreated disease (43% vs 33%) and worse parent-reported oral health status than the favourable cluster.

結論:

今回の結果は、集団研究において、共通で変更可能なECCリスク要因をクラスタリングすることの重要性と有用性を示している。つまり、健康増進の取り組みは、個々の行動リスク要因ではなく、集団を中心に行うことができる。

CONCLUSIONS: Our findings demonstrate the importance and utility of clustering common, modifiable ECC risk factors in population studies - health promotion efforts may centre on groups of people rather than individual behavioural risk factors.