Method: Data from NHANES III were downloaded and analyzed, replicating the 1999 Journal of Dental Research paper by Arbes, et al. titled “Association between extent of periodontal attachment loss and self-reported history of heart attack: an analysis of NHANES III data”. Data from the COHRI-DDR, a dataset containing clinical data extracted from electronic health records (EHRs) from 4 dentals schools’ clinics, were downloaded, and variables recoded to be consistent with NHANES. Multivariate logistic regression models were constructed with self-reported heart attack as the outcome. The NHANES analysis was rerun on the subset of variables that were available in both datasets. The COHRI-DDR data were analyzed two ways: excluding those with missing information on self-reported heart attack; and considering them as heart attack-free. Both methods were consistent. All analyses were performed using SAS 9.2 (Cary, NC).
Result: The COHRI-DDR was able to reproduce the NHANES analysis. Final models adjusted for age, sex, race/ethnicity, self-reported history of diabetes and hypertension, and body mass index while examining the relationship between the percent of sites with periodontal attachment loss of at least 3mm and self-reported history of heart attack. Data from 12,175 DDR subjects and 4850 NHANES subjects were analyzed [See Tables 1 and 2].
Conclusion: Our results demonstrate that clinical date from EHRs in dental schools can be used for research. Although the prevalence of periodontal disease was greater in the DDR, this may increase the utility of the DDR for exploring relationships between oral health and systemic health.
Table 1. Bivariate associations
|
DDR (n=12175) |
|
NHANES (n=4850) |
||||||||||||
|
Have you experienced a heart attack? |
Has a doctor ever told you that you had a heart attack? |
|||||||||||||
|
N |
% |
|
No % |
|
Yes % |
p-value |
|
N |
% |
|
No % |
Yes % |
p-value |
|
Percent of sites with periodontal attachment loss of ≥3mm |
|
|
|
|
|
|
0.02 |
|
|
|
|
|
|
<0.01 |
|
0 |
908 |
4.4 |
|
98.2 |
|
1.8 |
|
1746 |
31.4 |
|
98.4 |
|
1.6 |
|
|
>0-33 |
6272 |
30.0 |
|
98.3 |
|
1.8 |
|
2526 |
45.4 |
|
96.5 |
|
3.5 |
|
|
>33-67 |
8072 |
38.6 |
|
97.8 |
|
2.2 |
|
889 |
16.0 |
|
91.8 |
|
8.2 |
|
|
>67-100 |
5644 |
27.0 |
|
97.4 |
|
2.6 |
|
403 |
7.2 |
|
86.4 |
|
13.6 |
|
|
Sex |
|
|
|
|
|
|
<0.01 |
|
|
|
|
|
|
<0.01 |
|
Female |
11452 |
55.3 |
|
98.7 |
|
1.3 |
|
2807 |
50.5 |
|
98.0 |
|
2.0 |
|
|
Male |
9275 |
44.8 |
|
96.7 |
|
3.3 |
|
2757 |
49.6 |
|
94.5 |
|
5.5 |
|
|
Race/Ethnicity |
|
|
|
|
|
|
<0.01 |
|
|
|
|
|
|
0.21 |
|
Hispanic |
2439 |
11.8 |
|
98.8 |
|
1.2 |
|
1502 |
27.0 |
|
97.2 |
|
2.8 |
|
|
White, non-Hispanic |
7477 |
36.2 |
|
97.2 |
|
2.8 |
|
2496 |
44.9 |
|
96.1 |
|
3.9 |
|
|
Black, non-Hispanic |
2346 |
11.4 |
|
97.8 |
|
2.2 |
|
1349 |
24.3 |
|
96.9 |
|
3.1 |
|
|
Other |
8412 |
40.7 |
|
98.2 |
|
1.8 |
|
217 |
3.9 |
|
96.7 |
|
3.3 |
|
|
Smoking status |
|
|
|
|
|
|
0.02 |
|
|
|
|
|
|
<0.01 |
|
Never |
5083 |
53.7 |
|
96.9 |
|
3.07 |
|
2650 |
47.6 |
|
97.5 |
|
2.5 |
|
|
Quit |
1122 |
11.9 |
|
96.3 |
|
3.7 |
|
1748 |
31.4 |
|
95.5 |
|
4.5 |
|
|
Current |
3264 |
34.5 |
|
97.7 |
|
2.3 |
|
1166 |
21.0 |
|
94.9 |
|
5.1 |
|
|
History of diabetes |
|
|
|
|
|
|
<0.01 |
|
|
|
|
|
|
<0.01 |
|
No |
18691 |
89.5 |
|
98.4 |
|
1.7 |
|
5017 |
90.2 |
|
96.7 |
|
3.3 |
|
|
Yes |
2205 |
10.6 |
|
93.6 |
|
6.4 |
|
543 |
9.8 |
|
89.9 |
|
10.1 |
|
|
History of high blood pressure |
|
|
|
|
|
|
<0.01 |
|
|
|
|
|
|
<0.01 |
|
No |
19312 |
92.4 |
|
98.3 |
|
1.7 |
|
3625 |
65.5 |
|
97.4 |
|
2.6 |
|
|
Yes |
1584 |
7.6 |
|
92.7 |
|
7.3 |
|
|
1913 |
34.5 |
|
93.8 |
|
6.2 |
|
Table 2. Comparison of logistic regression results
|
|
DDR (n=12175) |
|
NHANES (n=4850) |
||||||
OR |
95% CI |
p-value |
OR |
95% CI |
p-value |
|||||
|
|
Lower |
Upper |
|
Lower |
Upper |
||||
Percent of sites with periodontal attachment loss of ≥3mm |
|
|
|
|
0.58 |
|
|
|
|
<0.01 |
0 |
|
1.00 |
Reference |
|
|
1.00 |
Reference |
|
||
>0-33 |
|
0.93 |
0.50 |
1.74 |
|
|
1.45 |
0.83 |
2.53 |
|
>33-67 |
|
0.99 |
0.54 |
1.83 |
|
|
2.48 |
1.28 |
4.78 |
|
>67-100 |
|
1.14 |
0.62 |
2.12 |
|
|
4.40 |
1.81 |
10.71 |
|
|
|
|
|
|
|
|
|
|
|
|
Age |
|
1.06 |
1.04 |
1.07 |
<0.01 |
|
1.06 |
1.04 |
1.08 |
<0.01 |
|
|
|
|
|
|
|
|
|
|
|
Sex |
|
|
|
|
<0.01 |
|
|
|
|
<0.01 |
Female |
|
1.00 |
Reference |
|
|
1.00 |
Reference |
|
||
Male |
|
2.65 |
2.08 |
3.37 |
|
|
2.87 |
1.91 |
4.32 |
|
|
|
|
|
|
|
|
|
|
|
|
Race/Ethnicity |
|
|
|
|
0.11 |
|
|
|
|
0.12 |
Hispanic |
|
1.00 |
Reference |
|
|
1.00 |
Reference |
|
||
White, non-Hispanic |
|
1.40 |
0.89 |
2.18 |
|
|
1.36 |
0.92 |
2.00 |
|
Black, non-Hispanic |
|
1.26 |
0.75 |
2.11 |
|
|
0.87 |
0.54 |
1.41 |
|
Other |
|
1.05 |
0.66 |
1.66 |
|
|
1.68 |
0.45 |
6.26 |
|
|
|
|
|
|
|
|
|
|
|
|
History of diabetes |
|
|
|
|
<0.01 |
|
|
|
|
0.02 |
No |
|
1.00 |
Reference |
|
|
1.00 |
Reference |
|
||
Yes |
|
2.50 |
1.95 |
3.21 |
|
|
1.73 |
1.09 |
2.75 |
|
|
|
|
|
|
|
|
|
|
|
|
History of high blood pressure |
|
|
|
|
<0.01 |
|
|
|
|
0.01 |
No |
1.00 |
Reference |
1.00 |
Reference |
||||||
Yes |
2.01 |
1.55 |
2.59 |
|
|
1.60 |
1.11 |
2.31 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Body mass index |
|
1.03 |
1.01 |
1.05 |
<0.01 |
|
1.06 |
1.03 |
1.10 |
<0.01 |