Chronic kidney disease and use of dental services in a united states public healthcare system: A retrospective cohort study

Vanessa Grubbs, Laura C. Plantinga, Delphine S. Tuot, Neil R. Powe

Research output: Contribution to journalArticle

Abstract

Background: As several studies have shown an association between periodontal disease and chronic kidney disease (CKD), regular dental care may be an important strategy for reducing the burden of CKD. Access to dental care may be limited in the US public health system. Methods. In this retrospective cohort study of 6,498 adult patients with (n = 2,235) and without (n = 4,263) CKD and at least 12 months of follow-up within the San Francisco Department of Public Health Community Health Network clinical databases, we examined the likelihood of having a dental visit within the observation period (2005-2010) using Cox proportional hazards models. To determine whether dental visits reflected a uniform approach to preventive service use in this setting, we similarly examined the likelihood of having an eye visit among those with diabetes, for whom regular retinopathy screening is recommended. We defined CKD status by average estimated glomerular filtration rate based on two or more creatinine measurements 3 months apart (no CKD, 60 ml/min/1.73 m 2; CKD, <60 ml/min/1.73 m 2). Results: Only 11.0% and 17.4% of patients with and without CKD, respectively, had at least one dental visit. Those with CKD had a 25% lower likelihood of having a dental visit [HR = 0.75, 95% CI (0.64-0.88)] than those without CKD after adjustment for confounders. Among the subgroup of patients with diabetes, 11.8% vs. 17.2% of those with and without CKD had a dental visit, while 58.8% vs. 57.8% had an eye visit. Conclusions: Dental visits, but not eye visits, in a US public healthcare setting are extremely low, particularly among patients with CKD. Given the emerging association between oral health and CKD, addressing factors that impede dental access may be important for reducing the disparate burden of CKD in this population.

Original languageEnglish (US)
Article number16
JournalBMC Nephrology
Volume13
Issue number1
DOIs
StatePublished - 2012
Externally publishedYes

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Chronic Renal Insufficiency
Tooth
Cohort Studies
Retrospective Studies
Delivery of Health Care
Dental Care
Public Health
Community Networks
San Francisco
Oral Health
Periodontal Diseases
Glomerular Filtration Rate
Proportional Hazards Models
Creatinine
Observation
Databases

ASJC Scopus subject areas

  • Nephrology

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Chronic kidney disease and use of dental services in a united states public healthcare system : A retrospective cohort study. / Grubbs, Vanessa; Plantinga, Laura C.; Tuot, Delphine S.; Powe, Neil R.

In: BMC Nephrology, Vol. 13, No. 1, 16, 2012.

Research output: Contribution to journalArticle

Grubbs, Vanessa ; Plantinga, Laura C. ; Tuot, Delphine S. ; Powe, Neil R. / Chronic kidney disease and use of dental services in a united states public healthcare system : A retrospective cohort study. In: BMC Nephrology. 2012 ; Vol. 13, No. 1.
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abstract = "Background: As several studies have shown an association between periodontal disease and chronic kidney disease (CKD), regular dental care may be an important strategy for reducing the burden of CKD. Access to dental care may be limited in the US public health system. Methods. In this retrospective cohort study of 6,498 adult patients with (n = 2,235) and without (n = 4,263) CKD and at least 12 months of follow-up within the San Francisco Department of Public Health Community Health Network clinical databases, we examined the likelihood of having a dental visit within the observation period (2005-2010) using Cox proportional hazards models. To determine whether dental visits reflected a uniform approach to preventive service use in this setting, we similarly examined the likelihood of having an eye visit among those with diabetes, for whom regular retinopathy screening is recommended. We defined CKD status by average estimated glomerular filtration rate based on two or more creatinine measurements 3 months apart (no CKD, 60 ml/min/1.73 m 2; CKD, <60 ml/min/1.73 m 2). Results: Only 11.0{\%} and 17.4{\%} of patients with and without CKD, respectively, had at least one dental visit. Those with CKD had a 25{\%} lower likelihood of having a dental visit [HR = 0.75, 95{\%} CI (0.64-0.88)] than those without CKD after adjustment for confounders. Among the subgroup of patients with diabetes, 11.8{\%} vs. 17.2{\%} of those with and without CKD had a dental visit, while 58.8{\%} vs. 57.8{\%} had an eye visit. Conclusions: Dental visits, but not eye visits, in a US public healthcare setting are extremely low, particularly among patients with CKD. Given the emerging association between oral health and CKD, addressing factors that impede dental access may be important for reducing the disparate burden of CKD in this population.",
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