口腔健康状况不佳与重症创伤患者的社会脆弱性相关。
Poor oral health is associated with social vulnerability in critically ill trauma patients.
作者信息
Fajemisin Mokunfayo O, Martinez Ugarte Stephanie, Guy-Frank Chelsea J, Hatton Gabrielle E, Quinton Kayli A, Syed Sophia, Fox Erin E, Wade Charles E, Mankiewicz Kimberly A, Kao Lillian S
机构信息
Department of Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA.
Center for Surgical Trials and Evidence-based Practice, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA.
出版信息
Trauma Surg Acute Care Open. 2025 Jun 12;10(2):e001636. doi: 10.1136/tsaco-2024-001636. eCollection 2025.
BACKGROUND
Social factors affect oral health status, and poor oral health has been associated with worse health outcomes. Using the Oral Health Risk Assessment Value Index (OHRAVI), a bedside tool for non-dentists to assess oral health, we investigated the interplay of oral health with social drivers of health and social vulnerability, as measured by the Social Vulnerability Index (SVI), in severely injured patients.
METHODS
Our retrospective study included dentulous critically ill trauma patients who were previously assigned an OHRAVI score (range 0-3; unhealthy score >1). Patient demographics, comorbidities, and self-reported social drivers were obtained from health records. SVI was calculated using census-tract data. Bayesian regression analyses were performed to calculate posterior probabilities of an association between risk factors and poor oral health (PP OR >1).
RESULTS
Among 170 patients, 91 (54%) patients had unhealthy OHRAVI scores. Median index OHRAVI score was 1.13 (IQR 0.86-1.43); median SVI was 0.7 (0.5-0.9). Median OHRAVI scores were higher in the high SVI group (SVI >0.7; OHRAVI 1.19) than in the low SVI group (SVI <0.7; OHRAVI 1.06, p=0.026). Social factors associated with poor oral health from Bayesian analysis (PP OR>1) included lack of social support (99%), housing instability (99%), divorced marital status (87%), and non-English primary language (86%). Social vulnerability was also associated with poor oral health (98%).
CONCLUSIONS
Poor oral health in critically ill injured patients was associated with lack of social support, housing insecurity, divorced marital status, non-English primary language, and increased social vulnerability. OHRAVI may provide quick, objective bedside assessment to help identify socially vulnerable patients and serve as a marker for the presence of social risk factors that may portend poor outcomes. Oral health may be a modifiable risk factor, and early identification of patients may allow them to benefit from oral hygiene regimens, including treatment with antimicrobial agents.
LEVEL OF EVIDENCE
Level II/III, prospective/retrospective cohort study with only one negative criterion.
背景
社会因素影响口腔健康状况，而口腔健康状况不佳与更差的健康结局相关。我们使用口腔健康风险评估价值指数（OHRAVI）这一供非牙医评估口腔健康的床旁工具，研究了在重伤患者中，口腔健康与健康的社会驱动因素以及社会脆弱性（通过社会脆弱性指数（SVI）衡量）之间的相互作用。
方法
我们的回顾性研究纳入了此前已被赋予OHRAVI评分（范围为0 - 3；不健康评分>1）的有牙的重症创伤患者。从健康记录中获取患者的人口统计学信息、合并症以及自我报告的社会驱动因素。使用普查区数据计算SVI。进行贝叶斯回归分析以计算风险因素与口腔健康不佳之间关联的后验概率（PP OR>1）。
结果
在170名患者中，91名（54%）患者的OHRAVI评分不健康。OHRAVI指数评分中位数为1.13（四分位间距0.86 - 1.43）；SVI中位数为0.7（0.5 - 0.9）。高SVI组（SVI>0.7；OHRAVI 1.19）的OHRAVI评分中位数高于低SVI组（SVI<0.7；OHRAVI 1.06，p = 0.026）。贝叶斯分析中与口腔健康不佳相关的社会因素（PP OR>1）包括缺乏社会支持（99%）、住房不稳定（99%）、离婚婚姻状况（87%）以及非英语母语（86%）。社会脆弱性也与口腔健康不佳相关（98%）。
结论
重症受伤患者口腔健康不佳与缺乏社会支持、住房不安全、离婚婚姻状况、非英语母语以及社会脆弱性增加有关。OHRAVI可提供快速、客观的床旁评估，以帮助识别社会脆弱患者，并作为可能预示不良结局的社会风险因素存在的标志物。口腔健康可能是一个可改变的风险因素，早期识别患者可能使他们受益于口腔卫生方案，包括使用抗菌药物治疗。
证据水平
II/III级，仅具有一个阴性标准的前瞻性/回顾性队列研究。
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