Higher levels of social and material deprivation are associated with higher rates of influenza-like illness-related emergency department visits: Edmonton, Alberta, 2004-2014

Association between dental visit behavior and mortality: a nationwide longitudinal cohort study from NHANES

OBJECTIVES

The benefits of professional dental treatment for oral diseases have been widely investigated. However, it is unclear whether professional dental treatment provides additional benefits for improving general health.

MATERIALS AND METHODS

Data were obtained from the US National Health and Nutrition Examination Survey (NHANES) 1999 to 2004 and 2011 to 2018 cycles. A total of 36,174 participants were included and followed-up for mortality until December 31, 2019. Dental visit behavior was defined as the time interval of last dental visit (TIDV, < 0.5 year, 0.5-1 year, 1-2 years, 2-5 years, and > 5 years) and the main reasons of the last dental visit (treatment, examination, and other reasons). The Cox proportional risk model was used to estimate the hazard ratio (HR) and 95% confidence interval (CI).

RESULTS

Compared with participants with time interval of less than 0.5 year, the multivariate-adjusted HRs and 95%CI for participants with time interval of more than 5 years were 1.45 (1.31, 1.61) for all-cause mortality (P trend < 0.0001), 1.49 (1.23, 1.80) for cardiovascular diseases mortality (P trend = 0.0009) and 1.53 (1.29, 1.81) for cancer mortality (P trend = 0.013). Compared with dental visit for examination, participants who had their dental visit for treatment had higher risk for mortality. For participants with dental visit for examination, TIDV of less than 1 year showed lower risk for mortality, whereas TIDV of less than 0.5 year is recommend for population with dental visit for treatment.

CONCLUSIONS

Poor dental visit behavior is associated with an increased risk of mortality. Further well-designed studies are needed to confirm the association between professional dental visit and mortality.

CLINICAL RELEVANCE

This study highlights the potential benefits of regular dental visits in maintaining general health.

Predictors of all-cause mortality among patients hospitalized with influenza, respiratory syncytial virus, or SARS-CoV-2

Background

Shared and divergent predictors of clinical severity across respiratory viruses may support clinical and community responses in the context of a novel respiratory pathogen.

Methods

We conducted a retrospective cohort study to identify predictors of 30‐day all‐cause mortality following hospitalization with influenza (N = 45,749; 2010‐09 to 2019‐05), respiratory syncytial virus (RSV; N = 24 345; 2010‐09 to 2019‐04), or severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2; N = 8988; 2020‐03 to 2020‐12; pre‐vaccine) using population‐based health administrative data from Ontario, Canada. Multivariable modified Poisson regression was used to assess associations between potential predictors and mortality. We compared the direction, magnitude, and confidence intervals of risk ratios to identify shared and divergent predictors of mortality.

Results

A total of 3186 (7.0%), 697 (2.9%), and 1880 (20.9%) patients died within 30 days of hospital admission with influenza, RSV, and SARS‐CoV‐2, respectively. Shared predictors of increased mortality included older age, male sex, residence in a long‐term care home, and chronic kidney disease. Positive associations between age and mortality were largest for patients with SARS‐CoV‐2. Few comorbidities were associated with mortality among patients with SARS‐CoV‐2 as compared with those with influenza or RSV.

Conclusions

Our findings may help identify patients at greatest risk of illness secondary to a respiratory virus, anticipate hospital resource needs, and prioritize local prevention and therapeutic strategies to communities with higher prevalence of risk factors.

British Columbia’s Index of Multiple Deprivation for Community Health Service Areas

Area-based socio-economic indicators, such as the Canadian Index of Multiple Deprivation (CIMD), have been used in equity analyses to inform strategies to improve needs-based, timely, and effective patient care and public health services to communities. The CIMD comprises four dimensions of deprivation: residential instability, economic dependency, ethno-cultural composition, and situational vulnerability. Using the CIMD methodology, the British Columbia Index of Multiple Deprivation (BCIMD) was developed to create indexes at the Community Health Services Area (CHSA) level in British Columbia (BC). BCIMD indexes are reported by quintiles, where quintile 1 represents the least deprived (or ethno-culturally diverse), and quintile 5 is the most deprived (or diverse). Distinctive characteristics of a community can be captured using the BCIMD, where a given CHSA may have a high level of deprivation in one dimension and a low level of deprivation in another. The utility of this data as a surveillance tool to monitor population demography has been used to inform decision making in healthcare by stakeholders in the regional health authorities and governmental agencies. The data have also been linked to health care data, such as COVID-19 case incidence and vaccination coverage, to understand the epidemiology of disease burden through an equity lens.