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Cheng J, Gregorich SE, Gansky SA, Fisher-Owens SA, Kottek AM, White JM, Mertz EA. Constructing Matched Groups in Dental Observational Health Disparity Studies for Causal Effects. JDR Clin Trans Res 2019; 5:82-91. [PMID: 30931723 DOI: 10.1177/2380084419830655] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Electronic health record (EHR) systems provide investigators with rich data from which to examine actual impacts of care delivery in real-world settings. However, confounding is a major concern when comparison groups are not randomized. OBJECTIVES This article introduced a step-by-step strategy to construct comparable matched groups in a dental study based on the EHR of the Willamette Dental Group. This strategy was employed in preparation for a longitudinal study evaluating the impact of a standardized risk-based caries prevention and management program across patients with public versus private dental insurance in Oregon. METHODS This study constructed comparable dental patient groups through a process of 1) evaluating the need for and feasibility of matching, 2) considering different matching methods, and 3) evaluating matching quality. The matched groups were then compared for their average ratio in the number of decayed, missing, and filled tooth surfaces (DMFS + dmfs) at baseline. RESULTS This systematic process resulted in comparably matched groups in baseline covariates but with a clear baseline disparity in caries experience between them. The weighted average ratio in our study showed that, at baseline, publicly insured patients had 1.21-times (95% CI: 1.08 to 1.32) and 1.21-times (95% CI: 1.08 to 1.37) greater number of DMFS + dmfs and number of decayed tooth surfaces (DS + ds) than privately insured patients, respectively. CONCLUSION Matching is a useful tool to create comparable groups with EHR data to resemble randomized studies, as demonstrated by our study where even with similar demographics, neighborhood and clinic characteristics, publicly insured pediatric patients had greater numbers of DMFS + dmfs and DS + ds than privately insured pediatric patients. KNOWLEDGE TRANSFER STATEMENT This article provides a systematic, step-by-step strategy for investigators to follow when matching groups in a study-in this case, a study based on electronic health record data. The results from this study will provide patients, clinicians, and policy makers with information to better understand the disparities in oral health between comparable publicly and privately insured pediatric patients who have similar values in individual, clinic, and community covariates. Such understanding will help clinicians and policy makers modify oral health care and relevant policies to improve oral health and reduce disparities between publicly and privately insured patients.
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Affiliation(s)
- J Cheng
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California-San Francisco, San Francisco, CA, USA.,Center to Address Disparities in Children's Oral Health, School of Dentistry, University of California-San Francisco, San Francisco, CA, USA
| | - S E Gregorich
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California-San Francisco, San Francisco, CA, USA.,Center to Address Disparities in Children's Oral Health, School of Dentistry, University of California-San Francisco, San Francisco, CA, USA.,Department of Medicine, School of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | - S A Gansky
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California-San Francisco, San Francisco, CA, USA.,Center to Address Disparities in Children's Oral Health, School of Dentistry, University of California-San Francisco, San Francisco, CA, USA.,Philip R. Lee Institute for Health Policy Studies, University of California-San Francisco, San Francisco, CA, USA.,Bakar Computational Health Sciences Institute, University of California-San Francisco, San Francisco, CA, USA
| | - S A Fisher-Owens
- Center to Address Disparities in Children's Oral Health, School of Dentistry, University of California-San Francisco, San Francisco, CA, USA.,Department of Pediatrics, School of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | - A M Kottek
- Center to Address Disparities in Children's Oral Health, School of Dentistry, University of California-San Francisco, San Francisco, CA, USA.,Philip R. Lee Institute for Health Policy Studies, University of California-San Francisco, San Francisco, CA, USA
| | - J M White
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California-San Francisco, San Francisco, CA, USA.,Center to Address Disparities in Children's Oral Health, School of Dentistry, University of California-San Francisco, San Francisco, CA, USA
| | - E A Mertz
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California-San Francisco, San Francisco, CA, USA.,Center to Address Disparities in Children's Oral Health, School of Dentistry, University of California-San Francisco, San Francisco, CA, USA.,Philip R. Lee Institute for Health Policy Studies, University of California-San Francisco, San Francisco, CA, USA
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Fisher-Owens SA, Soobader MJ, Gansky SA, Isong IA, Weintraub JA, Platt LJ, Newacheck PW. Geography matters: state-level variation in children's oral health care access and oral health status. Public Health 2016; 134:54-63. [PMID: 26995567 DOI: 10.1016/j.puhe.2015.04.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 04/27/2015] [Accepted: 04/28/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To ascertain differences across states in children's oral health care access and oral health status and the factors that contribute to those differences. STUDY DESIGN Observational study using cross-sectional surveys. METHODS Using the 2007 National Survey of Children's Health, we examined state variation in parents' report of children's oral health care access (absence of a preventive dental visit) and oral health status. We assessed the unadjusted prevalences of these outcomes, then adjusted with child-, family-, and neighbourhood-level variables using logistic regression; these results are presented directly and graphically. Using multilevel analysis, we then calculated the degree to which child-, family-, and community-level variables explained state variation. Finally, we quantified the influence of state-level variables on state variation. RESULTS Unadjusted rates of no preventive dental care ranged 9.0-26.8% (mean 17.5%), with little impact of adjusting (10.3-26.7%). Almost 9% of the population had fair/poor oral health; unadjusted range 4.1-14.5%. Adjusting analyses affected fair/poor oral health more than access (5.7-10.7%). Child, family and community factors explained ∼¼ of the state variation in no preventive visit and ∼½ of fair/poor oral health. State-level factors further contributed to explaining up to a third of residual state variation. CONCLUSION Geography matters: where a child lives has a large impact on his or her access to oral health care and oral health status, even after adjusting for child, family, community, and state variables. As state-level variation persists, other factors and richer data are needed to clarify the variation and drive changes for more egalitarian and overall improved oral health.
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Affiliation(s)
- S A Fisher-Owens
- University of California, San Francisco School of Medicine, Department of Pediatrics, San Francisco, CA, USA; Division of Oral Epidemiology & Dental Public Health, UCSF School of Dentistry, Department of Preventive & Restorative Dental Sciences, San Francisco, CA, USA.
| | | | - S A Gansky
- Division of Oral Epidemiology & Dental Public Health, UCSF School of Dentistry, Department of Preventive & Restorative Dental Sciences, San Francisco, CA, USA; Center to Address Disparities in Children's Oral Health (CAN-DO), University of California, UCSF School of Dentistry, Department of Preventive & Restorative Dental Sciences, San Francisco, CA, USA
| | - I A Isong
- MGH Center for Child and Adolescent Health Policy, Boston, MA, USA
| | - J A Weintraub
- Center to Address Disparities in Children's Oral Health (CAN-DO), University of California, UCSF School of Dentistry, Department of Preventive & Restorative Dental Sciences, San Francisco, CA, USA
| | - L J Platt
- Philip R. Lee Institute for Health Policy Studies, UCSF School of Medicine, San Francisco, CA, USA
| | - P W Newacheck
- University of California, San Francisco School of Medicine, Department of Pediatrics, San Francisco, CA, USA; Philip R. Lee Institute for Health Policy Studies, San Francisco, CA, USA
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