社区层面不平等与新发口腔衰弱的危险因素

文献信息

中文摘要

引言： 口腔衰弱以牙齿缺失、咀嚼困难和吞咽问题为特征，与老年人的不良健康结局相关。然而，关于社区层面不平等及新发口腔衰弱决定因素的纵向证据仍然有限。
目的： 本队列研究旨在考察口腔衰弱发病率的社区层面不平等，并识别日本老年人中与其发病相关的个体层面和市町村层面因素。
方法： 我们分析了42,987名年龄≥65岁参与者的数据，这些参与者完成了2019年和2022年的日本老年学评估研究调查。口腔衰弱采用一个经过验证的预测模型判定，该模型包括年龄、牙齿数量、咀嚼困难和呛咳。个体层面变量包括社会人口学、健康状况和社会资本指标。市町村层面变量包括人口密度、汇总社会资本以及都道府县或市町村牙科健康条例的存在情况。采用改良多水平泊松回归估计发病率比。
结果： 口腔衰弱发病率在各市町村间存在差异，范围为17.1%至33.3%。在完全调整的多水平模型中，与更高的新发口腔衰弱风险显著相关的个体层面因素为男性；丧偶、离婚或从未结婚；较低教育程度；较低等值收入；吸烟史；当前患病；以及缺乏社会凝聚力（P < 0.05）。在市町村层面，与居住在大都市区相比，居住在城市、半城市或农村农业地区与新发口腔衰弱风险较低相关。尽管并非在所有模型中均具有统计学显著性，较高的市町村层面公民参与度倾向于与新发口腔衰弱风险较低相关。
结论： 口腔衰弱发病率的社区层面不平等由个体脆弱性和市町村层面因素共同驱动。值得注意的是，较高的市町村层面公民参与度倾向于与较低的口腔衰弱发病率相关。有效的预防需要采取综合策略，解决社会经济因素并促进社区层面的公民参与。
知识转化声明： 这项全国性队列研究表明，口腔衰弱发病率的社区层面不平等十分显著。这些不平等在很大程度上不仅可由可改变的个体社会经济因素解释，也可由市町村层面的公民参与解释。这些发现强调了将基于个体风险的预防与可能有助于减少老龄化人群中口腔衰弱及相关口腔健康差异的社区策略相结合的重要性。

英文摘要

INTRODUCTION: Oral frailty, characterized by tooth loss, chewing difficulty, and swallowing problems, has been associated with adverse health outcomes in older adults. However, longitudinal evidence on community-level inequalities and determinants of incident oral frailty remains limited.
OBJECTIVES: This cohort study aimed to examine community-level inequalities in the incidence of oral frailty and identify individual- and municipality-level factors associated with its onset among older adults in Japan.
METHODS: We analyzed data from 42,987 participants aged ≥65 y who completed the Japan Gerontological Evaluation Study surveys in 2019 and 2022. Oral frailty was determined using a validated prediction model including age, number of teeth, chewing difficulty, and choking. Individual-level variables included sociodemographic, health status, and social capital indicators. Municipality-level variables included population density, aggregated social capital, and the presence of prefectural or municipal dental health ordinances. Modified multilevel Poisson regression was used to estimate incidence rate ratios.
RESULTS: The incidence of oral frailty varied across municipalities, ranging from 17.1% to 33.3%. In the fully adjusted multilevel model, individual-level factors significantly associated with a higher risk of incident oral frailty were male sex; being widowed, divorced, or never married; lower educational attainment; lower equivalent income; smoking history; current illness; and lack of social cohesion (P < 0.05). At the municipality level, residing in urban, semi-urban, or rural-agricultural areas was associated with a lower risk of incident oral frailty compared with metropolitan area residency. Although not statistically significant in all models, higher municipality-level civic participation tended to be associated with a lower risk of incident oral frailty.
CONCLUSION: Community-level inequalities in the incidence of oral frailty are driven by both individual vulnerabilities and municipality-level factors. Notably, higher municipality-level civic participation tended to be associated with a lower incidence of oral frailty. Effective prevention requires comprehensive strategies that address socioeconomic factors and promote community-level civic participation.Knowledge Transfer Statement:This nationwide cohort study demonstrates that community-level inequalities in the incidence of oral frailty are substantial. They are largely explained not only by modifiable individual socioeconomic factors but also by municipality-level civic participation. These findings highlight the importance of integrating individual risk-based prevention with community strategies that may contribute to reducing oral frailty and related oral health disparities in aging populations.