Missing Oral Health-Related Data in the interRAI-HC - Associations with Selected Variables of General Health and the Effect of Multiple Imputation on the Relationship between Oral and General Health

Stefanie Krausch-Hofmann; Kris Bogaerts; Michael Hofmann; Johanna de Almeida Mello; Nádia Cristina Fávaro Moreira; Emmanuel Lesaffre; Dominique Declerck; Anja Declercq; Joke Duyck

doi:10.1371/journal.pone.0146065

Missing Oral Health-Related Data in the interRAI-HC - Associations with Selected Variables of General Health and the Effect of Multiple Imputation on the Relationship between Oral and General Health

PLoS One. 2015 Dec 30;10(12):e0146065. doi: 10.1371/journal.pone.0146065. eCollection 2015.

Authors

Stefanie Krausch-Hofmann¹, Kris Bogaerts², Michael Hofmann³, Johanna de Almeida Mello⁴, Nádia Cristina Fávaro Moreira⁵, Emmanuel Lesaffre², Dominique Declerck¹, Anja Declercq⁴, Joke Duyck⁵

Affiliations

¹ Department of Oral Health Sciences, Population Studies in Oral Health, KU Leuven, Leuven, Belgium.
² Department of Public Health and Primary Care, KU Leuven and Hasselt University I-BioStat, KU Leuven, Leuven, Belgium.
³ Department of Neurosciences, Research Group Experimental Oto-Rhino-Laryngology, KU Leuven, Leuven, Belgium.
⁴ LUCAS, Center for Care Research and Consultancy, KU Leuven, Leuven, Belgium.
⁵ Department of Oral Health Sciences, Biomaterials, KU Leuven, Leuven, Belgium.

Abstract

Background: Missing data within the comprehensive geriatric assessment of the interRAI suite of assessment instruments potentially imply the under-detection of conditions that require care as well as the risk of biased statistical results. Impaired oral health in older individuals has to be registered accurately as it causes pain and discomfort and is related to the general health status.

Objective: This study was based on interRAI-Home Care (HC) baseline data from 7590 subjects (mean age 81.2 years, SD 6.9) in Belgium. It was investigated if missingness of the oral health-related items was associated with selected variables of general health. It was also determined if multiple imputation of missing data affected the associations between oral and general health.

Materials and methods: Multivariable logistic regression was used to determine if the prevalence of missingness in the oral health-related variables was associated with activities of daily life (ADLH), cognitive performance (CPS2) and depression (DRS). Associations between oral health and ADLH, CPS2 and DRS were determined, with missing data treated by 1. the complete-case technique and 2. by multiple imputation, and results were compared.

Results: The individual oral health-related variables had a similar proportion of missing values, ranging from 16.3% to 17.2%. The prevalence of missing data in all oral health-related variables was significantly associated with symptoms of depression (dental prosthesis use OR 1.66, CI 1.41-1.95; damaged teeth OR 1.74, CI 1.48-2.04; chewing problems OR 1.74, CI 1.47-2.05; dry mouth OR 1.65, CI 1.40-1.94). Missingness in damaged teeth (OR 1.27, CI 1.08-1.48), chewing problems (OR 1.22, CI 1.04-1.44) and dry mouth (OR 1.23, CI 1.05-1.44) occurred more frequently in cognitively impaired subjects. ADLH was not associated with the prevalence of missing data. When comparing the complete-case technique with the multiple imputation approach, nearly identical odds ratios characterized the associations between oral and general health.

Conclusion: Cognitively impaired and depressive individuals had a higher risk of missing oral health-related information. Associations between oral health and ADLH, CPS2 and DRS were not influenced by multiple imputation of missing data. Further research should concentrate on the mechanisms that mediate the occurrence of missingness to develop preventative strategies.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Activities of Daily Living
Aged
Aged, 80 and over
Belgium / epidemiology
Data Accuracy
Female
Geriatric Assessment / statistics & numerical data*
Health Status
Humans
Male
Oral Health / statistics & numerical data*

Grants and funding

The present study used data from the Protocol 3 project that was financed by the Belgian National Institute for Health and Disability Insurance (Protocol 3 M.B. 16/07/2009 – 49574). This federal non-commercial institution is responsible for the organization and supervision of the compulsory health insurance in Belgium. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.