249314 Demonstrating the oral-systemic link for cardiovascular disease in Maine: Strong association found between spending and periodontal care

Sunday, October 30, 2011

Margaret I. Gradie, PhD , Division of Health Improvement, Medical Care Development, Augusta, ME
Kala E. Ladenheim, PhD, MSPH , Division of Health Improvement, Medical Care Development, Augusta, ME
Kathleen E. Perkins, MPA , Director, Division of Health Improvement, Medical Care Development, Augusta, ME
To replicate studies of the oral-systemic link from more urban settings, the researchers analyzed merged medical-dental claims from 2005-2007 for all privately insured persons in Maine with full year dental coverage and some level of cardiovascular disease or syndrome, including hypertension and hyperlipidemia. Claims were aggregated by locus of care and cardiovascular condition (coronary artery disease; kidney disease; stroke; peripheral vascular disease; congestive heart failure) into 137,000 person-year records. To control for multi-year measurement, PASW procedure GEE was used to estimate association between level of care and expenditures, controlling for age, gender, and (at geographic level), rurality, %Medicaid and availability of dental providers. Preliminary findings show strong, consistent, and often significant dose-response relationship across four levels of periodontal care for lower spending. Marginal means for overall medical costs were > 20% less for people with CVD and three or more visits compared to people who had dental insurance yet received no periodontal care. Level of periodontal care was significantly associated with differences in estimated spending for inpatient care, outpatient primary care and emergency department care related to cardiovascular emergencies across the entire group, and for overall medical spending among subsets of people with coronary artery disease, peripheral vascular disorders, and chronic kidney disease. Other locations and groups showed the same trend but results were not significant , probably due to high variance in some categories. Findings support insurers' decisions to cover periodontal care, and have been presented to Maine legislators to support the case for adult dental coverage.

Learning Areas:
Advocacy for health and health education
Biostatistics, economics

Learning Objectives:
Describe systemic conditions that have been associated with poor oral health Compare the pros and cons of different approaches to aggregating claims data Articulate messages that convey the oral systemic association and coverage implications for a policy audience.

Keywords: Oral Health Needs, Chronic (CVD)

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have participated in the analysis.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.