Association between the number of existing permanent teeth and health-related quality of life (EuroQol-5 Dimension) among adults: findings from the fifth Korea National Health and Nutrition Examination Surveys, 2012

Hye-Sun Shin; Hyun-Duck Kim

doi:10.11149/jkaoh.2015.39.4.303

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Shin and Kim: Association between the number of existing permanent teeth and health-related quality of life (EuroQol-5 Dimension) among adults: findings from the fifth Korea National Health and Nutrition Examination Surveys, 2012

Original Article

J Korean Acad Oral Health 2015;39(4):303-310.

Published online: 12 December 2015

DOI: https://doi.org/10.11149/jkaoh.2015.39.4.303

Association between the number of existing permanent teeth and health-related quality of life (EuroQol-5 Dimension) among adults: findings from the fifth Korea National Health and Nutrition Examination Surveys, 2012

Hye-Sun Shin, Hyun-Duck Kim

Department of Preventive and Social Dentistry, School of Dentistry, Seoul National University, Seoul, Korea

Corresponding Author: Hyun-Duck Kim Department of Preventive and Social Dentistry, School of Dentistry, Seoul National University, Yeongun-dong, Jongno-gu, Seoul 03080, Korea Tel: +82-2-740-8684 Fax: +82-2-765-1722 E-mail: hyundkim@snu.ac.kr

Received 8 October 2015 Revised 9 November 2015 Accepted 7 December 2015

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives

The aim of this study was to evaluate whether the number of existing permanent teeth is associated with health-related quality of life by using EuroQol-5 Dimension (EuroQol-5D) in a representative sample of Korean adults.

Methods

A total of 5349 subjects who participated in the 2012 fifth Korea National Health and Nutrition Examination Survey (KNHANES) were examined. The dependent variable was EQ-5D index and independent variable was the number of existing permanent teeth. The health-related quality of life was assessed by using EQ-5D index. The number of existing permanent teeth was evaluated by dentists using World Health Organization Index. Demographic factors (age and gender), socioeconomic status (education, income), oral health behaviors (frequency of daily toothbrushing, and regular dental visit), health behaviors (cigarette smoking, drinking, regular physical activity), general health status (depression, stress, body mass index, hypertension, diabetes mellitus) were included as confounder in analysis. Multivariable linear regression model, stratified analysis and analysis of covariance were applied.

Results

After adjustment for various confounders, the number of existing permanent teeth was positively associated with EQ-5D index (P<0.001). This association was highlighted among 40-59 year-old males and over 60 year-old females.

Conclusions

Our data indicate that the number of existing permanent teeth was independently associated with EQ-5D index. Our results provided the substantially important evidence on the health and oral health promotion for Korean adults.

Keywords: EQ-5D, Existing permanent teeth, KNHANES, Korean adults, Quality of life

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Fig. 1.

Adjusted EQ-5D index according to the number of existing permanent teeth. Box and whisker plots denote the mean and standard error. All values of EQ-5D index were obtained from ANCOVA adjusted for age, sex, education, income, frequency of daily toothbrushing, regular dental check-up, smoking, alcohol drinking, physical activity, depression, stress, BMI, hypertension, diabetes mellitus. The letters a, b, c and d denote the differences between groups using post hoc multiple comparison tests by bonferroni. Values expressed unweighted N (%).

Table 1.

Distribution of EQ-5D Levels according to demographic and socioeconomic status (N=5349)

Characteristics	Category	EQ-5D index
Characteristics	Category	N	Mean±SE	P-value
Age (years)	20 to 39	1388	0.98 (0.002)	<0 001*
	40 to 59	1974	0.96 (0.003)
	60 over	1987	0.88 (0.004)
Sex	Male	2223	0.96 (0.002)	<0 001†
	Female	3126	0.93 (0.002)
Education	Primary school	1393	0.87 (0.006)	<0 001*
	Middle school	574	0.93 (0.005)
	High school	1792	0.96 (0.003)
	College	1590	0.98 (0.002)
Income	I (lowest)	1310	0.93 (0.005)	<0 001*
	II	1344	0.95 (0.003)
	III	1338	0.95 (0.003)
	IV (highest)	1357	0.96 (0.003)
Number of existing permanent teeth	0	144	0.83 (0.020)	<0 001*
	1 to 9	317	0.85 (0.011)
	10 to19	521	0.89 (0.008)
	20 to 24	867	0.93 (0.005)
	25 to 28	3500	0.96 (0.002)

Values expressed unweighted N (%).

^* Obtained from ANOVA

^† Obtained from t-test. Bold values denote statistical significance at P<0.05.

Table 2.

Linear relationship between the nu mber of existing permanent teeth and EQ-5D index (N=5349)

Variables	Model I				Model II				Model III				Model IV
Variables	β	SE	Partial r	P-value	β	SE	Partial r	P-value	β	SE	Partial r	P-value	β	SE	Partial r	P-value
Number of existing permanent teeth	0.002	0.000	0.100	<0.001	0.002	0.000	0.099	<0.001	0.002	0.000	0.090	<0.001	0.002	0.000	0.090	<0.001
Age (years)	-0.001	0.000	-0.136	<0.001	-0.001	0.000	-0.135	<0.001	-0.001	0.000	-0.143	<0.001	-0.001	0.000	—0.119	<0.001
Sex	-0.026	0.000	-0.110	<0.001	-0.027	0.003	-0.113	<0.001	-0.021	0.004	-0.069	<0.001	-0.022	0.004	—0.072	<0.001
Education	0.017	0.002	0.126	<0.001	0.016	0.002	0.116	<0.001	0.016	0.002	0.117	<0.001	0.015	0.002	0.114	<0.001
Income	0.007	0.001	0.063	<0.001	0.006	0.001	0.061	<0.001	0.005	0.001	0.049	<0.001	0.005	0.001	0.049	<0.001
Frequency of daily tooth-brushing					0.008	0.003	0.034	<0.001	0.006	0.00.	0.026	0.061	0.005	0.003	0.022	0.101
Regular dental check-up					0.004	0.004	0.014	0.298	0.003	0.004	0.013	0.352	0.003	0.004	0.012	0.382
Smoking status									-0.006	0.003	-0.034	0.012	—0.006	0.003	—0.035	0.011
Alcohol consumption									0.007	0.002	0.061	<0.001	0.007	0.002	0.060	<0.001
Regular physical activity									0.006	0.002	0.038	0.006	0.006	0.002	0.038	0.006
Depression									-0.110	0.010	-0.152	<0.001	—0.111	0.010	—0.153	<0.001
Stress									0.045	0.003	0.174	<0.001	0.045	0.003	—0.153	<0.001
Body mass index (kg/m2)													—0.008	0.003	—0.038	0.006
Hypertension													—0.011	0.004	—0.036	0.009
Diabetes mellitus													—0.013	0.006	—0.032	0.019
Adjusted R²			0.171			0.172				0.223				0.227

Values expressed unweighted N (%).

Number of existing permanent teeth: Continuous variable (Range: 0-28).

All variables are ordinal variables transformed from categorical variables in Table 1. Bold values denote statistical significance at P<0.05

Table 3.

Age and sex stratified linear relationship between the number of existing permanent teeth (5-scale ordinal variable) and EQ-5D index (N=5349)

Stratum	Subgroup	N	Adjusted R²	β	SE	Partial r	P-value
Age	20-39 years	1388	0.126	―0.001	0.001	―0.013	0.634
	40-59 years	1974	0.114	0.000	0.001	0.016	0.490
	60 years	1987	0.159	0.002	0.000	0.103	<0.001
Sex	Male	2223	0.167	0.001	0.000	0.078	<0.001
	Female	3126	0.241	0.002	0.000	0.094	<0.001
Age and sex Male	20-39 years	570	0.532	―0.002	0.001	―0.063	0.136
	40-59 years	809	0.097	0.002	0.001	0.116	0.001
	60 years	844	0.108	0.001	0.001	0.079	0.023
Female	20-39 years	818	0.109	0.001	0.001	0.024	0.500
	40-59 years	1165	0.110	―0.001	0.001	―0.046	0.115
	60 years	1143	0.154	0.002	0.001	0.119	<0.001

Values expressed unweighted N (%). Number of existing permanent teeth: Continuous variable (range: 0-28). β coefficients are from multivariable linear regression model adjusted for age, sex, education, income, frequency of daily toothbrushing, regular denta check-up, smoking, alcohol drinking, physical activity, depression, stress, BMI, hypertension, diabetes mellitus except for stratum. Bold values denote higher association (partial r) than unstratified partial r of 0.090.

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