Evaluation of Public Health Expenditure by Number of Teeth among Outpatients with Diabetes Mellitus

Abstract

The relationship between public health expenditure and number of teeth was investigated in patients with diabetes mellitus using data obtained from the Japanese National Database of Health Insurance Claims and Specific Health Checkups. Data on medical, dental, and pharmacy claims generated between April 2015 and March 2016 were analyzed in patients with diabetes mellitus aged 50-74 years who used outpatient services during this period. Patients initiating medical and pharmacy claims related to diabetes mellitus were defined as having diabetes mellitus. Number of teeth was defined as number of teeth in conjunction with periodontitis due to the nature of the data source. Descriptive statistics were used to investigate the association between number of teeth and public health expenditure. Data on a total of 1,017,758 patients with diabetes mellitus were analyzed. Patients with the fewest teeth incurred higher medical expenses. The largest mean difference in medical expenditure was observed between patients with 5-9 teeth and those with over 28 teeth. The results of this study suggest that public health expenditure on patients with diabetes mellitus differs based on number of teeth.

Association of tooth loss with morbidity and mortality by diabetes status in older adults: a systematic review

“…Of these, 8 were cross-sectional, and 5 were cohort designs. Three studies were conducted in the U.S.A. [44,46,53], 3 in Korea [48][49][50], 3 in Japan [42,47,52], 2 in Finland [24,43], 1 in Norway [45], and 1 using global data [51].…”

“…Patients with DM aged 50-59 years who had 5-9 teeth incurred the highest average public health expenditure while patients with 28 or more teeth incurred low average public health expenditure [52]. However, among patients with DM aged 60-74 years, the more teeth they had the fewer medical expenses incurred except for females aged 70-74 years [42].…”

“…Selection bias was a risk for 2 studies that used convenience samples, [47,52] 1 that used a consecutive sample, [46] 3 that recruited participants through telephone interview, [44,50,53] 1 did not describe the participant inclusion/exclusion criteria, [52] and another did not include women [45]. Additionally, measurement bias was present in some studies that identified DM status via self-report, [44] electronic health records, [45] national registries of death, [43][44][45] drug reimbursement, [24,42] and hospital discharge diagnosis [24,44]. Moreover, studies used different categories for the number of missing or remaining teeth, and the denominator for a full dentition varied between 28 and 32 teeth.…”

“…Moreover, studies used different categories for the number of missing or remaining teeth, and the denominator for a full dentition varied between 28 and 32 teeth. Five studies, [24,42,45,51,53] included third molars, which might lead to non-differential misclassification and may result in an underestimate of the strength of association between TL and DM-related outcomes. Further, some studies involved a self-reported number of missing teeth [51,53] or did not include edentulous participants [42] which also may lead to non-differential misclassification.…”

“…Five studies, [24,42,45,51,53] included third molars, which might lead to non-differential misclassification and may result in an underestimate of the strength of association between TL and DM-related outcomes. Further, some studies involved a self-reported number of missing teeth [51,53] or did not include edentulous participants [42] which also may lead to non-differential misclassification. Many studies mentioned that trained clinicians conducted the oral • Small sample size.…”