Underscreening and undertreatment? Periodontal service provision in very old Germans

Krois, Joachim; Krasowski, Aleksander; Rossi, Jesús Gómez; Paris, Sebastian; Kuhlmey, Adelheid; Meyer-Lückel, Hendrik; Schwendicke, Falk

doi:10.1007/s00784-020-03635-4

Cited by 4 publications

(7 citation statements)

References 16 publications

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“…For example, females were generally older (as they survived longer) and showed a higher level of care requirements in this older age. While we cannot fully ascertain the reasons for the observed (limited) cost differences, we showed differences in utilization along sexes in a similar direction before, indicating that both health status but also service consumption patterns may differ [ 16 , 17 , 18 ].…”

Section: Discussionmentioning

confidence: 54%

“…The cost difference between sexes was limited. Service consumption differences will have driven these cost differences [ 16 , 17 , 18 ], but also differences in confounders. For example, females were generally older (as they survived longer) and showed a higher level of care requirements in this older age.…”

Section: Discussionmentioning

confidence: 99%

“…The underlying dataset has been used to assess the utilization of general, operative and surgical [ 16 ], periodontal [ 17 ] and prosthetic [ 18 ] dental services by older Germans. The dataset contained claims data from a statutory (public) health insurance in Germany, the AOK Nordost, with a cohort of elderly followed over 6 years (2012 to 2017).…”

Section: Methodsmentioning

confidence: 99%

“…In a recent series of studies, we evaluated the utilization of general, operative, surgical, periodontal and prosthetic dental services in the very old (geriatric), defined as 75 years or older, in Germany [ 16 , 17 , 18 ]. In the present evaluation, using claims data from one large statutory insurer, we translate utilization into costs.…”

Section: Introductionmentioning

confidence: 99%

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Costs for Statutorily Insured Dental Services in Older Germans 2012–2017

Krasowski

Krois

Paris

et al. 2021

IJERPH

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Objectives: We assessed the costs of dental services in statutorily insured, very old (geriatric) Germans. Methods: A comprehensive sample of very old (≥75 years) people insured at a large Northeastern statutory insurer was followed over 6 years (2012–2017). We assessed dental services costs for: (1) examination, assessments and advice, (2) operative, (3) surgical, (4) prosthetic, (5) periodontal, (6) preventive and (7) outreach services. Association of utilization with: (1) sex, (2) age, (3) region, (4) social hardship status, (5) International Disease Classification (ICD-10) diagnoses and (6) Diagnoses Related Groups (DRGs) was explored. Results: 404,610 individuals with a mean (standard deviation, SD) age 81.9 (5.4 years) were followed, 173,733 did not survive follow-up. Total mean costs were 129.61 (310.97) euro per capita; the highest costs were for prosthetic (54.40, SD 242.89 euro) and operative services (28.40, SD 68.38 euro), examination/advice (21.15, SD 28.77 euro), prevention (13.31, SD 49.79 euro), surgery (5.91, SD 23.91 euro), outreach (4.81, SD 28.56 euro) and periodontal services (1.64, SD 7.39 euro). The introduction of new fee items for outreach and preventive services between 2012 and 2017 was reflected in costs. Total costs decreased with increasing age, and this was also found for all service blocks except outreach and preventive services. Costs were higher in those with social hardship status, and in Berlin than Brandenburg and Mecklenburg-Western Pomerania. Certain general health conditions were associated with increased or decreased costs. Conclusions: Costs were associated with sex, social hardship status, place of living and general health conditions. Clinical significance: Dental services costs for the elderly in Germany are unequally distributed and, up to a certain age or health status, generated by invasive interventions mainly. Policy makers should incentivize preventive services earlier on and aim to distribute expenses more equally.

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Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Costs for Statutorily Insured Dental Services in Older Germans 2012–2017

Krasowski

Krois

Paris

et al. 2021

IJERPH

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“…Generally, periodontitis or periodontal treatment need is an important public health issue, regardless of the presence of a severe heart disease; the population-representative fifth German oral health study (DMS V) showed about three quarters of German older adults to have periodontal treatment need [ 16 ]. Especially in the old Germans, periodontal diseases are reported to be underscreened, underdiagnosed and thus often undertreated [ 17 ]. Alongside with the potential relationship between periodontal and cardiovascular diseases [ 5 ], a high periodontal burden in severely heart diseased patients appears plausible.…”

Section: Discussionmentioning

confidence: 99%

Comparison of periodontal parameters between patients with ischemic and dilative cardiomyopathy

Ziebolz

Binner

Reuschel

et al. 2021

BMC Cardiovasc Disord

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Background This cross-sectional study aimed in the comparison of periodontal parameters, number of remaining teeth and oral behaviour between patients with ischemic- (ICM) and non-ischemic dilative cardiomyopathy (DCM). Methods Patients with HF from the Department for Cardiac Surgery at the Heart Center Leipzig were included. The two groups (ICM and DCM) were composed by matching according to age, gender and smoking habits. All participants received a comprehensive periodontal examination, including a periodontal probing on six measurement points of each tooth. Results A total of 226 patients (n = 113 each group) was included. Patients in DCM group used interdental cleaning significantly more often than ICM (23.9% vs. 12.5%, p = 0.04). The majority of patients in both groups (ICM: 83.6%, DCM: 84.6%, p = 0.23) were diagnosed with stage III–IV periodontitis. Periodontal parameters were comparable between groups (p > 0.05). Variance analysis revealed no influence of the group (ICM vs. DCM) on the number of remaining teeth (p = 0.16), periodontitis stage (p = 0.27) or the periodontal inflamed surface area (p = 0.62). Conclusions Patients with severe HF show high periodontal burden, without any differences between ICM and DCM group. Therefore, increased attention should be payed to periodontal health of patients with severe heart disease, irrespective of their underlying disease.

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Predicting mortality in the very old: a machine learning analysis on claims data

Krasowski

Krois

Kuhlmey

et al. 2022

Sci Rep

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Machine learning (ML) may be used to predict mortality. We used claims data from one large German insurer to develop and test differently complex ML prediction models, comparing them for their (balanced) accuracy, but also the importance of different predictors, the relevance of the follow-up period before death (i.e. the amount of accumulated data) and the time distance of the data used for prediction and death. A sample of 373,077 insured very old, aged 75 years or above, living in the Northeast of Germany in 2012 was drawn and followed over 6 years. Our outcome was whether an individual died in one of the years of interest (2013–2017) or not; the primary metric was (balanced) accuracy in a hold-out test dataset. From the 86,326 potential variables, we used the 30 most important ones for modeling. We trained a total of 45 model combinations: (1) Three different ML models were used; logistic regression (LR), random forest (RF), extreme gradient boosting (XGB); (2) Different periods of follow-up were employed for training; 1–5 years; (3) Different time distances between data used for prediction and the time of the event (death/survival) were set; 0–4 years. The mortality rate was 9.15% in mean per year. The models showed (balanced) accuracy between 65 and 93%. A longer follow-up period showed limited to no advantage, but models with short time distance from the event were more accurate than models trained on more distant data. RF and XGB were more accurate than LR. For RF and XGB sensitivity and specificity were similar, while for LR sensitivity was significantly lower than specificity. For all three models, the positive-predictive-value was below 62% (and even dropped to below 20% for longer time distances from death), while the negative-predictive-value significantly exceeded 90% for all analyses. The utilization of and costs for emergency transport as well as emergency and any hospital visits as well as the utilization of conventional outpatient care and laboratory services were consistently found most relevant for predicting mortality. All models showed useful accuracies, and more complex models showed advantages. The variables employed for prediction were consistent across models and with medical reasoning. Identifying individuals at risk could assist tailored decision-making and interventions.

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Underscreening and undertreatment? Periodontal service provision in very old Germans

Cited by 4 publications

References 16 publications

Costs for Statutorily Insured Dental Services in Older Germans 2012–2017

Costs for Statutorily Insured Dental Services in Older Germans 2012–2017

Comparison of periodontal parameters between patients with ischemic and dilative cardiomyopathy

Predicting mortality in the very old: a machine learning analysis on claims data

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