Links between oral health-related quality of life in US adults and type 2 diabetes: structural equation modeling analysis

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  • Giang Vu
  • Bert B. Little
  • Robert Esterhay
  • J’Aime Jennings
  • Liza Creel
  • Lawrence Gettleman


Objectives: To analyze the effects of type 2 diabetes mellitus (T2DM), need for dental care, personal health practices and use of services
on oral health-related quality of life (OHRQoL) in US adults. Basic research design: The sample included 2,945 participants (aged ≥ 20)
selected from the National Health and Nutrition Examination Survey (NHANES) 2003-2004 stratified probability sample that represented
124,525,899 individuals in the weighted sample. Two-stage structural equation modelling (SEM) assessed interrelationships between T2DM
regressions on factors associated with OHRQoL in a simplified three-factor Andersen Behavioral Model (ABM). Results: SEM supported
the hypotheses that T2DM directly predicted need (perceived need, evaluated need, general health condition) with a significant path coefficient of 0.49 (β=0.49, p<0.05). Need had direct (77%) and indirect (23%) effects on OHRQoL (βdirect=0.30, βindirect=0.09, p< 0.001). Need
predicted personal health practices including use of services (reason for dental visit, frequency of dental visits, smoking status) (β=0.46,
p<0.001). Need, in turn, predicted OHRQoL (β=0.19, p<0.001). In the model, 23.8%, 59.7%, and 18.1% of the variance was explained by
need, personal health practices including use of services, and OHRQoL, respectively. Conclusions: The results confirmed T2DM predicted
need, which in sequence had direct and indirect effects on OHRQoL.
Keywords: Quality of Life, Oral Health, United States, Type 2 diabetes, Structural Equation Modeling

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