title: Missing Oral Health-Related Data in the interRAI-HC - Associations with Selected Variables of General Health and the Effect of Multiple Imputation on the Relationship between Oral and General Health.
abstract: BACKGROUND
  Missing data within the comprehensive geriatric assessment of the interRAI suite of assessment instruments potentially imply the under-detection of conditions that require care as well as the risk of biased statistical results. Impaired oral health in older individuals has to be registered accurately as it causes pain and discomfort and is related to the general health status.
  
  
  OBJECTIVE
  This study was based on interRAI-Home Care (HC) baseline data from 7590 subjects (mean age 81.2 years, SD 6.9) in Belgium. It was investigated if missingness of the oral health-related items was associated with selected variables of general health. It was also determined if multiple imputation of missing data affected the associations between oral and general health.
  
  
  METHODS
  Multivariable logistic regression was used to determine if the prevalence of missingness in the oral health-related variables was associated with activities of daily life (ADLH), cognitive performance (CPS2) and depression (DRS). Associations between oral health and ADLH, CPS2 and DRS were determined, with missing data treated by 1. the complete-case technique and 2. by multiple imputation, and results were compared.
  
  
  RESULTS
  The individual oral health-related variables had a similar proportion of missing values, ranging from 16.3% to 17.2%. The prevalence of missing data in all oral health-related variables was significantly associated with symptoms of depression (dental prosthesis use OR 1.66, CI 1.41-1.95; damaged teeth OR 1.74, CI 1.48-2.04; chewing problems OR 1.74, CI 1.47-2.05; dry mouth OR 1.65, CI 1.40-1.94). Missingness in damaged teeth (OR 1.27, CI 1.08-1.48), chewing problems (OR 1.22, CI 1.04-1.44) and dry mouth (OR 1.23, CI 1.05-1.44) occurred more frequently in cognitively impaired subjects. ADLH was not associated with the prevalence of missing data. When comparing the complete-case technique with the multiple imputation approach, nearly identical odds ratios characterized the associations between oral and general health.
  
  
  CONCLUSIONS
  Cognitively impaired and depressive individuals had a higher risk of missing oral health-related information. Associations between oral health and ADLH, CPS2 and DRS were not influenced by multiple imputation of missing data. Further research should concentrate on the mechanisms that mediate the occurrence of missingness to develop preventative strategies.
authors.affiliation: Department of Oral Health Sciences, Population Studies in Oral Health, KU Leuven, Leuven, Belgium.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Krausch-Hofmann
authors.affiliation: Department of Public Health and Primary Care, KU Leuven and Hasselt University I-BioStat, KU Leuven, Leuven, Belgium.
authors.forename: Kris
authors.initials: K
authors.lastname: Bogaerts
authors.affiliation: Department of Neurosciences, Research Group Experimental Oto-Rhino-Laryngology, KU Leuven, Leuven, Belgium.
authors.forename: Michael
authors.initials: M
authors.lastname: Hofmann
authors.affiliation: LUCAS, Center for Care Research and Consultancy, KU Leuven, Leuven, Belgium.
authors.forename: Johanna
authors.initials: J
authors.lastname: de Almeida Mello
authors.affiliation: Department of Oral Health Sciences, Biomaterials, KU Leuven, Leuven, Belgium.
authors.forename: Nádia Cristina
authors.initials: NC
authors.lastname: Fávaro Moreira
authors.affiliation: Department of Public Health and Primary Care, KU Leuven and Hasselt University I-BioStat, KU Leuven, Leuven, Belgium.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Lesaffre
authors.affiliation: Department of Oral Health Sciences, Population Studies in Oral Health, KU Leuven, Leuven, Belgium.
authors.forename: Dominique
authors.initials: D
authors.lastname: Declerck
authors.affiliation: LUCAS, Center for Care Research and Consultancy, KU Leuven, Leuven, Belgium.
authors.forename: Anja
authors.initials: A
authors.lastname: Declercq
authors.affiliation: Department of Oral Health Sciences, Biomaterials, KU Leuven, Leuven, Belgium.
authors.forename: Joke
authors.initials: J
authors.lastname: Duyck
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium / Q000453:epidemiology; D000068598:Data Accuracy; D005260:Female; D015577:Geriatric Assessment / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D008297:Male; D009909:Oral Health / Q000706:statistics & numerical data*