Health insurance status is associated with periodontal disease progression among Gullah African-Americans with type 2 diabetes mellitus

Objectives: Assess periodontal disease progression among Gullah African Americans with type 2 diabetes mellitus (T2DM) according to health insurance coverage. Methods: Froman ongoing clinical trial among T2DM Gullah, we extracted a cohort that was previously enrolled in a cross-sectional study (N = 93). Comparing prior exam to trial initiation, total tooth sites/person with periodontal disease progression events [evaluated separately: 2+ mm of clinical attachment loss (CAL), 2+ mm increased periodontal probing depths (PPD), bleeding on probing (BOP) emergence] were evaluated according to health insurance coverage using regression techniques appropriate for data with different counts of potential events per subject (varying tooth sites available). We used negative binomial regression techniques to account for overdispersion and fit multivariable models that also included baseline glycemic control (poor: glycated hemoglobin >= 7 percent, well: glycated hemoglobin < 7 percent), history of established periodontitis, age, gender, body mass index, annual income, and oral hygiene behaviors. Final models included health insurance status, other significant predictors, and any observed confounders. Results: Privately insured were most prevalent (41.94 percent), followed by uninsured (23.66 percent), Medicare (19.35 percent), and Medicaid (15.05 percent). Those with poor glycemic control (65.59 percent) were more prevalent than well-controlled (34.41 percent). CAL events ranged from 0 to 58.8 percent tooth sites/person (11.83 +/- 12.44 percent), while PPD events ranged from 0 to 44.2 percent (8.66 +/- 10.97 percent) and BOP events ranged from 0 to 95.8 percent (23.65 +/- 17.21 percent). Rates of CAL events were increased among those who were uninsured [ rate ratio (RR) = 1.75, P = 0.02], Medicare-insured (RR = 1.90, P = 0.03), and Medicaid-insured (RR = 1.89, P = 0.06). Conclusions: Increased access to health care, including dental services, may achieve reduction in chronic periodontal disease progression (as determined by CAL) for this study population. These results are very timely given the March 2010 passing of the US healthcare reform bills.