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

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 (beta=0.49, p<0.05). Need had direct (77%) and indirect (23%) effects on OHRQoL (beta(direct)=0.30, beta(indi)(rect)=0.09, p< 0.001). Need predicted personal health practices including use of services (reason for dental visit, frequency of dental visits, smoking status) (beta=0.46, p<0.001). Need, in turn, predicted OHRQoL (beta=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.