Preventive Dental Care Utilization and Infective Endocarditis Among MEDICAID Beneficiaries with Congenital Heart Defects in Georgia, 2008-2019 Public

Abstract

Background: Congenital heart defects (CHD) are common birth defects affecting ~1% of U.S. live births annually. Children with CHD are recommended to receive preventive dental care due to their susceptibility to infective endocarditis (IE). Understanding the association of preventive dental care utilization and IE is crucial for informing targeted interventions that could improve oral health outcomes and mitigate IE burden for children with CHD. It is hypothesized that children with CHD, enrolled in Georgia Medicaid between 2008-2019, with at least one annual preventive dental care visit, will be at lower risk of IE compared to those without any preventive dental care visits.

Methods: This retrospective cohort study assessed the association between preventive dental care utilization and IE among 61,024 children with CHD, aged 1 to 18 years, enrolled in Georgia Medicaid between 2008-2019. Logistic regression models estimated crude and adjusted risk ratios (RRs) and 95% confidence intervals (CIs) for IE risk, controlling for CHD anatomic severity, sex, race and ethnicity, birth year cohort, Social Deprivation Index (SDI), and rurality. Effect modification was explored, with the CHD anatomic group identified as a significant modifier, leading to subgroup analyses.

Results: Among all CHD patients, 181 IE (0.30%) cases were identified, and 65.64% had at least one annual preventative dental visit. For subgroups with valve lesions or shunt lesions, having at least one annual preventive dental care visit showed a significantly lower risk of IE (aRR=0.32, 95% CI: 0.18-0.56, and aRR=0.17, 95% CI: 0.07-0.38, respectively).

Conclusions: At least one annual preventive dental care visit reduced the risk of IE among children with CHD. Despite Medicaid dental coverage, a large proportion of children with CHD did not receive annual preventive dental care visits. Future research should focus on developing and evaluating interventions to increase dental care access and improve utilization among this vulnerable population.

Table of Contents

CHAPTER 1: BACKGROUND. 1

Congenital Heart Defects. 1

CHD Severity. 2

CHD Treatment, Costs, and Healthcare Utilization. 3

CHD and Health Issues. 4

CHD and Infectious Endocarditis (IE). 4

CHD and Dental Infections. 5

IE and Dental Infections. 6

Study Rationale. 7

CHAPTER II: METHODS. 9

Study Design. 9

Data Source and Storage. 9

Study Population. 9

Exposure Variable. 10

Outcome Variable. 11

Covariables. 11

CHD Anatomic Severity. 11

Birth Year Cohort 11

Sex. 11

Race and Ethnicity. 11

Social Deprivation Index (SDI) 12

Rurality. 12

Statistical Analysis. 13

IRB and Ethnical Considerations. 14

CHAPTER III: RESULTS. 15

CHAPTER IV: DISCUSSION. 18

CHAPTER V: FUTURE DIRECTIONS AND PUBLIC HEALTH IMPLICATIONS. 23

REFERENCES. 24

TABLES. 29

Table1. Descriptive characteristics of Georgia Medicaid beneficiaries with congenital heart defects by infectious endocarditis status, 2008-2019. 29

Table 2a. Association between average annual preventive dental care visits and infectious endocarditis among children, 1-18 years old, with severe congenital heart defects, Georgia Medicaid, 2008-2019. 30

Table 2b. Association between average annual preventive dental care visits and infectious endocarditis among children, 1-18 years old, with valve congenital heart defects, Georgia Medicaid, 2008-2019. 31

Table 2c. Association between average annual preventive dental care visits and infectious endocarditis among children, 1-18 years old, with shunt congenital heart defects, Georgia Medicaid, 2008-2019. 32

FIGURES. 33

Figure 1. Cohort construction with inclusion and exclusion criteria. 33

APPENDICES. 34

Appendix A. Congenital heart defect severity, ICD-9-CM and ICD-10M codes. 34

Appendix B. Endocarditis, ICD-9-CM and ICD-10 CM codes. 37

Appendix C. Dental CDT codes, American Dental Association. 38

Appendix D. R code. 39

About this Master's Thesis

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• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Epidemiology Health Sciences, Dentistry Health Sciences, Public Health
Mot-clé	Preventive Dental Care Pediatric Medicaid Beneficiaries Congenital Heart Defects Infective Endocarditis
Committee Chair / Thesis Advisor	Kancherla, Vijaya, Emory University
Committee Members	Book, Wendy, Emory University Raskind-Hood, Cheryl, Emory University

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