Validity of a Combined General and Oral Health Indicator for Vulnerability

Area of Science:

• Public Health
• Gerontology
• Oral Health Epidemiology

Background:

• Self-rated health (SRH) is a common metric for population health surveillance.
• SRH may not adequately capture oral health-related vulnerabilities.
• Assessing multidimensional vulnerability in adults aged 45 and older requires comprehensive health indicators.

Purpose of the Study:

• To investigate if combining SRH with self-rated oral health (SROH) improves the identification of multidimensional vulnerability.
• To examine the utility of a combined SRH-SROH indicator in adults aged 45 years and older.
• To assess the incremental validity of the combined indicator compared to SRH alone.

Main Methods:

• Utilized 2024 Korea Community Health Survey data for adults aged 45+.
• Developed a four-category SRH-SROH indicator (good both, poor oral only, poor general only, poor both).
• Employed survey-weighted multinomial logistic regression and assessed incremental validity using Nagelkerke R² and AUC, with chewing difficulty as a validation outcome.

Main Results:

• 32.6% reported poor health in both domains, 20.2% poor oral health only, 7.6% poor general health only, and 39.6% good health in both.
• The 'poor both' group exhibited higher rates of mobility limitation, chronic conditions, depressive symptoms, and unmet healthcare needs.
• Among those with good SRH, poor SROH identified hidden vulnerabilities, including mobility limitations, unmet medical needs, and chewing difficulty; the combined model significantly improved prediction for chewing difficulty (Nagelkerke R² from 0.373 to 0.540, AUC from 0.822 to 0.883).

Conclusions:

• Combining SRH and SROH is more effective than SRH alone in identifying hidden functional and care-related vulnerabilities, especially in individuals with good general health.
• The combined indicator's primary utility lies in subgroup identification for population health monitoring.
• Further validation is needed before considering the combined measure for stand-alone clinical screening.