Impact of oral disease on quality of life in the US and Australian populations.

UNLABELLED: The US National Health and Nutrition Examination Survey (NHANES 2003-2004) evaluated oral health quality of life for the first time using a previously untested subset of seven Oral Health Impact Profile (OHIP) questions, i.e. the NHANES-OHIP. OBJECTIVES: (i) To describe the impact of dental conditions on quality of life in the US adult population; (ii) to evaluate construct validity and adequacy of the NHANES-OHIP in NHANES 2003-2004 and a comparable Australian survey. METHODS: In the cross-sectional NHANES 2003-2004 survey of a nationally representative sample of US adults (n=4907), prevalence was quantified as the proportion of adults who reported experiencing one or more impacts fairly often or very often within the past year. Construct validity was tested by comparing prevalence estimates across categories of sociodemographic, dental health and utilization characteristics known to vary in oral health. In 2002, Australian cross-sectional survey of a nationally representative sample of adults (n=2644), adequacy of the NHANES-OHIP questions were tested with reference to a slightly modified version of the OHIP-14 questions. RESULTS: NHANES-OHIP prevalence estimates were markedly similar in the United States (15.3%) and Australia (15.7%). In the US construct, validity was evidenced by higher NHANES-OHIP scores among groups with greater levels of tooth loss, perceived treatment need and problem-oriented visiting and with lack of private dental insurance and low income. In Australia, prevalence for the NHANES-OHIP closely resembled prevalence estimates of the modified OHIP-14. Both varied to a similar degree across levels of tooth loss, perceived treatment need, problem-oriented visiting, and private dental insurance and income, demonstrating adequacy of the NHANES-OHIP as a brief independent instrument. CONCLUSIONS: There was acceptable construct validity and adequacy of the NHANES-OHIP questionnaire. In the United States, the impact of oral disease disproportionately affected disadvantaged groups, a finding that supports application of the US Healthy People 2010 major goals of improved quality of life and reduced health disparities.

Work disability resulting from chronic health conditions.

OBJECTIVES: To describe current programs and policies for addressing work disability among adults with chronic health conditions, and to identify opportunities for new research aimed at reducing the problem. METHODS: The authors conducted secondary data analysis and a literature review. RESULTS: Millions of Americans with a chronic health condition have a work disability or are at risk of developing one. This public health problem is costing hundreds of billions of dollars a year nationally in lost productivity and diminishing the quality of life of millions of Americans. The medical care system, employers, and government--three traditional sources of help for adults with chronic health problems--are not sufficiently oriented toward the primary or secondary prevention of work disability. CONCLUSIONS: New research is urgently needed to reduce the burden of work disability on individuals and society.