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Indicator Details — Emerging Topics: Prevalence of Periodontal Disease in the U.S. Adult Populationa
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  • NHANES III

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Published literature or one-time analysis, ongoing surveillance not available Published literature or one-time analysis, ongoing surveillance not available

Footnotes:
a The prevalence of periodontal disease in participants with CKD compared to those that did not have CKD has a p-value < 0.001.




Periodontal disease was more prevalent in those with CKD than in those without CKD (9.2% vs. 4.8%; p< 0.001).
Chart Explanation:  Periodontal disease has been implicated as a novel risk factor for CKD. In 1988-1994, the prevalence of periodontal disease in U.S. adults was 7.6%. Periodontal disease was significantly more prevalent in those with CKD than in those without CKD (9.2% vs. 4.8%; p< 0.001). The median follow-up time was 14 years. The overall prevalence of CKD in the examined population was 12.4%.
The National Health and Nutrition Examination Survey III (NHANES III) is an earlier version of today’s continuous NHANES; this third iteration of the National Health Examination Survey was conducted from 1988-1994. NHANES III focused on oversampling many groups within the U.S. population aged 2 months or older. These oversampled groups included children aged 2 months to 5 years, persons 60 years or older, Mexican-Americans, and non-Hispanic blacks. This survey also concentrated on health and nutrition but additionally began to collect environmental exposure and infectious disease data. 

This indicator is based upon analysis in published literature: Ricardo AC, Athavale A, Chen J, et al. Periodontal disease, chronic kidney disease and mortality: results from the third National Health and Nutrition Examination Survey. BMC Nephrol. 2015;16:97.
http://www.ncbi.nlm.nih.gov/pubmed/26149680
FieldData
Description of MeasurePrevalence of Periodontal Disease 
Data SourceCDC/NCHS
Type of Data SourcePublic
Data SetNHANES III
Health Care System DataNo
Regional or National?National
Demographic GroupNoninstitutionalized U.S. residents aged 18 years or older
NumeratorNHANES III adults (18 years or older) men and non-pregnant women with periodontal disease who completed a periodontal assessment
DenominatorNHANES III adults (18 years or older) men and non-pregnant women without CKD who completed a periodontal assessment
Definition of CKDEstimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2, using the CKD epidemiology collaboration (CKD-EPI) equation for creatinine or the presence of urine albumin-tocreatinine ratio (ACR) ≥ 30 mg/g
Primary Data Source IndicatorPrevalence of periodontal disease
Primary Indicator Method of MeasurementPeriodontal disease was defined based on the Centers for Disease Control and Prevention (CDC) criteria as follows: moderate periodontal disease as at least 2 mesial sites with > 4 mm attachment loss or at least 2 mesial sites with 5 mm pocket depth (not on the same tooth), and severe periodontal disease as at least 2 mesial sites with > 6 mm attachment loss and one or more mesial sites with > 5 mm pocket depth. For the purposes of this study, individuals with either moderate or severe disease were classified as having periodontal disease.
Secondary Data Source IndicatorPresence of CKD
Secondary Indicator Method of MeasurementMeasuring the estimated glomerular filtration rate (eGFR) or measuring the presence of urine albumin-to-creatinine
Frequency of Measurement (Primary)Once (at baseline)
Period1988-1994
Pending DataNone
U.S. Region Covered by Primary VariableAll
Additional Data Items of InterestStage of CKD, other stratification variables of interest (race/ethnicity, educational attainment, smoking by self-report, diabetes, BMI, hypertension, CVD by self-report)
Limitations of IndicatorPossible misclassification of CKD (CKD was defined in study by single measurement of eGFR and albuminuria); periodontal disease status determined by assessment of only half of the mouth; definition of periodontal disease used might underestimate prevalence; periodontal disease development during follow-up was not taken into consideration
Analytical Considerations
Appropriate NHANES survey weights must be used for all analyses; creatinine measurements must be calibrated for NHANES III
References and Sources:
  • Ricardo AC, Athavale A, Chen J, et al. Periodontal disease, chronic kidney disease and mortality: results from the third National Health and Nutrition Examination Survey. BMC Nephrol. 2015;16:97.
    http://www.ncbi.nlm.nih.gov/pubmed/26149680

Suggested Citation:
Centers for Disease Control and Prevention. Chronic Kidney Disease Surveillance System—United States.
website. http://www.cdc.gov/ckd