Oral Health and Its Associated Factors Among the Elderly in the Emergency Department: A Latent Class Analysis

Figures & data

Table 1 Descriptive Statistics and Analysis of Variance for All Variables (n=504)

Variables	Total (n=504)	C1 (n=208, 41.27%)	C2 (n=128, 25.4%)	C3 (n=168, 33.33%)	χ^2/F	P-value
Age (mean)	77.27±7.672	80.54±8.028	77.47±6.421	73.08±5.924	86.468^#	<0.001**
Gender (%)					2.005	0.367
Male	298 (59.13)	117 (56.25)	82 (64.06)	99 (58.93)
Female	206 (40.87)	91 (43.75)	46 (35.94)	69 (41.07)
BMI (mean)	22.03±3.049	21.35±2.976	21.94±2.855	22.95±3.043	13.532	<0.001**
Educational level (%)					4.204	0.379
None	139 (27.58)	62 (29.81)	40 (31.25)	37 (22.02)
Elementary school	265 (52.58)	108 (51.92)	63 (49.22)	94 (55.96)
Middle school and above	100 (19.84)	38 (18.27)	25 (19.53)	37 (22.02)
Smoking history (%)					2.515	0.284
Yes	160 (31.75)	58 (27.88)	43 (33.59)	59 (35.12)
No	344 (68.25)	150 (74.52)	85 (66.41)	109 (64.88)
Drinking history (%)					0.389	0.823
Yes	156 (30.95)	63 (30.29)	38 (29.69)	55 (32.74)
No	348 (69.05)	145 (69.71)	90 (70.31)	113 (67.26)
Rural/urban residence (%)					1.434	0.488
Urban	155 (30.75)	60 (28.47)	39 (30.47)	58 (34.52)
Rural	349 (69.25)	148 (71.15)	89 (69.53)	110 (65.48)
WBC (mean)	9.17±5.622	10.41±6.886	8.83±5.334	7.87±3.332	24.259^#	<0.001**
Neutrophil percentage (mean)	74.23±14.759	77.29±15.836	73.19±12.731	71.24±14.161	8.478	<0.001**
Lymphocyte percentage (mean)	17.86±12.797	19.51±12.661	17.97±11.279	16.48±13.646	2.61	0.075
CRP (mean)	36.34±54.508	53.35±66.256	27.5±44.339	22.03±37.227	48.137	<0.001**
Multimorbidity (%)					12.931	0.002*
No	160 (31.75)	54 (25.96)	35 (27.34)	71 (42.26)
Yes	344 (68.25)	154 (74.04)	93 (72.66)	97 (57.74)
Polypharmacy (%)					4.61	0.1
Yes	148 (29.37)	67 (32.21)	42 (32.81)	39 (23.21)
No	356 (70.63)	141 (67.79)	86 (67.19)	129 (76.79)
MNA-SF (%)					24.899	<0.001**
Normal	303 (60.12)	100 (48.08)	80 (62.5)	123 (73.21)
Malnutrition	201 (39.88)	108 (51.92)	48 (37.5)	45 (26.79)
FSQ (%)					52.056	<0.001**
No	243 (48.21)	63 (30.29)	67 (52.34)	113 (67.26)
Yes	261 (51.79)	145 (69.71)	61 (47.66)	55 (32.74)
OFI-8 (%)					60.919	<0.001**
No	116 (23.02)	22 (10.58)	21 (16.41)	73 (43.45)
Yes	388 (76.98)	186 (89.42)	107 (83.59)	95 (56.55)

Notes: *p value significant at < 0.05. **p value significant at < 0.001. ^#nonparametric test: Kruskal–Wallis Test.

Abbreviations: BMI, Body Mass Index; CRP, C-reactive protein; WBC, white blood cell count; OFI-8, Oral Frailty Index-8; MNA-SF, Mini-Nutritional Assessment Short Form; FSQ, Frailty Screening Questionnaire.

Table 2 Model Fit Indices Derived from Latent Class Analysis on Models with 1–4 Classes

Model	K	AIC	BIC	ABIC	Entropy	LMR	BLRT	Class probability
1	10	3997.335	4039.561	4007.820	–	–	–	–
2	21	3377.424	3466.099	3399.443	0.855	<0.0001*	<0.0001*	0.589/0.411
3	32	3326.285	3461.407	3359.836	0.874	<0.0001*	<0.0001*	0.333/0.413/0.254
4	43	3295.893	3477.464	3340.978	0.798	0.0832	<0.0001*	0.268/0.059/0.411/0.262

Notes: *p value significant at < 0.001.

Abbreviations: AIC, Akaike information criterion; BIC, Bayesian information criterion; aBIC, adjusted BIC; LMR, Lo Mendell-Rubin; BLRT, Bootstrapped likelihood ratio test.

Figure 1 The three-class model and probability of 10 oral health symptoms within each class (n = 504).

Notes: This Figure was made by this group on 2 February 2024 using GraphPad Prism. Class 1, Low level group - oral health; Class 2, Moderate level group - oral health; Class 3, High level group - oral health. A1, Lymph nodes; A2, Lips; A3, Tongue; A4, Tissue inside cheek, floor, and roof of mouth; A5, Tissue inside cheek, floor, and roof of mouth; A6, Saliva and effect on tissue; A7, Condition of natural teeth; A8, Condition of artificial teeth; A9, Pairs of teeth in chewing position (natural or artificial); A10, Oral cleanliness.

Abbreviations: BMI, Body Mass Index; CRP, C-reactive protein; WBC, white blood cell count; BOHSE, Brief oral health status examination; OFI-8, Oral Frailty Index-8; MNA-SF, Mini-Nutritional Assessment Short Form; FSQ, Frailty Screening Questionnaire; AIC, Akaike information criterion; BIC, Bayesian information criterion; aBIC, adjusted BIC; LMR, Lo Mendell-Rubin; BLRT, Bootstrapped likelihood ratio test; C1, Low level group - oral health; C2, Moderate level group - oral health; C3, High level group - oral health.

Table 3 Multiple Multinomial Logistic Regression for Latent Classes

	Variables	B	SE	Wald (X^2)	P-value	OR (95% CI)
C3 VS C1 (ref: C1)	Intercept	− 8.775	2.110	17.302	<0.001**
	Age	0.139	0.021	42.524	<0.001**	1.149 (1.102, 1.198)
	BMI	− 0.151	0.046	10.808	0.001*	0.86 (0.786, 0.941)
	WBC	0.055	0.028	3.733	0.053	1.056 (0.999, 1.116)
	Neutrophil percentage	0.024	0.011	4.725	0.03*	1.024 (1.002, 1.046)
	CRP	0.008	0.003	8.757	0.003*	1.008 (1.003, 1.014)
	MNA-SF (ref: malnutrition)	− 0.604	0.304	3.960	0.047*	0.546 (0.301, 0.991)
	FSQ (ref: yes)	− 0.654	0.279	5.499	0.019*	0.52 (0.301, 0.898)
C2 VS C1 (ref: C1)	Intercept	5.411	1.917	7.970	0.005*
	Age	− 0.057	0.018	10.492	0.001*	0.945 (0.913, 0.978)
	Neutrophil percentage	− 0.025	0.010	5.848	0.016*	0.975 (0.956, 0.995)
	CRP	− 0.007	0.003	6.720	0.01*	0.993 (0.988, 0.998)
	FSQ (ref: yes)	0.603	0.267	5.100	0.024*	1.827 (1.083, 3.082)
C2 VS C3 (ref: C3)	Intercept	− 3.364	2.081	2.612	0.106
	Age	0.082	0.021	14.480	<0.001**	1.085 (1.04, 1.132)
	BMI	− 0.111	0.044	6.304	0.012*	0.89 (0.82, 0.976)
	Multimorbidity (ref: yes)	− 0.599	0.278	4.657	0.031*	0.549 (0.319, 0.947)
	OFI-8 (ref: yes)	− 0.701	0.340	4.252	0.039*	0.496 (0.255, 0.966)

Notes: *p value significant at < 0.05. **p value significant at < 0.001. Likelihood ratio X² (df 18) = 206,581 (p < 0.001). Nagelkerke Pseudo‐R² = 0.38.

Abbreviations: BMI, Body Mass Index; CRP, C-reactive protein; WBC, white blood cell count; OFI-8, Oral Frailty Index-8; MNA-SF, Mini-Nutritional Assessment Short Form; FSQ, Frailty Screening Questionnaire; C1, Low level group - oral health; C2, Moderate level group - oral health; C3, High level group - oral health.

Data Sharing Statement

The original contributions presented in the study are included in the article, further inquiries can be directed to the corresponding authors.