Matching the Statistical Model to the Research Question for Dental Caries Indices with Many Zero Counts

Marginalized zero-inflated count regression models have recently been introduced for the statistical analysis of dental caries indices and other zero-inflated count data as alternatives to traditional zero-inflated and hurdle models. Unlike the standard approaches, the marginalized models directly estimate overall exposure or treatment effects by relating covariates to the marginal mean count. This article discusses model interpretation and model class choice according to the research question being addressed in caries research. Two datasets, one consisting of fictional dmft counts in two groups and the other on DMFS among schoolchildren from a randomized clinical trial (RCT) comparing three toothpaste formulations to prevent incident dental caries, are analysed with negative binomial hurdle (NBH), zero-inflated negative binomial (ZINB), and marginalized zero-inflated negative binomial (MZINB) models. In the first example, estimates of treatment effects vary according to the type of incidence rate ratio (IRR) estimated by the model. Estimates of IRRs in the analysis of the RCT were similar despite their distinctive interpretations. Choice of statistical model class should match the study’s purpose, while accounting for the broad decline in children’s caries experience, such that dmft and DMFS indices more frequently generate zero counts. Marginalized (marginal mean) models for zero-inflated count data should be considered for direct assessment of exposure effects on the marginal mean dental caries count in the presence of high frequencies of zero counts