Oral Health Literacy and Oral Health-Related Quality of Life in Maintenance Hemodialysis Patients: The Serial Mediation of Social Support and Self-Efficacy

Oral Health Literacy and Oral Health-Related Quality of Life in Maintenance Hemodialysis Patients: The Serial Mediation of Social Support and Self-Efficacy | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Oral Health Literacy and Oral Health-Related Quality of Life in Maintenance Hemodialysis Patients: The Serial Mediation of Social Support and Self-Efficacy Bixia Yuan, QingHua Lai, XiaoTing Huang, JinLi Li, YongMei Lu, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8040368/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective To examine the relationship between oral health literacy (OHL) and oral health-related quality of life (OHRQoL) in patients undergoing maintenance hemodialysis (MHD), and to analyze the mediating roles of social support and self-efficacy for self-care of oral health (SESS) in this relationship. Methods A cross-sectional study was conducted using convenience sampling to recruit 402 MHD patients from three tertiary hospitals in Guangzhou between June 2023 and January 2024. Data were collected using the Health Literacy in Dentistry scale (HeLD-14), the Perceived Social Support Scale (PSSS), the Self-Efficacy for Self-Care of Oral Health Scale (SESS), and the Oral Health Impact Profile-14 (OHIP-14). Data analysis was performed using SPSS 27.0 for descriptive statistics, correlation analysis, and linear regression analysis. The mediation effects were tested using Model 6 from Hayes' PROCESS macro. Results (1) OHL was positively correlated with both social support (r = 0.649, p < 0.001) and SESS (r = 0.731, p < 0.001), and negatively correlated with OHRQoL (r=-0.523, p < 0.001) in MHD patients. (2) Mediation analysis revealed a significant direct effect of OHL on OHRQoL (effect size: -0.199). Both social support and SESS served as independent mediators in the relationship between OHL and OHRQoL, with indirect effect sizes of -0.135 and − 0.148, respectively. Furthermore, they played a serial mediating role, with an indirect effect size of -0.041. Conclusion Oral health literacy in MHD patients not only directly influences their OHRQoL but also exerts indirect effects through the independent mediating roles of social support and self-efficacy for oral health self-care, as well as their serial mediation. Clinical interventions should focus on synergistically enhancing patients' perceived social support and self-efficacy levels. Maintenance Hemodialysis Oral Health Literacy Social Support Self-efficacy Oral Health-Related Quality of Life Figures Figure 1 Figure 2 Introduction Maintenance Hemodialysis (MHD) serves as the primary treatment modality for end-stage renal disease, with a progressively growing patient population. By 2021, the number of MHD patients in China had reached 749,000 [ 1 ]. Due to endocrine disturbances, metabolic abnormalities, and immune dysfunction, MHD patients commonly experience severe oral complications such as periodontitis and xerostomia [ 2 – 4 ]. These conditions not only impair oral function but also exacerbate the micro-inflammatory state, increasing the risk of cardiovascular disease and mortality [ 5 – 7 ]. Furthermore, xerostomia often leads to increased fluid intake, resulting in excessive interdialytic weight gain, which further elevates morbidity and mortality risks [ 8 ]. Additionally, oral halitosis frequently causes social avoidance, and its long-term persistence can adversely affect patients' psychological well-being [ 9 , 10 ]. Consequently, oral health issues in MHD patients extend beyond localized pathologies, posing multifaceted threats to physiological function, psychological health, and social adaptability, thereby severely compromising their quality of life [ 11 ]. Given this context, improving the oral health status of MHD patients is of paramount importance for enhancing their overall quality of life. Oral Health-Related Quality of Life (OHRQoL) is a comprehensive measure reflecting the impact of oral conditions on an individual's overall physical and psychological well-being [ 7 ]. It captures not only patients' subjective perceptions of oral diseases but also reflects the effects of these conditions on physical function and mental health throughout the disease progression [ 12 ]. A meta-analysis [ 13 ] has confirmed that poor oral hygiene is prevalent among MHD patients. Furthermore, a multinational cohort study revealed that dental health status is significantly associated with early mortality in MHD patients, while preventive oral care measures are clearly linked to prolonged survival [ 14 ]. Therefore, investigating the mechanisms influencing OHRQoL in MHD patients holds significant clinical value for improving their oral health quality of life. Health literacy, as a multidimensional construct, encompasses an individual's comprehensive capacity to access, comprehend, evaluate, and apply health information [ 15 ]. As a critical component, Oral Health Literacy (OHL) specifically refers to an individual's ability to obtain, process, and understand the basic health information and services required to make appropriate oral health decisions [ 16 ].Research indicates that OHL not only effectively predicts oral health status but also significantly influences health behavior choices, playing a pivotal role in improving OHRQoL [ 17 ]. Accurately assessing the OHL levels of MHD patients can help identify individuals with deficient oral health knowledge and provide a basis for healthcare providers to conduct targeted communication and develop personalized oral health intervention plans, ultimately leading to improved OHRQoL. Social support, as a crucial external resource, generally refers to material or psychological assistance provided by family members, social networks, and other channels. For MHD patients, a robust social support system can provide both practical care and psychological comfort, exerting a positive influence on health status and quality of life. Studies have shown a significant positive correlation between the level of social support and the quality of life in young MHD patients [ 18 ]. Although research in other populations generally supports the role of social support as a positive predictor of OHRQoL, it is noteworthy that one study specifically investigating hemodialysis patients found no significant association between the two[ 19 ]. This discrepancy may stem from sample characteristics or methodological heterogeneity, warranting further investigation. Self-efficacy (SE), an important predictor of oral health-related quality of life, can be categorized into general self-efficacy and specific task self-efficacy [ 20 ]. Among these, self-efficacy for oral health self-care, a type of specific task self-efficacy, refers specifically to an individual's confidence in their ability to perform oral health behaviors [ 21 ]. Research indicates [ 22 ] that individuals with higher self-efficacy typically demonstrate better adherence to oral health behaviors. The Health Literacy Skills (HLS) framework, proposed by American scholar Squiers et al. [ 23 ], posits that in addition to directly influencing health outcomes, the pathways through which health literacy exerts its effects may also be moderated by mediating factors such as individual characteristics and the external environment. Consequently, in clinical practice, healthcare providers need to comprehensively consider patients' psychological states and socio-environmental factors to more effectively improve their OHRQoL. Although existing research has explored certain factors influencing OHRQoL in MHD patients, the pathways through which OHL affects OHRQoL remain unclear. Building upon the HLS framework, this study incorporates social support and self-efficacy for oral health self-care as mediating variables, aiming to systematically elucidate the mechanism by which OHL influences OHRQoL, thereby providing a reference for developing scientific oral health intervention strategies for MHD patients. Accordingly, we propose the following hypotheses:(see Fig. 1 for details) H1: Significant correlations exist among oral health literacy, social support, self-efficacy for oral health self-care, and oral health-related quality of life. H2: Oral health literacy can directly influence the oral health-related quality of life of MHD patients. H3: Oral health literacy influences oral health-related quality of life through the mediating roles of social support and self-efficacy for oral health self-care. H4: Social support and self-efficacy for oral health self-care play a serial mediating role in the relationship between oral health literacy and oral health-related quality of life. Study Participants and Methods Study Participants A convenience sampling method was employed to recruit MHD patients from three tertiary hospitals in Guangzhou between June 2023 and January 2024. (1) Inclusion Criteria ① Age ≥ 18 years; ② Diagnosed with end-stage renal disease according to the criteria outlined in the "Guidelines for the Screening, Diagnosis, and Prevention of Chronic Kidney Disease" [ 24 ], receiving regular hemodialysis 2–3 times per week for ≥ 3 months; ③ Clinically stable with clear consciousness; ④ Provided informed consent and voluntarily participated in the study. (2) Exclusion Criteria ① Patients with comorbid acute/critical conditions such as heart failure or myocardial infarction; ② Patients with a history of psychiatric disorders or intellectual disability; ③ Patients who had undergone kidney transplantation. (3) Elimination Criteria ① Questionnaires with incomplete responses; ② Questionnaires showing random or patterned responses. Study Instruments General Information Questionnaire Self-designed based on literature review and the study objectives, including 16 items: gender, age, marital status, education level, place of residence, monthly household income, medical payment method, smoking status, primary disease, duration of hemodialysis, number of comorbid conditions, daily tooth brushing frequency, duration of each brushing, dental visit within the past year, self-rated oral health status, and dental treatment needs. Short Form of the Health Literacy in Dentistry Scale (HeLD-14) This scale, originally developed by Australian scholar Jones [ 25 ], was translated and adapted into Chinese by Chinese scholars Yan et al. [ 26 ]. It comprises 7 dimensions (Concern, Understanding, Support, Financial Burden, Access, Communication, and Application) across 14 items. Responses are scored on a 5-point Likert scale. The total score ranges from 0 to 56, with higher scores indicating higher levels of oral health literacy. In this study, the scale's Cronbach's α coefficient was 0.836. Perceived Social Support Scale (PSSS) Translated and culturally adapted from Zimet's original scale [ 28 ] by Jiang Qianjin et al. [ 27 ] for the Chinese context. This scale includes 3 dimensions (Family Support, Friend Support, and Other Support) across 12 items. Responses are scored on a 7-point Likert scale from "strongly disagree" (1) to "strongly agree" (7), with total scores ranging from 12 to 84. Total scores are categorized into low (12–36), medium (37–60), and high (61–84) support levels. In this study, the scale's Cronbach's α coefficient was 0.893. Self-Efficacy Scale for Self-care (SESS) Originally developed by Kakudate et al. [ 29 ] in 2007, the Chinese version was introduced by Wu Di et al. [ 30 ] in 2015. This scale includes 3 dimensions (Self-efficacy for Dental Visits, Correct Brushing, and Balanced Diet) across 15 items. Responses are scored on a 5-point Likert scale from "not confident at all" (1) to "very confident" (5), with total scores ranging from 15 to 75. Scores are categorized into low (≤ 53), medium (54–59), and high (60–75) self-efficacy levels, with higher scores indicating greater self-efficacy for oral health self-care. In this study, the scale's Cronbach's α coefficient was 0.921. Sample Size Estimation The sample size was calculated based on the standard method for studies investigating influencing factors [ 34 ], requiring a sample size 10 times the number of independent variables. Accounting for a potential 20% attrition rate, and considering the 27 variables involved (16 general information variables, 7 dimensions from the HeLD-14, 3 dimensions from the PSSS, 3 dimensions from the SESS, and 4 dimensions from the OHIP-14), the minimum required sample size was calculated to be 396 participants. Data Collection The survey was conducted in the hemodialysis centers in accordance with the Declaration of Helsinki. Prior to data collection, the study purpose and procedures were explained to the relevant hospital administrators and the head nurse of the department to obtain their approval. Two trained investigators used a standardized script to distribute the questionnaires. Participants were informed about the study's purpose, significance, and the confidentiality of their responses, and provided informed consent. They were also advised of their right to withdraw from the study at any time. Questionnaires were administered prior to hemodialysis sessions without interfering with treatment. Participants completed the questionnaires independently. For those unable to self-complete, the investigators read the items aloud and recorded the responses verbatim. The survey took approximately 15–20 minutes to complete. Upon collection, questionnaires were immediately checked for completeness, and participants were asked to fill in any missing items promptly. This study was approved by the Hospital Ethics Committee (Approval No.: YE202311301). Statistical Analysis All statistical analyses were performed using IBM SPSS Statistics 27.0 and the SPSS macro PROCESS v4.2. General demographic and clinical variables were described using means and standard deviations (mean ± SD) or frequencies (%). Pearson correlation analysis was employed to examine the relationships among OHL, perceived social support, self-efficacy for oral health self-care (SESS), and OHRQoL. Linear regression models were used to assess the predictive effects of OHL, perceived social support, and SESS on OHRQoL. The serial mediation model (Model 6) of the PROCESS macro v4.2 was used to test the significance of the mediating roles of social support and SESS in the relationship between OHL and OHRQoL in MHD patients. The bias-corrected percentile Bootstrap method (5000 samples, 95% CI) was applied to evaluate the total, direct, and indirect effects of the model. An indirect effect was considered statistically significant if its 95% confidence interval did not include zero. Results Common Method Bias Test As a self-designed questionnaire was used in this study, potential common method bias was assessed using Harman's single-factor test. An exploratory factor analysis including all study variables yielded 10 factors with eigenvalues greater than 1. The first factor accounted for 38.37% of the variance (< 40%), indicating no significant common method bias or multicollinearity. Demographic Characteristics of MHD Patients and Differences in Study Variables A total of 402 valid questionnaires were collected (response rate 96.6%). Among the participants, 60% (n = 241) were male and 40% (n = 161) were female; 40.6% were over 60 years old; 77.9% were married; 38.1% had a junior high school education level; 77.4% resided in urban areas; 40.8% had a monthly household income per capita exceeding ¥5,000; and 53.7% were enrolled in employee medical insurance. The primary renal diseases were chronic glomerulonephritis (36.1%) and diabetes (31.6%); 41.5% had been on hemodialysis for 1–3 years; and 77.6% had 1–3 comorbid conditions. Regarding oral health and behaviors: 44.8% brushed their teeth once daily, while 10.4% never or rarely brushed; 62.9% brushed for less than 3 minutes each time; 44.0% self-rated their oral health as fair; 54.0% reported a need for dental treatment, yet only 25.6% had visited a dentist within the past year. Details are presented in Table 1 . Table 1 Comparison of Study Variables across Different Characteristics of MHD Patients [n = 402, (x̄±s)] Characteristic n(%) OHRQoL OHL Social Support Self-Efficacy Gender Male 241(60.0) 13.11 ± 9.98 44.94 ± 12.07 49.91 ± 14.15 47.91 ± 11.36 Female 161(40.0) 12.20 ± 9.36 44.52 ± 12.76 51.14 ± 13.91 49.15 ± 11.12 t-value 0.911 0.331 -0.860 -1.078 Age (years) 18 ~ 45 68(16.9) 12.13 ± 9.87 49.28 ± 13.83 50.76 ± 13.89 50.07 ± 13.59 46 ~ 60 149(37.1) 11.42 ± 9.57 47.79 ± 12.19 52.63 ± 14.08 50.17 ± 10.93 >60 185(46.0) 14.04 ± 9.70 40.69 ± 10.53 48.48 ± 13.88 46.38 ± 10.28 F-value 3.717* 21.044*** 3.676* 5.694** Marital Status Unmarried 24(6.0) 10.67 ± 9.07 50.88 ± 12.55 51.50 ± 12.20 49.33 ± 11.58 Married 313(77.9) 12.93 ± 9.62 45.11 ± 11.80 50.99 ± 13.52 48.45 ± 11.23 Divorced/Widowed 65(16.2) 12.63 ± 10.53 40.89 ± 13.72 47.20 ± 16.70 47.88 ± 11.49 F-value 0.607 6.439** 2.044 0.154 Education Level Primary or below 126(31.3) 14.96 ± 10.70 38.38 ± 10.12 46.18 ± 13.89 45.32 ± 10.90 Junior high school 153(38.1) 12.98 ± 8.89 44.69 ± 11.46 49.33 ± 13.96 48.37 ± 10.56 Senior high school 72(17.9) 11.17 ± 9.90 49.13 ± 11.69 54.33 ± 12.67 50.07 ± 11.83 Junior college 23(5.7) 10.61 ± 9.60 52.09 ± 11.81 57.22 ± 14.17 52.13 ± 11.67 Bachelor's or above 28(7.0) 7.32 ± 5.95 56.79 ± 11.71 59.57 ± 9.89 55.18 ± 10.82 F-value 4.751*** 23.754*** 9.560*** 6.227*** Residence Rural 91(22.6) 12.11 ± 9.42 40.37 ± 12.59 46.60 ± 13.83 44.98 ± 10.98 Town 151(37.6) 13.11 ± 9.05 43.91 ± 10.55 49.82 ± 12.37 47.90 ± 10.36 Urban 160(39.8) 12.77 ± 10.54 48.08 ± 12.89 53.12 ± 15.13 50.84 ± 11.73 t-value 0.297 12.596*** 6.627** 8.390*** Monthly Household Income (CNY) < 1000 16(4.0) 19.13 ± 10.94 35.06 ± 13.39 39.25 ± 12.79 40.69 ± 12.75 1000 ~ 3000 101(25.1) 14.50 ± 9.84 40.66 ± 10.85 48.20 ± 14.16 45.45 ± 9.63 3000 ~ 5000 121(30.1) 11.79 ± 9.08 44.64 ± 11.86 50.97 ± 13.91 48.98 ± 11.57 >5000 164(40.8) 11.74 ± 9.71 48.34 ± 12.23 52.44 ± 13.62 50.56 ± 11.21 F-value 4.500** 12.632*** 5.590*** 7.260*** Medical Payment Method Self-pay 6(1.5) 8.17 ± 9.30 39.33 ± 16.65 46.67 ± 18.62 42.83 ± 15.74 Employee medical insurance 216(53.7) 12.72 ± 9.93 47.45 ± 12.75 52.18 ± 13.89 50.27 ± 11.93 Resident health insurance 180(44.8) 12.93 ± 9.52 41.74 ± 10.91 48.41 ± 13.87 46.36 ± 9.86 F-value 0.697 11.704*** 3.804* 6.845** Smoking Status Yes 112(27.9) 13.28 ± 9.91 44.13 ± 12.45 49.70 ± 14.00 48.39 ± 11.35 No 289(72.1) 11.36 ± 9.15 46.42 ± 11.93 52.22 ± 14.07 48.46 ± 11.10 t-value 1.783 -1.669 -1.615 -0.052 Primary Disease Chronic Glomerulonephritis 145(36.1) 11.14 ± 9.70 45.73 ± 13.01 50.97 ± 14.46 50.85 ± 11.83 Diabetes 127(31.6) 14.87 ± 9.28 41.52 ± 11.11 47.08 ± 13.44 44.56 ± 10.70 Hypertension 98(24.4) 13.74 ± 9.83 45.50 ± 11.53 52.09 ± 13.71 49.19 ± 9.64 Other 32(8.0) 8.56 ± 9.18 51.09 ± 13.18 55.91 ± 13.14 50.22 ± 11.88 F-value 5.849*** 6.398*** 4.682** 8.047*** Hemodialysis Vintage (years) <1 103(25.6) 11.18 ± 9.90 45.79 ± 12.42 50.83 ± 13.87 49.30 ± 11.16 1 ~ 3 167(41.5) 13.51 ± 9.21 43.88 ± 12.41 48.68 ± 13.92 47.21 ± 11.48 3 ~ 10 113(28.1) 13.12 ± 10.06 45.04 ± 11.86 51.93 ± 14.19 49.13 ± 11.21 >10 19(4.7) 12.26 ± 11.01 45.53 ± 14.34 54.16 ± 14.41 49.79 ± 10.02 F-value 1.304 0.562 1.774 1.098 Number of Comorbidities <3 312(77.6) 11.29 ± 9.26 45.90 ± 11.96 52.38 ± 13.53 49.79 ± 10.44 ≥ 3 90(22.4) 17.81 ± 9.67 40.87 ± 12.89 43.56 ± 13.74 43.62 ± 12.71 t-value 5.830*** 3.455*** 5.434*** 4.693*** Daily Tooth Brushing Frequency Never/Occasionally 42(10.4) 16.79 ± 11.37 33.98 ± 9.56 40.29 ± 11.19 38.10 ± 8.26 Once 180(44.8) 14.07 ± 9.32 41.75 ± 10.06 49.06 ± 13.15 45.86 ± 9.69 ≥ Twice 180(44.8) 10.48 ± 9.22 50.31 ± 12.30 54.12 ± 14.16 53.37 ± 10.89 F-value 10.670*** 49.151*** 19.687*** 49.186*** Brushing Duration per Session <3min 253(62.9) 14.18 ± 10.11 41.40 ± 11.71 46.85 ± 13.23 45.57 ± 11.12 ≥ 3min 149(37.1) 10.31 ± 8.54 50.50 ± 11.25 56.45 ± 13.35 53.23 ± 9.80 t-value 3.922*** -7.635*** -7.006*** -6.973*** Dental Visit in Past Year Yes 103(25.6) 15.53 ± 9.60 47.21 ± 11.76 51.92 ± 14.35 49.35 ± 11.97 No 299(74.4) 11.79 ± 9.61 43.93 ± 12.42 49.88 ± 13.93 48.08 ± 11.01 t-value 3.415*** 2.343* 1.272 0.984 Self-rated Oral Health Very poor 19(4.7) 20.89 ± 11.41 43.47 ± 11.17 50.00 ± 12.71 45.26 ± 11.54 poor 125(31.1) 18.11 ± 9.98 38.60 ± 11.16 43.24 ± 13.03 42.38 ± 10.91 Fair 177(44.0) 10.59 ± 7.83 45.50 ± 11.81 51.80 ± 13.20 49.64 ± 9.96 Good 74(18.4) 7.68 ± 7.42 52.27 ± 9.70 58.49 ± 11.94 55.24 ± 8.88 Very good 7(1.7) 3.00 ± 5.83 60.86 ± 13.81 58.71 ± 18.41 61.14 ± 12.48 F-value 27.555*** 21.485*** 17.882*** 23.029*** Perceived Need for Dental Treatment Yes 217(54.0) 15.11 ± 10.29 43.36 ± 11.86 48.68 ± 13.30 47.44 ± 11.28 No 184(46.0) 9.97 ± 8.23 46.42 ± 12.70 52.43 ± 14.66 49.54 ± 11.17 t-value 5.558*** -2.493* -2.692** -1.867 Note: OHRQoL = Oral Health-Related Quality of Life; * p < 0.05, ** p < 0.01, *** p < 0.001. Scores of Study Variables The mean score for Oral Health-Related Quality of Life (OHRQoL) among MHD patients was 12.75 ± 9.73. The mean score for Oral Health Literacy (OHL) was 44.77 ± 12.34. The mean score for Social Support was 50.41 ± 14.05. The mean score for Self-Efficacy for Self-Care (SESS) was 48.41 ± 11.27. Scores for OHL, social support, SESS, and OHRQoL demonstrated statistically significant differences (P < 0.05) across most demographic and study-related variables. Details are presented in Table 1 . Correlational Analysis Among Variables Results of the Pearson correlation analysis revealed that OHL was positively correlated with social support (r = 0.649, P < 0.001) and with SESS (r = 0.731, P < 0.001) in MHD patients. OHL was negatively correlated with OHRQoL (r = -0.523, P < 0.001). Social support was positively correlated with SESS (r = 0.616, P < 0.001) and negatively correlated with OHRQoL (r = -0.496, P < 0.001). SESS was negatively correlated with OHRQoL (r = -0.532, P < 0.001). Details are presented in Table 2 . Table 2 Correlation Analysis of OHL, Social Support, Self-Efficacy for Self-Care, and OHRQoL in MHD Patients Variable Mean SD OHL Social Support Self-Efficacy OHRQoL OHL 44.77 12.336 1 Social Support 50.41 14.048 0.649*** 1 Self-Efficacy 48.41 11.265 0.731*** 0.616*** 1 OHRQoL 12.746 9.7318 -0.523*** -0.496*** -0.532*** 1 Note : *** p < 0.001 Multiple Linear Regression Analysis of Factors Influencing OHRQoL in MHD Patients Variables that showed statistical significance in the univariate analysis were included in the model. Using education level, monthly household income per capita, primary disease, number of comorbidities, daily tooth brushing frequency, brushing duration per session, dental visit frequency within the past year, self-rated oral health status, and perceived need for dental treatment as control variables, and Oral Health Literacy (OHL), social support, and Self-Efficacy for Self-care (SESS) as independent variables, a multiple stepwise linear regression analysis was performed with the total OHIP-14 score as the dependent variable. The aim was to investigate the predictive effects of these variables on OHRQoL in MHD patients (details in Table 3 ). The results of Model I indicated that education level (β = -0.948, P = 0.028), number of comorbidities (β = 4.948, P < 0.001), daily tooth brushing frequency (β = -1.538, P = 0.027), dental visit frequency within the past year (β = 2.326, P = 0.017), self-rated oral health status (β = -3.625, P < 0.001), and perceived need for dental treatment (β = 2.942, P = 0.001) were significant predictors of the OHRQoL score.In Model II, OHL (β = -0.361, P < 0.001) significantly and negatively predicted the OHIP-14 score; thus, H1 was supported.Building upon Model II, in Model III, social support had a significant negative impact on the OHIP-14 score (β = -0.130, P < 0.001).In Model IV, when OHL, social support, and SESS were simultaneously entered into the regression equation, the predictive effect of social support on OHRQoL remained significant. SESS (β = -0.177, P = 0.001) also significantly and negatively predicted the OHIP-14 score. However, the negative predictive effect of OHL on the OHIP-14 score remained significant (β = -0.189, P < 0.001), indicating that social support and SESS partially mediated the relationship between OHL and OHRQoL.Furthermore, as shown in Table 3 , compared to the first three models, Model IV had the largest Adjusted R², indicating that OHL, social support, and SESS together provided greater explanatory power for OHRQoL. Table 3 Multiple Linear Regression Analysis of Factors Influencing OHRQoL in MHD Patients (n = 402) Variable β SD t P 95%CI (LL, UL) Model I Constant 23.362 3.418 6.835 <0.001 16.643,30.082 Age -0.574 0.628 -0.913 0.362 -1.809,0.661 Education Level -0.948 0.429 -2.207 0.028 -1.792,-0.104 Monthly Household Income -0.623 0.512 -1.216 0.225 -1.630,0.384 Primary Disease -0.010 0.446 -0.023 0.981 -0.887,0.866 Number of Comorbidities 4.948 1.034 4.787 <0.001 2.916,6.980 Daily Tooth Brushing Frequency -1.538 0.691 -2.226 0.027 -2.897,-0.180 Brushing Duration 0.201 0.955 0.210 0.834 -1.677,2.079 Dental Visit Frequency 2.326 0.973 2.390 0.017 0.413,4.240 Self-rated Oral Health -3.625 0.538 -6.742 <0.001 -4.682,-2.568 Perceived Need for Dental Treatment 2.942 0.905 3.252 0.001 1.163,4.721 R 2 0.309 Adjusted R 2 0.291 F-value 17.481*** Model II Constant 29.575 3.183 9.290 <0.001 23.316,35.834 Age -1.219 0.576 -2.117 0.035 -2.351,-0.087 Education Level -0.144 0.400 -0.359 0.720 -0.931,0.644 Monthly Household Income -0.059 0.470 -0.126 0.900 -0.983,0.865 Primary Disease 0.361 0.408 0.885 0.377 -0.441,1.162 Number of Comorbidities 3.946 0.947 4.168 <0.001 2.084,5.807 Daily Tooth Brushing Frequency 0.334 0.662 0.505 0.614 -0.966,1.635 Brushing Duration 0.986 0.873 1.129 0.259 -0.731,2.703 Dental Visit Frequency 3.448 0.894 3.857 <0.001 1.690,5.205 Self-rated Oral Health -2.595 0.502 -5.168 <0.001 -3.582,-1.608 Perceived Need for Dental Treatment 2.487 0.825 3.016 0.003 0.866,4.108 OHL -0.361 0.040 -9.084 <0.001 -0.439,-0.283 R 2 0.430 Adjusted R 2 0.414 F-value 26.708*** Model III Constant 31.272 3.170 9.865 <0.001 25.039,37.504 Age -0.859 0.576 -1.492 0.137 -1.991,0.273 Education Level -0.054 0.395 -0.137 0.891 -0.831,0.723 Monthly Household Income -0.151 0.464 -0.326 0.745 -1.062,0.761 Primary Disease 0.407 0.402 1.015 0.311 -0.382,1.197 Number of Comorbidities 3.362 0.946 3.554 <0.001 1.502,5.223 Daily Tooth Brushing Frequency 0.348 0.652 0.534 0.593 -0.933,1.629 Brushing Duration 1.294 0.864 1.497 0.135 -0.405,2.993 Dental Visit Frequency 3.532 0.881 4.011 <0.001 1.801,5.264 Self-rated Oral Health -2.416 0.497 -4.862 <0.001 -3.393,-1.439 Perceived Need for Dental Treatment 2.293 0.814 2.817 0.005 0.693,3.893 OHL -0.274 0.046 -5.977 <0.001 -0.365,-0.184 Social Support -0.130 0.036 -3.620 <0.001 -0.201,-0.060 R 2 0.448 Adjusted R 2 0.431 F-value 26.334*** Model IV Constant 33.236 3.187 10.428 <0.001 26.970,39.503 Age -0.748 0.570 -1.313 0.190 -1.867,0.372 Education Level -0.213 0.393 -0.543 0.588 -0.987,0.560 Monthly Household Income -0.150 0.458 -0.327 0.743 -1.050,0.750 Primary Disease 0.232 0.400 0.579 0.563 -0.555,1.018 Number of Comorbidities 3.036 0.940 3.231 0.001 1.188,4.884 Daily Tooth Brushing Frequency 0.752 0.655 1.148 0.252 -0.536,2.040 Brushing Duration 1.392 0.854 1.630 0.104 -0.287,3.071 Dental Visit Frequency 3.434 0.870 3.946 <0.001 1.723,5.145 Self-rated Oral Health -2.142 0.498 -4.303 <0.001 -3.121,-1.163 Perceived Need for Dental Treatment 2.566 0.808 3.176 0.002 0.978,4.155 OHL -0.189 0.052 -3.632 <0.001 -0.292,-0.087 Social Support -0.102 0.037 -2.782 0.006 -0.174,-0.030 Self-Efficacy -0.172 0.052 -3.286 0.001 -0.275,-0.069 R 2 0.463 Adjusted R 2 0.445 F-value 25.751*** Note : *** p < 0.001 Validation Analysis of the Mediation Model A serial mediation analysis was conducted using the SPSS PROCESS macro (Model 6), with MHD patients' Oral Health Literacy (OHL) as the independent variable, Oral Health-Related Quality of Life (OHRQoL) as the dependent variable, and social support and Self-Efficacy for Self-care (SESS) as the mediating variables. As illustrated in Fig. 2 , the direct predictive effect of OHL on OHRQoL was significant (β = -0.199, P < 0.01). Both social support (β = -0.208, P < 0.01) and SESS (β = -0.259, P < 0.01) demonstrated significant negative predictive effects on the OHRQoL score, consistent with the results of the multiple linear regression analysis. The Bootstrap method was employed to test the mediation effects. The results indicated a direct effect of OHL on OHRQoL of -0.199 [95% CI (-0.324, -0.073)]. The total indirect effect and the total effect were − 0.324 [95% CI (-0.442, -0.206)] and − 0.523 [95% CI (-0.606, -0.439)], respectively.The mediating effects of both social support and SESS were statistically significant. The specific indirect effects of OHL on OHRQoL through social support and through SESS were − 0.135 [95% CI (-0.222, -0.052)] and − 0.148 [95% CI (-0.232, -0.069)], accounting for 25.81% and 28.30% of the total effect, respectively. The serial mediation effect of social support and SESS was − 0.041 [95% CI (-0.070, -0.017)], accounting for 7.84% of the total effect. (Details are presented in Table 4 .) Table 4 Tests of Direct and Mediating Effects between OHL and OHRQoL Effect Type Effect Boot SE 95%CI Relative mediation effect (%) LLCI ULCI Direct Effect -0.199 0.064 -0.324 -0.073 38.05 Indirect Effects OHL→Social Support→OHRQoL -0.135 0.044 -0.222 -0.052 25.81 OHL→SESS→OHRQoL -0.148 0.041 -0.232 -0.069 28.30 OHL→Social Support→SESS→OHRQoL -0.041 0.014 -0.070 -0.017 7.84 Total Indirect Effect -0.324 0.060 -0.442 -0.206 61.95 Total Effect -0.523 0.043 -0.606 -0.439 100 Discussion Oral health literacy (OHL), as a significant predictor of Oral Health-Related Quality of Life (OHRQoL), has been demonstrated to be positively associated with OHRQoL. In this study, OHL in MHD patients was found to directly influence their OHRQoL. Within the established serial mediation model, social support and self-efficacy for oral health self-care (SESS) served as serial mediators in the relationship between OHL and OHRQoL. Status of OHL, Social Support, SESS, and OHRQoL in MHD Patients The mean OHIP-14 score for the 402 MHD patients was 12.75 ± 9.73, which exceeded the critical value of 12, aligning with findings from domestic scholar Li Amin [ 35 ]. This indicates a relatively low level of OHRQoL among MHD patients that requires improvement. The impact of oral health issues on the lives of MHD patients primarily manifested in pain and discomfort, with a lesser effect on independent functioning. Factors such as long-term hemodialysis, medication use, and fluid intake restrictions contribute to complications like reduced saliva secretion and xerostomia in most MHD patients [ 36 ]. Saliva reduction and oral dryness accelerate the deterioration of oral health, leading to issues like impaired taste and oral pain/discomfort. Because oral health problems in MHD patients are primarily localized to the oral cavity and have minimal impact on physical independence, this is a significant reason why MHD patients often neglect their oral health. Furthermore, most patients, being overly focused on their kidney disease, tend to overlook oral health, perceiving oral diseases as having little impact on their overall health. Consequently, they often endure oral problems rather than seeking timely medical care, leading to further aggravation of oral conditions. Therefore, there is an urgent need to enhance MHD patients' awareness of oral health importance and improve their self-care consciousness. The OHL level of MHD patients was moderate but lower than that of the general domestic population [ 37 ]. Patients' focus on oral health is often reduced due to long-term suffering from pain, post-dialysis fatigue, and other complications. Coupled with limited access to oral health-related support, this increases feelings of helplessness, resulting in lower oral health literacy. The level of social support among patients was moderate, consistent with previous research. The long-term requirement for hemodialysis treatment imposes significant changes on patients' work, diet, and lifestyle. Combined with complications like post-dialysis fatigue and skin pruritus, patients are prone to negative emotions, reduced social interaction, and limited support resources. Family support constitutes the most crucial source of support for MHD patients during treatment, a finding consistent with multiple studies [ 38 – 40 ]]. The level of self-efficacy for oral health self-care (SESS) among MHD patients was relatively low, lower than results found by Yuan Chenxi et al. [ 41 ] in patients with chronic periodontitis. The reasons may include the substantial economic burden and psychological pressure from long-term disease management. Furthermore, the frequent travel to hospitals for dialysis treatments leaves patients with limited time, often leading them to reduce the frequency and duration of brushing and flossing to save time. Additionally, patients bear high treatment costs due to frequent dialysis and complication management, leading to prevalent financial toxicity [ 42 ]. Concerns over expensive dental care costs deter patients from seeking treatment, resulting in low self-efficacy for dental visits. Thus, there is significant potential for improving SESS among MHD patients. Correlations Among Variables In this study, OHL was positively correlated with OHRQoL, indicating that better abilities in accessing, understanding oral health information, and making appropriate oral health decisions can enhance patients' OHRQoL. Social support was significantly positively correlated with OHRQoL, consistent with the findings of Shan Yan et al [ 18 ]. Higher social support provides patients with more resources, potentially alleviating negative emotions associated with the disease and promoting positive health behaviors, thereby improving OHRQoL. Self-efficacy for oral health self-care was significantly positively correlated with OHRQoL, aligning with several studies [ 43 , 44 ]. As oral healthcare is a long-term process, enhancing self-efficacy can effectively maintain good oral health status and promote the adoption of oral health behaviors [ 45 ], consequently improving patients' OHRQoL. The Mediating Roles of Social Support and Self-Efficacy The results indicate that social support and SESS partially mediated the relationship between OHL and OHRQoL in MHD patients, with indirect effects accounting for 25.81% and 28.30% of the total effect, respectively. This means OHL can directly influence OHRQoL and also exert an indirect influence through social support and SESS. As a potential mediating factor in the Health Literacy Skills framework, social support can motivate behavioral change, facilitate the establishment and maintenance of healthy behaviors, and indirectly promote patients' quality of life [ 46 ]. When patients possess adequate oral health knowledge and skills and receive high levels of social support, they pay more attention to their oral health, better understand the characteristics of oral diseases, actively express their needs for oral treatment, and engage proactively in self-managing their oral health. Higher SESS is associated with better OHRQoL. Previous research also confirms the relationships between OHL, self-efficacy, and quality of life [ 47 , 48 ]. Studies show that changing individual health behaviors relies not only on improved health knowledge; interventions solely targeting health literacy have limited effectiveness in improving health status. Utilizing psychosocial factors like self-efficacy is crucial to motivate individuals to change daily habits for positive health outcomes [ 49 ]. This suggests that healthcare providers should pay close attention to the level of social support received by MHD patients, help them expand their support networks, enhance their ability to utilize support resources, and simultaneously stimulate their SESS to leverage their subjective initiative, thereby improving OHRQoL. The Serial Mediating Effect of Social Support and Self-Efficacy The results demonstrate a significant serial mediating effect of social support and SESS between OHL and OHRQoL in MHD patients, accounting for 7.84% of the total effect. This indicates that OHL can indirectly influence OHRQoL through the sequential pathway of social support and SESS, further validating the Health Literacy Skills framework. Individuals with higher health literacy typically exhibit stronger willingness and capability for health promotion, display positive attitudes in managing external relationships, obtain broader social support, and possess stronger self-efficacy, ultimately leading to improved health outcomes [ 50 ]. Research indicates a significant positive correlation between social support and SESS in MHD patients [ 51 ]. According to the buffering model of social support [ 52 ], social support serves as an external protective factor, helping individuals effectively mitigate negative emotions and helplessness caused by various adverse stimuli, improving their mental health, and consequently enhancing self-efficacy. Patients with higher SESS can better buffer the negative impacts of oral health problems and adopt proactive coping strategies to slow further deterioration of their oral health status. Therefore, healthcare professionals should develop appropriate oral health intervention plans for MHD patients based on scientific and rational principles, enhancing their confidence and ability to maintain and promote oral health, while assisting them in establishing broader social networks to access more support, thereby achieving the goal of improving OHRQoL. Conclusions In summary, this study explored the relationships among OHL, social support, SESS, and OHRQoL in MHD patients and constructed a serial mediation model. The findings revealed a significant direct predictive effect of OHL on OHRQoL, while both social support and SESS significantly negatively predicted OHRQoL scores. Therefore, while focusing on renal disease treatment, clinical healthcare workers should emphasize patients' oral health management. This can be achieved by implementing systematic oral health education to enhance health literacy, assisting in building social support networks including family and community, and employing strategies like goal setting and behavioral encouragement to strengthen self-efficacy, thereby synergistically improving patients' oral health and overall quality of life through multiple pathways. Abbreviations OHL Oral health literacy OHRQoL Oral health-related quality of life MHD Maintenance hemodialysis SESS Self-efficacy scale for self-care HeLD-14 Short form of health literacy dental scale PSSS Perceived social support scale OHIP-14 Oral health impact profile-14 SE Self-efficacy HLS Health Literacy Skills Declarations Ethics approval and consent to participate This study was approved by the ethics committee of The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Grant number: YE202311301). And informed consent was obtained from the participants and their guardians before starting the program. We confirm that all the experiment is in accordance with the relevant guidelines and regulations such as the declaration of Helsinki. Consent for publication Not applicable. Availability of data and materials Due to the privacy of the research participants, the data generated during the current study are not publicly available but are available from the corresponding author upon reasonable request. Competing interests The authors declare that they have no competing interests. Funding Not applicable. Authors' contributions BiXia Yuan 1245, QingHua Lai 1235, XiaoTing Huang 123, JinLi Li 156, YongMei Lu 156, Meng Wu 156, LingYan Yao135, Yun Chen 156, JieQian Wu 156. 1 Conceptualization; 2 Methodology; 3 Data curation; 4 Writing Original Draft; 5 Writing - Review & Editing; 6 Funding acquisition. Acknowledgements The authors are grateful to all the participants in the study. 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Social support and cognitive function in Chinese older adults who experienced depressive symptoms: is there an age difference? Front Aging Neurosci. 2023;15:1175252. 10.3389/fnagi.2023.1175252 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8040368","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":581873431,"identity":"6f910ca4-d391-425b-8780-e6285908a98b","order_by":0,"name":"Bixia Yuan","email":"","orcid":"","institution":"Shenzhen Hospital (Futian) of Guangzhou University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Bixia","middleName":"","lastName":"Yuan","suffix":""},{"id":581873432,"identity":"de760afb-544d-4a1c-9738-6a4a9fbc61ad","order_by":1,"name":"QingHua Lai","email":"","orcid":"","institution":"Shenzhen Hospital (Futian) of Guangzhou University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"QingHua","middleName":"","lastName":"Lai","suffix":""},{"id":581873436,"identity":"d6452584-0981-4785-b259-bdbe6205a95c","order_by":2,"name":"XiaoTing Huang","email":"","orcid":"","institution":"Shenzhen Hospital (Futian) of Guangzhou University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"XiaoTing","middleName":"","lastName":"Huang","suffix":""},{"id":581873438,"identity":"0cbbe3da-4038-4a3d-8280-6559d466a67e","order_by":3,"name":"JinLi Li","email":"","orcid":"","institution":"The Fifth Affiliated Hospital of Guangzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"JinLi","middleName":"","lastName":"Li","suffix":""},{"id":581873440,"identity":"015d56c0-93ec-46a4-91c4-50318e19980d","order_by":4,"name":"YongMei Lu","email":"","orcid":"","institution":"School of Nursing, Guangzhou University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"YongMei","middleName":"","lastName":"Lu","suffix":""},{"id":581873443,"identity":"5f83a4db-0cb3-44d8-8099-f8c24d4509c9","order_by":5,"name":"Meng Wu","email":"","orcid":"","institution":"Shenzhen Hospital (Futian) of Guangzhou University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Meng","middleName":"","lastName":"Wu","suffix":""},{"id":581873444,"identity":"426ea3d3-9a03-410e-9d8e-3b732abae7e2","order_by":6,"name":"LingYan Yao","email":"","orcid":"","institution":"Shenzhen Hospital (Futian) of Guangzhou University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"LingYan","middleName":"","lastName":"Yao","suffix":""},{"id":581873446,"identity":"f02186b9-176d-40d2-a4a4-bdc90f4029f4","order_by":7,"name":"Yun Chen","email":"","orcid":"","institution":"Shenzhen Hospital (Futian) of Guangzhou University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Yun","middleName":"","lastName":"Chen","suffix":""},{"id":581873449,"identity":"c8f3515f-134a-48b9-a874-3d42f1a65a84","order_by":8,"name":"JieQian Wu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAuklEQVRIiWNgGAWjYBACNvbmgw8+VNTIybM3EKmFj+dYsuGMM8eMDXsOEKlFTiJHTZi3hTmx4UYCsQ5jyGFj5m1gM2ac+XjjDYYam2gitJw99nDuDhk5dum0YguGY2m5DQS1MPalG7w9A7Rldo6ZBGPDYSK0MPOYSfC2Af1y8wyxWth4zCTBWm7wEKuFhw0WyEC/JBDjF/n5j2FReXjjjQ81NoS1IAMDiQRSlEO0kKpjFIyCUTAKRgYAAKPnPs78HSlmAAAAAElFTkSuQmCC","orcid":"","institution":"Shenzhen Hospital (Futian) of Guangzhou University of Chinese Medicine","correspondingAuthor":true,"prefix":"","firstName":"JieQian","middleName":"","lastName":"Wu","suffix":""}],"badges":[],"createdAt":"2025-11-05 16:35:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8040368/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8040368/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":101497866,"identity":"339b9d7d-6567-441d-81d3-f916804e1063","added_by":"auto","created_at":"2026-01-30 12:58:22","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":33877,"visible":true,"origin":"","legend":"\u003cp\u003eThe conceptual model\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8040368/v1/bbe4e11bb9526567c1a12650.png"},{"id":101497867,"identity":"903ed26a-f321-41f4-9da7-3bf2a3128ffc","added_by":"auto","created_at":"2026-01-30 12:58:22","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":57360,"visible":true,"origin":"","legend":"\u003cp\u003eThe mediating effect of social support and self-efficacy on OHL and OHRQoL\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-8040368/v1/92cb1e48a96cbd4d60fe0f65.png"},{"id":103905152,"identity":"6b6a62f9-c5fa-40d4-9c48-1bced5da395e","added_by":"auto","created_at":"2026-03-04 10:41:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1951759,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8040368/v1/6846f04f-e75a-4dc7-8b6c-b759843a3365.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Oral Health Literacy and Oral Health-Related Quality of Life in Maintenance Hemodialysis Patients: The Serial Mediation of Social Support and Self-Efficacy","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMaintenance Hemodialysis (MHD) serves as the primary treatment modality for end-stage renal disease, with a progressively growing patient population. By 2021, the number of MHD patients in China had reached 749,000 [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Due to endocrine disturbances, metabolic abnormalities, and immune dysfunction, MHD patients commonly experience severe oral complications such as periodontitis and xerostomia [\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. These conditions not only impair oral function but also exacerbate the micro-inflammatory state, increasing the risk of cardiovascular disease and mortality [\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Furthermore, xerostomia often leads to increased fluid intake, resulting in excessive interdialytic weight gain, which further elevates morbidity and mortality risks [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Additionally, oral halitosis frequently causes social avoidance, and its long-term persistence can adversely affect patients' psychological well-being [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Consequently, oral health issues in MHD patients extend beyond localized pathologies, posing multifaceted threats to physiological function, psychological health, and social adaptability, thereby severely compromising their quality of life [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Given this context, improving the oral health status of MHD patients is of paramount importance for enhancing their overall quality of life.\u003c/p\u003e \u003cp\u003eOral Health-Related Quality of Life (OHRQoL) is a comprehensive measure reflecting the impact of oral conditions on an individual's overall physical and psychological well-being [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. It captures not only patients' subjective perceptions of oral diseases but also reflects the effects of these conditions on physical function and mental health throughout the disease progression [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. A meta-analysis [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] has confirmed that poor oral hygiene is prevalent among MHD patients. Furthermore, a multinational cohort study revealed that dental health status is significantly associated with early mortality in MHD patients, while preventive oral care measures are clearly linked to prolonged survival [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Therefore, investigating the mechanisms influencing OHRQoL in MHD patients holds significant clinical value for improving their oral health quality of life.\u003c/p\u003e \u003cp\u003eHealth literacy, as a multidimensional construct, encompasses an individual's comprehensive capacity to access, comprehend, evaluate, and apply health information [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. As a critical component, Oral Health Literacy (OHL) specifically refers to an individual's ability to obtain, process, and understand the basic health information and services required to make appropriate oral health decisions [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].Research indicates that OHL not only effectively predicts oral health status but also significantly influences health behavior choices, playing a pivotal role in improving OHRQoL [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Accurately assessing the OHL levels of MHD patients can help identify individuals with deficient oral health knowledge and provide a basis for healthcare providers to conduct targeted communication and develop personalized oral health intervention plans, ultimately leading to improved OHRQoL.\u003c/p\u003e \u003cp\u003eSocial support, as a crucial external resource, generally refers to material or psychological assistance provided by family members, social networks, and other channels. For MHD patients, a robust social support system can provide both practical care and psychological comfort, exerting a positive influence on health status and quality of life. Studies have shown a significant positive correlation between the level of social support and the quality of life in young MHD patients [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Although research in other populations generally supports the role of social support as a positive predictor of OHRQoL, it is noteworthy that one study specifically investigating hemodialysis patients found no significant association between the two[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. This discrepancy may stem from sample characteristics or methodological heterogeneity, warranting further investigation.\u003c/p\u003e \u003cp\u003eSelf-efficacy (SE), an important predictor of oral health-related quality of life, can be categorized into general self-efficacy and specific task self-efficacy [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Among these, self-efficacy for oral health self-care, a type of specific task self-efficacy, refers specifically to an individual's confidence in their ability to perform oral health behaviors [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Research indicates [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] that individuals with higher self-efficacy typically demonstrate better adherence to oral health behaviors.\u003c/p\u003e \u003cp\u003eThe Health Literacy Skills (HLS) framework, proposed by American scholar Squiers et al. [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], posits that in addition to directly influencing health outcomes, the pathways through which health literacy exerts its effects may also be moderated by mediating factors such as individual characteristics and the external environment. Consequently, in clinical practice, healthcare providers need to comprehensively consider patients' psychological states and socio-environmental factors to more effectively improve their OHRQoL. Although existing research has explored certain factors influencing OHRQoL in MHD patients, the pathways through which OHL affects OHRQoL remain unclear. Building upon the HLS framework, this study incorporates social support and self-efficacy for oral health self-care as mediating variables, aiming to systematically elucidate the mechanism by which OHL influences OHRQoL, thereby providing a reference for developing scientific oral health intervention strategies for MHD patients. Accordingly, we propose the following hypotheses:(see Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e for details)\u003c/p\u003e \u003cp\u003eH1: Significant correlations exist among oral health literacy, social support, self-efficacy for oral health self-care, and oral health-related quality of life.\u003c/p\u003e \u003cp\u003eH2: Oral health literacy can directly influence the oral health-related quality of life of MHD patients.\u003c/p\u003e \u003cp\u003e H3: Oral health literacy influences oral health-related quality of life through the mediating roles of social support and self-efficacy for oral health self-care.\u003c/p\u003e \u003cp\u003e H4: Social support and self-efficacy for oral health self-care play a serial mediating role in the relationship between oral health literacy and oral health-related quality of life.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Study Participants and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Participants\u003c/h2\u003e \u003cp\u003eA convenience sampling method was employed to recruit MHD patients from three tertiary hospitals in Guangzhou between June 2023 and January 2024.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003e(1) Inclusion Criteria\u003c/strong\u003e \u003cp\u003e① Age\u0026thinsp;\u0026ge;\u0026thinsp;18 years; ② Diagnosed with end-stage renal disease according to the criteria outlined in the \"Guidelines for the Screening, Diagnosis, and Prevention of Chronic Kidney Disease\" [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], receiving regular hemodialysis 2\u0026ndash;3 times per week for \u0026ge;\u0026thinsp;3 months; ③ Clinically stable with clear consciousness; ④ Provided informed consent and voluntarily participated in the study.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003e(2) Exclusion Criteria\u003c/strong\u003e \u003cp\u003e① Patients with comorbid acute/critical conditions such as heart failure or myocardial infarction; ② Patients with a history of psychiatric disorders or intellectual disability; ③ Patients who had undergone kidney transplantation.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003e(3) Elimination Criteria\u003c/strong\u003e \u003cp\u003e① Questionnaires with incomplete responses; ② Questionnaires showing random or patterned responses.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy Instruments\u003c/h3\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eGeneral Information Questionnaire\u003c/h2\u003e \u003cp\u003eSelf-designed based on literature review and the study objectives, including 16 items: gender, age, marital status, education level, place of residence, monthly household income, medical payment method, smoking status, primary disease, duration of hemodialysis, number of comorbid conditions, daily tooth brushing frequency, duration of each brushing, dental visit within the past year, self-rated oral health status, and dental treatment needs.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eShort Form of the Health Literacy in Dentistry Scale (HeLD-14)\u003c/h3\u003e\n\u003cp\u003eThis scale, originally developed by Australian scholar Jones [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], was translated and adapted into Chinese by Chinese scholars Yan et al. [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. It comprises 7 dimensions (Concern, Understanding, Support, Financial Burden, Access, Communication, and Application) across 14 items. Responses are scored on a 5-point Likert scale. The total score ranges from 0 to 56, with higher scores indicating higher levels of oral health literacy. In this study, the scale's Cronbach's α coefficient was 0.836.\u003c/p\u003e\n\u003ch3\u003ePerceived Social Support Scale (PSSS)\u003c/h3\u003e\n\u003cp\u003eTranslated and culturally adapted from Zimet's original scale [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] by Jiang Qianjin et al. [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] for the Chinese context. This scale includes 3 dimensions (Family Support, Friend Support, and Other Support) across 12 items. Responses are scored on a 7-point Likert scale from \"strongly disagree\" (1) to \"strongly agree\" (7), with total scores ranging from 12 to 84. Total scores are categorized into low (12\u0026ndash;36), medium (37\u0026ndash;60), and high (61\u0026ndash;84) support levels. In this study, the scale's Cronbach's α coefficient was 0.893.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eSelf-Efficacy Scale for Self-care (SESS)\u003c/h2\u003e \u003cp\u003eOriginally developed by Kakudate et al. [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] in 2007, the Chinese version was introduced by Wu Di et al. [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] in 2015. This scale includes 3 dimensions (Self-efficacy for Dental Visits, Correct Brushing, and Balanced Diet) across 15 items. Responses are scored on a 5-point Likert scale from \"not confident at all\" (1) to \"very confident\" (5), with total scores ranging from 15 to 75. Scores are categorized into low (\u0026le;\u0026thinsp;53), medium (54\u0026ndash;59), and high (60\u0026ndash;75) self-efficacy levels, with higher scores indicating greater self-efficacy for oral health self-care. In this study, the scale's Cronbach's α coefficient was 0.921.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSample Size Estimation\u003c/h3\u003e\n\u003cp\u003eThe sample size was calculated based on the standard method for studies investigating influencing factors [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], requiring a sample size 10 times the number of independent variables. Accounting for a potential 20% attrition rate, and considering the 27 variables involved (16 general information variables, 7 dimensions from the HeLD-14, 3 dimensions from the PSSS, 3 dimensions from the SESS, and 4 dimensions from the OHIP-14), the minimum required sample size was calculated to be 396 participants.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eData Collection\u003c/h2\u003e \u003cp\u003e The survey was conducted in the hemodialysis centers in accordance with the Declaration of Helsinki. Prior to data collection, the study purpose and procedures were explained to the relevant hospital administrators and the head nurse of the department to obtain their approval. Two trained investigators used a standardized script to distribute the questionnaires. Participants were informed about the study's purpose, significance, and the confidentiality of their responses, and provided informed consent. They were also advised of their right to withdraw from the study at any time. Questionnaires were administered prior to hemodialysis sessions without interfering with treatment. Participants completed the questionnaires independently. For those unable to self-complete, the investigators read the items aloud and recorded the responses verbatim. The survey took approximately 15\u0026ndash;20 minutes to complete. Upon collection, questionnaires were immediately checked for completeness, and participants were asked to fill in any missing items promptly. This study was approved by the Hospital Ethics Committee (Approval No.: YE202311301).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eAll statistical analyses were performed using IBM SPSS Statistics 27.0 and the SPSS macro PROCESS v4.2. General demographic and clinical variables were described using means and standard deviations (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD) or frequencies (%). Pearson correlation analysis was employed to examine the relationships among OHL, perceived social support, self-efficacy for oral health self-care (SESS), and OHRQoL. Linear regression models were used to assess the predictive effects of OHL, perceived social support, and SESS on OHRQoL. The serial mediation model (Model 6) of the PROCESS macro v4.2 was used to test the significance of the mediating roles of social support and SESS in the relationship between OHL and OHRQoL in MHD patients. The bias-corrected percentile Bootstrap method (5000 samples, 95% CI) was applied to evaluate the total, direct, and indirect effects of the model. An indirect effect was considered statistically significant if its 95% confidence interval did not include zero.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eCommon Method Bias Test\u003c/h2\u003e \u003cp\u003eAs a self-designed questionnaire was used in this study, potential common method bias was assessed using Harman's single-factor test. An exploratory factor analysis including all study variables yielded 10 factors with eigenvalues greater than 1. The first factor accounted for 38.37% of the variance (\u0026lt;\u0026thinsp;40%), indicating no significant common method bias or multicollinearity.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eDemographic Characteristics of MHD Patients and Differences in Study Variables\u003c/h2\u003e \u003cp\u003eA total of 402 valid questionnaires were collected (response rate 96.6%). Among the participants, 60% (n\u0026thinsp;=\u0026thinsp;241) were male and 40% (n\u0026thinsp;=\u0026thinsp;161) were female; 40.6% were over 60 years old; 77.9% were married; 38.1% had a junior high school education level; 77.4% resided in urban areas; 40.8% had a monthly household income per capita exceeding \u0026yen;5,000; and 53.7% were enrolled in employee medical insurance. The primary renal diseases were chronic glomerulonephritis (36.1%) and diabetes (31.6%); 41.5% had been on hemodialysis for 1\u0026ndash;3 years; and 77.6% had 1\u0026ndash;3 comorbid conditions. Regarding oral health and behaviors: 44.8% brushed their teeth once daily, while 10.4% never or rarely brushed; 62.9% brushed for less than 3 minutes each time; 44.0% self-rated their oral health as fair; 54.0% reported a need for dental treatment, yet only 25.6% had visited a dentist within the past year. Details are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Study Variables across Different Characteristics of MHD Patients [n\u0026thinsp;=\u0026thinsp;402, (x̄\u0026plusmn;s)]\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"13\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003en(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eOHRQoL\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eOHL\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003eSocial Support\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e \u003cp\u003eSelf-Efficacy\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003e241(60.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e13.11\u0026thinsp;\u0026plusmn;\u0026thinsp;9.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e44.94\u0026thinsp;\u0026plusmn;\u0026thinsp;12.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e49.91\u0026thinsp;\u0026plusmn;\u0026thinsp;14.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e47.91\u0026thinsp;\u0026plusmn;\u0026thinsp;11.36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003e161(40.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e12.20\u0026thinsp;\u0026plusmn;\u0026thinsp;9.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e44.52\u0026thinsp;\u0026plusmn;\u0026thinsp;12.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e51.14\u0026thinsp;\u0026plusmn;\u0026thinsp;13.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e49.15\u0026thinsp;\u0026plusmn;\u0026thinsp;11.12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003et-value\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.911\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.331\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-0.860\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e-1.078\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u0026thinsp;~\u0026thinsp;45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003e68(16.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e12.13\u0026thinsp;\u0026plusmn;\u0026thinsp;9.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e49.28\u0026thinsp;\u0026plusmn;\u0026thinsp;13.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e50.76\u0026thinsp;\u0026plusmn;\u0026thinsp;13.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e50.07\u0026thinsp;\u0026plusmn;\u0026thinsp;13.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e46\u0026thinsp;~\u0026thinsp;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003e149(37.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e11.42\u0026thinsp;\u0026plusmn;\u0026thinsp;9.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e47.79\u0026thinsp;\u0026plusmn;\u0026thinsp;12.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e52.63\u0026thinsp;\u0026plusmn;\u0026thinsp;14.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e50.17\u0026thinsp;\u0026plusmn;\u0026thinsp;10.93\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003e185(46.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e14.04\u0026thinsp;\u0026plusmn;\u0026thinsp;9.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e40.69\u0026thinsp;\u0026plusmn;\u0026thinsp;10.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e48.48\u0026thinsp;\u0026plusmn;\u0026thinsp;13.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e46.38\u0026thinsp;\u0026plusmn;\u0026thinsp;10.28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eF-value\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e3.717*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e21.044***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e3.676*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e5.694**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnmarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003e24(6.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e10.67\u0026thinsp;\u0026plusmn;\u0026thinsp;9.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e50.88\u0026thinsp;\u0026plusmn;\u0026thinsp;12.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e51.50\u0026thinsp;\u0026plusmn;\u0026thinsp;12.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e49.33\u0026thinsp;\u0026plusmn;\u0026thinsp;11.58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003e313(77.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e12.93\u0026thinsp;\u0026plusmn;\u0026thinsp;9.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e45.11\u0026thinsp;\u0026plusmn;\u0026thinsp;11.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e50.99\u0026thinsp;\u0026plusmn;\u0026thinsp;13.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e48.45\u0026thinsp;\u0026plusmn;\u0026thinsp;11.23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDivorced/Widowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003e65(16.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e12.63\u0026thinsp;\u0026plusmn;\u0026thinsp;10.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e40.89\u0026thinsp;\u0026plusmn;\u0026thinsp;13.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e47.20\u0026thinsp;\u0026plusmn;\u0026thinsp;16.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e47.88\u0026thinsp;\u0026plusmn;\u0026thinsp;11.49\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eF-value\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.607\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e6.439**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e2.044\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.154\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation Level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary or below\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003e126(31.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e14.96\u0026thinsp;\u0026plusmn;\u0026thinsp;10.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e38.38\u0026thinsp;\u0026plusmn;\u0026thinsp;10.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e46.18\u0026thinsp;\u0026plusmn;\u0026thinsp;13.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e45.32\u0026thinsp;\u0026plusmn;\u0026thinsp;10.90\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJunior high school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003e153(38.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e12.98\u0026thinsp;\u0026plusmn;\u0026thinsp;8.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e44.69\u0026thinsp;\u0026plusmn;\u0026thinsp;11.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e49.33\u0026thinsp;\u0026plusmn;\u0026thinsp;13.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e48.37\u0026thinsp;\u0026plusmn;\u0026thinsp;10.56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSenior high school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003e72(17.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e11.17\u0026thinsp;\u0026plusmn;\u0026thinsp;9.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e49.13\u0026thinsp;\u0026plusmn;\u0026thinsp;11.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e54.33\u0026thinsp;\u0026plusmn;\u0026thinsp;12.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e50.07\u0026thinsp;\u0026plusmn;\u0026thinsp;11.83\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJunior college\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003e23(5.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e10.61\u0026thinsp;\u0026plusmn;\u0026thinsp;9.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e52.09\u0026thinsp;\u0026plusmn;\u0026thinsp;11.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e57.22\u0026thinsp;\u0026plusmn;\u0026thinsp;14.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e52.13\u0026thinsp;\u0026plusmn;\u0026thinsp;11.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBachelor's or above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003e28(7.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e7.32\u0026thinsp;\u0026plusmn;\u0026thinsp;5.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e56.79\u0026thinsp;\u0026plusmn;\u0026thinsp;11.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e59.57\u0026thinsp;\u0026plusmn;\u0026thinsp;9.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e55.18\u0026thinsp;\u0026plusmn;\u0026thinsp;10.82\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eF-value\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e4.751***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e23.754***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e9.560***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e6.227***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eResidence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003e91(22.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e12.11\u0026thinsp;\u0026plusmn;\u0026thinsp;9.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e40.37\u0026thinsp;\u0026plusmn;\u0026thinsp;12.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e46.60\u0026thinsp;\u0026plusmn;\u0026thinsp;13.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e44.98\u0026thinsp;\u0026plusmn;\u0026thinsp;10.98\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003e151(37.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e13.11\u0026thinsp;\u0026plusmn;\u0026thinsp;9.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e43.91\u0026thinsp;\u0026plusmn;\u0026thinsp;10.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e49.82\u0026thinsp;\u0026plusmn;\u0026thinsp;12.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e47.90\u0026thinsp;\u0026plusmn;\u0026thinsp;10.36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003e160(39.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e12.77\u0026thinsp;\u0026plusmn;\u0026thinsp;10.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e48.08\u0026thinsp;\u0026plusmn;\u0026thinsp;12.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e53.12\u0026thinsp;\u0026plusmn;\u0026thinsp;15.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e50.84\u0026thinsp;\u0026plusmn;\u0026thinsp;11.73\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003et-value\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.297\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e12.596***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e6.627**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e8.390***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMonthly Household Income (CNY)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003e16(4.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e19.13\u0026thinsp;\u0026plusmn;\u0026thinsp;10.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e35.06\u0026thinsp;\u0026plusmn;\u0026thinsp;13.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e39.25\u0026thinsp;\u0026plusmn;\u0026thinsp;12.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e40.69\u0026thinsp;\u0026plusmn;\u0026thinsp;12.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1000\u0026thinsp;~\u0026thinsp;3000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003e101(25.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e14.50\u0026thinsp;\u0026plusmn;\u0026thinsp;9.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e40.66\u0026thinsp;\u0026plusmn;\u0026thinsp;10.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e48.20\u0026thinsp;\u0026plusmn;\u0026thinsp;14.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e45.45\u0026thinsp;\u0026plusmn;\u0026thinsp;9.63\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3000\u0026thinsp;~\u0026thinsp;5000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003e121(30.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e11.79\u0026thinsp;\u0026plusmn;\u0026thinsp;9.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e44.64\u0026thinsp;\u0026plusmn;\u0026thinsp;11.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e50.97\u0026thinsp;\u0026plusmn;\u0026thinsp;13.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e48.98\u0026thinsp;\u0026plusmn;\u0026thinsp;11.57\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;5000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003e164(40.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e11.74\u0026thinsp;\u0026plusmn;\u0026thinsp;9.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e48.34\u0026thinsp;\u0026plusmn;\u0026thinsp;12.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e52.44\u0026thinsp;\u0026plusmn;\u0026thinsp;13.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e50.56\u0026thinsp;\u0026plusmn;\u0026thinsp;11.21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eF-value\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e4.500**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e12.632***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e5.590***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e7.260***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMedical Payment Method\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c9\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-pay\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003e6(1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e8.17\u0026thinsp;\u0026plusmn;\u0026thinsp;9.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e39.33\u0026thinsp;\u0026plusmn;\u0026thinsp;16.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e46.67\u0026thinsp;\u0026plusmn;\u0026thinsp;18.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e42.83\u0026thinsp;\u0026plusmn;\u0026thinsp;15.74\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployee medical insurance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003e216(53.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e12.72\u0026thinsp;\u0026plusmn;\u0026thinsp;9.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e47.45\u0026thinsp;\u0026plusmn;\u0026thinsp;12.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e52.18\u0026thinsp;\u0026plusmn;\u0026thinsp;13.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e50.27\u0026thinsp;\u0026plusmn;\u0026thinsp;11.93\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResident health insurance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003e180(44.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e12.93\u0026thinsp;\u0026plusmn;\u0026thinsp;9.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e41.74\u0026thinsp;\u0026plusmn;\u0026thinsp;10.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e48.41\u0026thinsp;\u0026plusmn;\u0026thinsp;13.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e46.36\u0026thinsp;\u0026plusmn;\u0026thinsp;9.86\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eF-value\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.697\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e11.704***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e3.804*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e6.845**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSmoking Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003e112(27.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e13.28\u0026thinsp;\u0026plusmn;\u0026thinsp;9.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e44.13\u0026thinsp;\u0026plusmn;\u0026thinsp;12.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e49.70\u0026thinsp;\u0026plusmn;\u0026thinsp;14.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e48.39\u0026thinsp;\u0026plusmn;\u0026thinsp;11.35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003e289(72.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e11.36\u0026thinsp;\u0026plusmn;\u0026thinsp;9.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e46.42\u0026thinsp;\u0026plusmn;\u0026thinsp;11.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e52.22\u0026thinsp;\u0026plusmn;\u0026thinsp;14.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e48.46\u0026thinsp;\u0026plusmn;\u0026thinsp;11.10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003et-value\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.783\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-1.669\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-1.615\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e-0.052\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePrimary Disease\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronic Glomerulonephritis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003e145(36.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e11.14\u0026thinsp;\u0026plusmn;\u0026thinsp;9.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e45.73\u0026thinsp;\u0026plusmn;\u0026thinsp;13.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e50.97\u0026thinsp;\u0026plusmn;\u0026thinsp;14.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e50.85\u0026thinsp;\u0026plusmn;\u0026thinsp;11.83\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003e127(31.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e14.87\u0026thinsp;\u0026plusmn;\u0026thinsp;9.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e41.52\u0026thinsp;\u0026plusmn;\u0026thinsp;11.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e47.08\u0026thinsp;\u0026plusmn;\u0026thinsp;13.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e44.56\u0026thinsp;\u0026plusmn;\u0026thinsp;10.70\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003e98(24.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e13.74\u0026thinsp;\u0026plusmn;\u0026thinsp;9.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e45.50\u0026thinsp;\u0026plusmn;\u0026thinsp;11.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e52.09\u0026thinsp;\u0026plusmn;\u0026thinsp;13.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e49.19\u0026thinsp;\u0026plusmn;\u0026thinsp;9.64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003e32(8.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e8.56\u0026thinsp;\u0026plusmn;\u0026thinsp;9.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e51.09\u0026thinsp;\u0026plusmn;\u0026thinsp;13.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e55.91\u0026thinsp;\u0026plusmn;\u0026thinsp;13.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e50.22\u0026thinsp;\u0026plusmn;\u0026thinsp;11.88\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eF-value\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e5.849***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e6.398***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e4.682**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e8.047***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHemodialysis Vintage (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c9\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003e103(25.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e11.18\u0026thinsp;\u0026plusmn;\u0026thinsp;9.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e45.79\u0026thinsp;\u0026plusmn;\u0026thinsp;12.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e50.83\u0026thinsp;\u0026plusmn;\u0026thinsp;13.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e49.30\u0026thinsp;\u0026plusmn;\u0026thinsp;11.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026thinsp;~\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003e167(41.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e13.51\u0026thinsp;\u0026plusmn;\u0026thinsp;9.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e43.88\u0026thinsp;\u0026plusmn;\u0026thinsp;12.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e48.68\u0026thinsp;\u0026plusmn;\u0026thinsp;13.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e47.21\u0026thinsp;\u0026plusmn;\u0026thinsp;11.48\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u0026thinsp;~\u0026thinsp;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003e113(28.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e13.12\u0026thinsp;\u0026plusmn;\u0026thinsp;10.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e45.04\u0026thinsp;\u0026plusmn;\u0026thinsp;11.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e51.93\u0026thinsp;\u0026plusmn;\u0026thinsp;14.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e49.13\u0026thinsp;\u0026plusmn;\u0026thinsp;11.21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003e19(4.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e12.26\u0026thinsp;\u0026plusmn;\u0026thinsp;11.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e45.53\u0026thinsp;\u0026plusmn;\u0026thinsp;14.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e54.16\u0026thinsp;\u0026plusmn;\u0026thinsp;14.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e49.79\u0026thinsp;\u0026plusmn;\u0026thinsp;10.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eF-value\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.304\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.562\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1.774\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e1.098\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of Comorbidities\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c9\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003e312(77.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e11.29\u0026thinsp;\u0026plusmn;\u0026thinsp;9.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e45.90\u0026thinsp;\u0026plusmn;\u0026thinsp;11.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e52.38\u0026thinsp;\u0026plusmn;\u0026thinsp;13.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e49.79\u0026thinsp;\u0026plusmn;\u0026thinsp;10.44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003e90(22.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e17.81\u0026thinsp;\u0026plusmn;\u0026thinsp;9.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e40.87\u0026thinsp;\u0026plusmn;\u0026thinsp;12.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e43.56\u0026thinsp;\u0026plusmn;\u0026thinsp;13.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e43.62\u0026thinsp;\u0026plusmn;\u0026thinsp;12.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003et-value\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e5.830***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e3.455***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e5.434***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e4.693***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDaily Tooth Brushing Frequency\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever/Occasionally\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003e42(10.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e16.79\u0026thinsp;\u0026plusmn;\u0026thinsp;11.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e33.98\u0026thinsp;\u0026plusmn;\u0026thinsp;9.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e40.29\u0026thinsp;\u0026plusmn;\u0026thinsp;11.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e38.10\u0026thinsp;\u0026plusmn;\u0026thinsp;8.26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOnce\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003e180(44.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e14.07\u0026thinsp;\u0026plusmn;\u0026thinsp;9.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e41.75\u0026thinsp;\u0026plusmn;\u0026thinsp;10.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e49.06\u0026thinsp;\u0026plusmn;\u0026thinsp;13.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e45.86\u0026thinsp;\u0026plusmn;\u0026thinsp;9.69\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026nbsp;Twice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003e180(44.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e10.48\u0026thinsp;\u0026plusmn;\u0026thinsp;9.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e50.31\u0026thinsp;\u0026plusmn;\u0026thinsp;12.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e54.12\u0026thinsp;\u0026plusmn;\u0026thinsp;14.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e53.37\u0026thinsp;\u0026plusmn;\u0026thinsp;10.89\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eF-value\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e10.670***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e49.151***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e19.687***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e49.186***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBrushing Duration per Session\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;3min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003e253(62.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e14.18\u0026thinsp;\u0026plusmn;\u0026thinsp;10.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e41.40\u0026thinsp;\u0026plusmn;\u0026thinsp;11.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e46.85\u0026thinsp;\u0026plusmn;\u0026thinsp;13.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e45.57\u0026thinsp;\u0026plusmn;\u0026thinsp;11.12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;3min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003e149(37.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e10.31\u0026thinsp;\u0026plusmn;\u0026thinsp;8.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e50.50\u0026thinsp;\u0026plusmn;\u0026thinsp;11.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e56.45\u0026thinsp;\u0026plusmn;\u0026thinsp;13.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e53.23\u0026thinsp;\u0026plusmn;\u0026thinsp;9.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003et-value\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e3.922***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-7.635***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-7.006***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e-6.973***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDental Visit in Past Year\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c9\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003e103(25.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e15.53\u0026thinsp;\u0026plusmn;\u0026thinsp;9.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e47.21\u0026thinsp;\u0026plusmn;\u0026thinsp;11.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e51.92\u0026thinsp;\u0026plusmn;\u0026thinsp;14.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e49.35\u0026thinsp;\u0026plusmn;\u0026thinsp;11.97\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003e299(74.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e11.79\u0026thinsp;\u0026plusmn;\u0026thinsp;9.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e43.93\u0026thinsp;\u0026plusmn;\u0026thinsp;12.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e49.88\u0026thinsp;\u0026plusmn;\u0026thinsp;13.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e48.08\u0026thinsp;\u0026plusmn;\u0026thinsp;11.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003et-value\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e3.415***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e2.343*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1.272\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.984\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSelf-rated Oral Health\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c9\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVery poor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003e19(4.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e20.89\u0026thinsp;\u0026plusmn;\u0026thinsp;11.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e43.47\u0026thinsp;\u0026plusmn;\u0026thinsp;11.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e50.00\u0026thinsp;\u0026plusmn;\u0026thinsp;12.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e45.26\u0026thinsp;\u0026plusmn;\u0026thinsp;11.54\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003epoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003e125(31.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e18.11\u0026thinsp;\u0026plusmn;\u0026thinsp;9.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e38.60\u0026thinsp;\u0026plusmn;\u0026thinsp;11.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e43.24\u0026thinsp;\u0026plusmn;\u0026thinsp;13.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e42.38\u0026thinsp;\u0026plusmn;\u0026thinsp;10.91\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFair\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003e177(44.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e10.59\u0026thinsp;\u0026plusmn;\u0026thinsp;7.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e45.50\u0026thinsp;\u0026plusmn;\u0026thinsp;11.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e51.80\u0026thinsp;\u0026plusmn;\u0026thinsp;13.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e49.64\u0026thinsp;\u0026plusmn;\u0026thinsp;9.96\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003e74(18.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e7.68\u0026thinsp;\u0026plusmn;\u0026thinsp;7.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e52.27\u0026thinsp;\u0026plusmn;\u0026thinsp;9.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e58.49\u0026thinsp;\u0026plusmn;\u0026thinsp;11.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e55.24\u0026thinsp;\u0026plusmn;\u0026thinsp;8.88\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVery good\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003e7(1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e3.00\u0026thinsp;\u0026plusmn;\u0026thinsp;5.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e60.86\u0026thinsp;\u0026plusmn;\u0026thinsp;13.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e58.71\u0026thinsp;\u0026plusmn;\u0026thinsp;18.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e61.14\u0026thinsp;\u0026plusmn;\u0026thinsp;12.48\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eF-value\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e27.555***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e21.485***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e17.882***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e23.029***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePerceived Need for Dental Treatment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003e217(54.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e15.11\u0026thinsp;\u0026plusmn;\u0026thinsp;10.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e43.36\u0026thinsp;\u0026plusmn;\u0026thinsp;11.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e48.68\u0026thinsp;\u0026plusmn;\u0026thinsp;13.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e47.44\u0026thinsp;\u0026plusmn;\u0026thinsp;11.28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003e184(46.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e9.97\u0026thinsp;\u0026plusmn;\u0026thinsp;8.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e46.42\u0026thinsp;\u0026plusmn;\u0026thinsp;12.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e52.43\u0026thinsp;\u0026plusmn;\u0026thinsp;14.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e49.54\u0026thinsp;\u0026plusmn;\u0026thinsp;11.17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003et-value\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e5.558***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-2.493*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-2.692**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e-1.867\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"13\"\u003eNote: OHRQoL\u0026thinsp;=\u0026thinsp;Oral Health-Related Quality of Life; * p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, ** p\u0026thinsp;\u0026lt;\u0026thinsp;0.01, *** p\u0026thinsp;\u0026lt;\u0026thinsp;0.001.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eScores of Study Variables\u003c/h2\u003e \u003cp\u003eThe mean score for Oral Health-Related Quality of Life (OHRQoL) among MHD patients was 12.75\u0026thinsp;\u0026plusmn;\u0026thinsp;9.73. The mean score for Oral Health Literacy (OHL) was 44.77\u0026thinsp;\u0026plusmn;\u0026thinsp;12.34. The mean score for Social Support was 50.41\u0026thinsp;\u0026plusmn;\u0026thinsp;14.05. The mean score for Self-Efficacy for Self-Care (SESS) was 48.41\u0026thinsp;\u0026plusmn;\u0026thinsp;11.27. Scores for OHL, social support, SESS, and OHRQoL demonstrated statistically significant differences (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) across most demographic and study-related variables. Details are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eCorrelational Analysis Among Variables\u003c/h2\u003e \u003cp\u003eResults of the Pearson correlation analysis revealed that OHL was positively correlated with social support (r\u0026thinsp;=\u0026thinsp;0.649, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and with SESS (r\u0026thinsp;=\u0026thinsp;0.731, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) in MHD patients. OHL was negatively correlated with OHRQoL (r = -0.523, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Social support was positively correlated with SESS (r\u0026thinsp;=\u0026thinsp;0.616, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and negatively correlated with OHRQoL (r = -0.496, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). SESS was negatively correlated with OHRQoL (r = -0.532, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Details are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation Analysis of OHL, Social Support, Self-Efficacy for Self-Care, and OHRQoL in MHD Patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOHL\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSocial Support\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSelf-Efficacy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eOHRQoL\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOHL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.336\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial Support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.048\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.649***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-Efficacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.265\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.731***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.616***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOHRQoL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.746\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.7318\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.523***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.496***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.532***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003cb\u003eNote\u003c/b\u003e: *** p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eMultiple Linear Regression Analysis of Factors Influencing OHRQoL in MHD Patients\u003c/h2\u003e \u003cp\u003eVariables that showed statistical significance in the univariate analysis were included in the model. Using education level, monthly household income per capita, primary disease, number of comorbidities, daily tooth brushing frequency, brushing duration per session, dental visit frequency within the past year, self-rated oral health status, and perceived need for dental treatment as control variables, and Oral Health Literacy (OHL), social support, and Self-Efficacy for Self-care (SESS) as independent variables, a multiple stepwise linear regression analysis was performed with the total OHIP-14 score as the dependent variable. The aim was to investigate the predictive effects of these variables on OHRQoL in MHD patients (details in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe results of Model I indicated that education level (β = -0.948, P\u0026thinsp;=\u0026thinsp;0.028), number of comorbidities (β\u0026thinsp;=\u0026thinsp;4.948, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), daily tooth brushing frequency (β = -1.538, P\u0026thinsp;=\u0026thinsp;0.027), dental visit frequency within the past year (β\u0026thinsp;=\u0026thinsp;2.326, P\u0026thinsp;=\u0026thinsp;0.017), self-rated oral health status (β = -3.625, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and perceived need for dental treatment (β\u0026thinsp;=\u0026thinsp;2.942, P\u0026thinsp;=\u0026thinsp;0.001) were significant predictors of the OHRQoL score.In Model II, OHL (β = -0.361, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) significantly and negatively predicted the OHIP-14 score; thus, H1 was supported.Building upon Model II, in Model III, social support had a significant negative impact on the OHIP-14 score (β = -0.130, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).In Model IV, when OHL, social support, and SESS were simultaneously entered into the regression equation, the predictive effect of social support on OHRQoL remained significant. SESS (β = -0.177, P\u0026thinsp;=\u0026thinsp;0.001) also significantly and negatively predicted the OHIP-14 score. However, the negative predictive effect of OHL on the OHIP-14 score remained significant (β = -0.189, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), indicating that social support and SESS partially mediated the relationship between OHL and OHRQoL.Furthermore, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, compared to the first three models, Model IV had the largest Adjusted R\u0026sup2;, indicating that OHL, social support, and SESS together provided greater explanatory power for OHRQoL.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultiple Linear Regression Analysis of Factors Influencing OHRQoL in MHD Patients (n\u0026thinsp;=\u0026thinsp;402)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eβ\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eSD\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e95%CI (LL, UL)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModel I\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eConstant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.362\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.418\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6.835\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e16.643,30.082\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.574\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.628\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.913\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.362\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-1.809,0.661\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eEducation Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.948\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.429\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-2.207\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-1.792,-0.104\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMonthly Household Income\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.623\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.512\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-1.216\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-1.630,0.384\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePrimary Disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.446\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.981\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.887,0.866\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eNumber of Comorbidities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.948\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.034\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.787\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.916,6.980\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDaily Tooth Brushing Frequency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e-1.538\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.691\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-2.226\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-2.897,-0.180\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eBrushing Duration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.201\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.955\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.210\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.834\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-1.677,2.079\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eDental Visit Frequency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.326\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.973\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.390\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.413,4.240\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eSelf-rated Oral Health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-3.625\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.538\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-6.742\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-4.682,-2.568\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePerceived Need for Dental Treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e2.942\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.905\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.252\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.163,4.721\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003eR\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.309\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eAdjusted \u003cem\u003eR\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.291\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003eF-value\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17.481***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModel II\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eConstant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29.575\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.183\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9.290\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e23.316,35.834\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1.219\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.576\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-2.117\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.035\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-2.351,-0.087\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eEducation Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.144\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.400\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.359\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.720\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.931,0.644\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMonthly Household Income\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.059\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.470\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.900\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.983,0.865\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePrimary Disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.361\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.408\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.885\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.377\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.441,1.162\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eNumber of Comorbidities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.946\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.947\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.168\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.084,5.807\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eDaily Tooth Brushing Frequency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.334\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.662\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.505\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.614\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.966,1.635\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eBrushing Duration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.986\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.873\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.129\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.259\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.731,2.703\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eDental Visit Frequency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.448\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.894\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.857\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.690,5.205\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eSelf-rated Oral Health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-2.595\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.502\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-5.168\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-3.582,-1.608\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePerceived Need for Dental Treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.487\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.825\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.866,4.108\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eOHL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.361\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.040\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-9.084\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.439,-0.283\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003eR\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.430\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eAdjusted \u003cem\u003eR\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.414\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003eF-value\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e26.708***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModel III\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eConstant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31.272\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.170\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9.865\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e25.039,37.504\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.859\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.576\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-1.492\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.137\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-1.991,0.273\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eEducation Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.054\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.395\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.137\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.891\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.831,0.723\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMonthly Household Income\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.151\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.464\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.326\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.745\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-1.062,0.761\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePrimary Disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.407\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.402\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.311\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.382,1.197\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eNumber of Comorbidities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.362\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.946\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.554\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.502,5.223\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eDaily Tooth Brushing Frequency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.348\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.652\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.534\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.593\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.933,1.629\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eBrushing Duration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.294\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.864\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.497\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.405,2.993\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eDental Visit Frequency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.532\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.881\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.801,5.264\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eSelf-rated Oral Health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-2.416\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.497\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-4.862\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-3.393,-1.439\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePerceived Need for Dental Treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.293\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.814\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.817\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.693,3.893\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eOHL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.274\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.046\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-5.977\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.365,-0.184\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eSocial Support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.130\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.036\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-3.620\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.201,-0.060\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003eR\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.448\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eAdjusted \u003cem\u003eR\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.431\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003eF-value\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e26.334***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModel IV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eConstant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.236\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10.428\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e26.970,39.503\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.748\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.570\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-1.313\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.190\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-1.867,0.372\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eEducation Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.213\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.393\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.543\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.588\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.987,0.560\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMonthly Household Income\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.458\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.327\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.743\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-1.050,0.750\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePrimary Disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.232\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.400\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.579\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.563\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.555,1.018\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eNumber of Comorbidities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.036\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.940\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.231\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.188,4.884\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eDaily Tooth Brushing Frequency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.752\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.655\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.148\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.252\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.536,2.040\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eBrushing Duration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.392\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.854\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.630\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.287,3.071\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eDental Visit Frequency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.434\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.870\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.946\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.723,5.145\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eSelf-rated Oral Health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-2.142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.498\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-4.303\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-3.121,-1.163\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePerceived Need for Dental Treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.566\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.808\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.176\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.978,4.155\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eOHL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.189\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.052\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-3.632\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.292,-0.087\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eSocial Support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.037\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-2.782\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.174,-0.030\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eSelf-Efficacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.172\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.052\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-3.286\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.275,-0.069\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003eR\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.463\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eAdjusted \u003cem\u003eR\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.445\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003eF-value\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25.751***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003cb\u003eNote\u003c/b\u003e: *** p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eValidation Analysis of the Mediation Model\u003c/h2\u003e \u003cp\u003eA serial mediation analysis was conducted using the SPSS PROCESS macro (Model 6), with MHD patients' Oral Health Literacy (OHL) as the independent variable, Oral Health-Related Quality of Life (OHRQoL) as the dependent variable, and social support and Self-Efficacy for Self-care (SESS) as the mediating variables.\u003c/p\u003e \u003cp\u003eAs illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, the direct predictive effect of OHL on OHRQoL was significant (β = -0.199, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Both social support (β = -0.208, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and SESS (β = -0.259, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01) demonstrated significant negative predictive effects on the OHRQoL score, consistent with the results of the multiple linear regression analysis.\u003c/p\u003e \u003cp\u003eThe Bootstrap method was employed to test the mediation effects. The results indicated a direct effect of OHL on OHRQoL of -0.199 [95% CI (-0.324, -0.073)]. The total indirect effect and the total effect were \u0026minus;\u0026thinsp;0.324 [95% CI (-0.442, -0.206)] and \u0026minus;\u0026thinsp;0.523 [95% CI (-0.606, -0.439)], respectively.The mediating effects of both social support and SESS were statistically significant. The specific indirect effects of OHL on OHRQoL through social support and through SESS were \u0026minus;\u0026thinsp;0.135 [95% CI (-0.222, -0.052)] and \u0026minus;\u0026thinsp;0.148 [95% CI (-0.232, -0.069)], accounting for 25.81% and 28.30% of the total effect, respectively. The serial mediation effect of social support and SESS was \u0026minus;\u0026thinsp;0.041 [95% CI (-0.070, -0.017)], accounting for 7.84% of the total effect. (Details are presented in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.)\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTests of Direct and Mediating Effects between OHL and OHRQoL\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e \u003cp\u003eEffect Type\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEffect\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBoot \u003cem\u003eSE\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u003cem\u003e95%CI\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRelative mediation\u003c/p\u003e \u003cp\u003eeffect (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLLCI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eULCI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDirect Effect\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.199\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.064\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.324\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.073\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e38.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eIndirect Effects\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOHL\u0026rarr;Social Support\u0026rarr;OHRQoL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.044\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.222\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.052\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e25.81\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOHL\u0026rarr;SESS\u0026rarr;OHRQoL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.148\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.041\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.232\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.069\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e28.30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOHL\u0026rarr;Social Support\u0026rarr;SESS\u0026rarr;OHRQoL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.041\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.070\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7.84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal Indirect Effect\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.324\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.060\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.442\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.206\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e61.95\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal Effect\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.523\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.043\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.606\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.439\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eOral health literacy (OHL), as a significant predictor of Oral Health-Related Quality of Life (OHRQoL), has been demonstrated to be positively associated with OHRQoL. In this study, OHL in MHD patients was found to directly influence their OHRQoL. Within the established serial mediation model, social support and self-efficacy for oral health self-care (SESS) served as serial mediators in the relationship between OHL and OHRQoL.\u003c/p\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eStatus of OHL, Social Support, SESS, and OHRQoL in MHD Patients\u003c/h2\u003e \u003cp\u003eThe mean OHIP-14 score for the 402 MHD patients was 12.75\u0026thinsp;\u0026plusmn;\u0026thinsp;9.73, which exceeded the critical value of 12, aligning with findings from domestic scholar Li Amin [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. This indicates a relatively low level of OHRQoL among MHD patients that requires improvement. The impact of oral health issues on the lives of MHD patients primarily manifested in pain and discomfort, with a lesser effect on independent functioning. Factors such as long-term hemodialysis, medication use, and fluid intake restrictions contribute to complications like reduced saliva secretion and xerostomia in most MHD patients [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Saliva reduction and oral dryness accelerate the deterioration of oral health, leading to issues like impaired taste and oral pain/discomfort. Because oral health problems in MHD patients are primarily localized to the oral cavity and have minimal impact on physical independence, this is a significant reason why MHD patients often neglect their oral health. Furthermore, most patients, being overly focused on their kidney disease, tend to overlook oral health, perceiving oral diseases as having little impact on their overall health. Consequently, they often endure oral problems rather than seeking timely medical care, leading to further aggravation of oral conditions. Therefore, there is an urgent need to enhance MHD patients' awareness of oral health importance and improve their self-care consciousness.\u003c/p\u003e \u003cp\u003eThe OHL level of MHD patients was moderate but lower than that of the general domestic population [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Patients' focus on oral health is often reduced due to long-term suffering from pain, post-dialysis fatigue, and other complications. Coupled with limited access to oral health-related support, this increases feelings of helplessness, resulting in lower oral health literacy. The level of social support among patients was moderate, consistent with previous research. The long-term requirement for hemodialysis treatment imposes significant changes on patients' work, diet, and lifestyle. Combined with complications like post-dialysis fatigue and skin pruritus, patients are prone to negative emotions, reduced social interaction, and limited support resources. Family support constitutes the most crucial source of support for MHD patients during treatment, a finding consistent with multiple studies [\u003cspan additionalcitationids=\"CR39\" citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]].\u003c/p\u003e \u003cp\u003eThe level of self-efficacy for oral health self-care (SESS) among MHD patients was relatively low, lower than results found by Yuan Chenxi et al. [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e] in patients with chronic periodontitis. The reasons may include the substantial economic burden and psychological pressure from long-term disease management. Furthermore, the frequent travel to hospitals for dialysis treatments leaves patients with limited time, often leading them to reduce the frequency and duration of brushing and flossing to save time. Additionally, patients bear high treatment costs due to frequent dialysis and complication management, leading to prevalent financial toxicity [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Concerns over expensive dental care costs deter patients from seeking treatment, resulting in low self-efficacy for dental visits. Thus, there is significant potential for improving SESS among MHD patients.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eCorrelations Among Variables\u003c/h2\u003e \u003cp\u003e In this study, OHL was positively correlated with OHRQoL, indicating that better abilities in accessing, understanding oral health information, and making appropriate oral health decisions can enhance patients' OHRQoL. Social support was significantly positively correlated with OHRQoL, consistent with the findings of Shan Yan et al [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Higher social support provides patients with more resources, potentially alleviating negative emotions associated with the disease and promoting positive health behaviors, thereby improving OHRQoL. Self-efficacy for oral health self-care was significantly positively correlated with OHRQoL, aligning with several studies [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. As oral healthcare is a long-term process, enhancing self-efficacy can effectively maintain good oral health status and promote the adoption of oral health behaviors [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e], consequently improving patients' OHRQoL.\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eThe Mediating Roles of Social Support and Self-Efficacy\u003c/h2\u003e \u003cp\u003eThe results indicate that social support and SESS partially mediated the relationship between OHL and OHRQoL in MHD patients, with indirect effects accounting for 25.81% and 28.30% of the total effect, respectively. This means OHL can directly influence OHRQoL and also exert an indirect influence through social support and SESS. As a potential mediating factor in the Health Literacy Skills framework, social support can motivate behavioral change, facilitate the establishment and maintenance of healthy behaviors, and indirectly promote patients' quality of life [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. When patients possess adequate oral health knowledge and skills \u003cem\u003eand\u003c/em\u003e receive high levels of social support, they pay more attention to their oral health, better understand the characteristics of oral diseases, actively express their needs for oral treatment, and engage proactively in self-managing their oral health. Higher SESS is associated with better OHRQoL. Previous research also confirms the relationships between OHL, self-efficacy, and quality of life [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. Studies show that changing individual health behaviors relies not only on improved health knowledge; interventions solely targeting health literacy have limited effectiveness in improving health status. Utilizing psychosocial factors like self-efficacy is crucial to motivate individuals to change daily habits for positive health outcomes [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. This suggests that healthcare providers should pay close attention to the level of social support received by MHD patients, help them expand their support networks, enhance their ability to utilize support resources, and simultaneously stimulate their SESS to leverage their subjective initiative, thereby improving OHRQoL.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eThe Serial Mediating Effect of Social Support and Self-Efficacy\u003c/h2\u003e \u003cp\u003eThe results demonstrate a significant serial mediating effect of social support and SESS between OHL and OHRQoL in MHD patients, accounting for 7.84% of the total effect. This indicates that OHL can indirectly influence OHRQoL through the sequential pathway of social support and SESS, further validating the Health Literacy Skills framework. Individuals with higher health literacy typically exhibit stronger willingness and capability for health promotion, display positive attitudes in managing external relationships, obtain broader social support, and possess stronger self-efficacy, ultimately leading to improved health outcomes [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. Research indicates a significant positive correlation between social support and SESS in MHD patients [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]. According to the buffering model of social support [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e], social support serves as an external protective factor, helping individuals effectively mitigate negative emotions and helplessness caused by various adverse stimuli, improving their mental health, and consequently enhancing self-efficacy. Patients with higher SESS can better buffer the negative impacts of oral health problems and adopt proactive coping strategies to slow further deterioration of their oral health status. Therefore, healthcare professionals should develop appropriate oral health intervention plans for MHD patients based on scientific and rational principles, enhancing their confidence and ability to maintain and promote oral health, while assisting them in establishing broader social networks to access more support, thereby achieving the goal of improving OHRQoL.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn summary, this study explored the relationships among OHL, social support, SESS, and OHRQoL in MHD patients and constructed a serial mediation model. The findings revealed a significant direct predictive effect of OHL on OHRQoL, while both social support and SESS significantly negatively predicted OHRQoL scores. Therefore, while focusing on renal disease treatment, clinical healthcare workers should emphasize patients' oral health management. This can be achieved by implementing systematic oral health education to enhance health literacy, assisting in building social support networks including family and community, and employing strategies like goal setting and behavioral encouragement to strengthen self-efficacy, thereby synergistically improving patients' oral health and overall quality of life through multiple pathways.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eOHL Oral health literacy\u003c/p\u003e \u003cp\u003eOHRQoL Oral health-related quality of life\u003c/p\u003e \u003cp\u003eMHD Maintenance hemodialysis\u003c/p\u003e \u003cp\u003eSESS Self-efficacy scale for self-care\u003c/p\u003e \u003cp\u003eHeLD-14 Short form of health literacy dental scale\u003c/p\u003e \u003cp\u003ePSSS Perceived social support scale\u003c/p\u003e \u003cp\u003eOHIP-14 Oral health impact profile-14\u003c/p\u003e \u003cp\u003eSE Self-efficacy\u003c/p\u003e \u003cp\u003eHLS Health Literacy Skills\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the ethics committee of The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Grant number: YE202311301). And informed consent was obtained from the participants and their guardians before starting the program. We confirm that all the experiment is in accordance with the relevant guidelines and regulations such as the declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDue to the privacy of the research participants, the data generated during the current study are not publicly available but are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBiXia Yuan 1245, QingHua Lai 1235, XiaoTing Huang 123, JinLi Li 156, YongMei Lu 156, Meng Wu 156, LingYan Yao135, Yun Chen 156, JieQian Wu 156. 1 Conceptualization; 2 Methodology; 3 Data curation; 4 Writing Original Draft; 5 Writing - Review \u0026amp; Editing; 6 Funding acquisition.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors are grateful to all the participants in the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLi G, Cao L, Xu Y, et al. 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Front Aging Neurosci. 2023;15:1175252. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fnagi.2023.1175252\u003c/span\u003e\u003cspan address=\"10.3389/fnagi.2023.1175252\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Maintenance Hemodialysis, Oral Health Literacy, Social Support;Self-efficacy, Oral Health-Related Quality of Life","lastPublishedDoi":"10.21203/rs.3.rs-8040368/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8040368/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003e To examine the relationship between oral health literacy (OHL) and oral health-related quality of life (OHRQoL) in patients undergoing maintenance hemodialysis (MHD), and to analyze the mediating roles of social support and self-efficacy for self-care of oral health (SESS) in this relationship.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional study was conducted using convenience sampling to recruit 402 MHD patients from three tertiary hospitals in Guangzhou between June 2023 and January 2024. Data were collected using the Health Literacy in Dentistry scale (HeLD-14), the Perceived Social Support Scale (PSSS), the Self-Efficacy for Self-Care of Oral Health Scale (SESS), and the Oral Health Impact Profile-14 (OHIP-14). Data analysis was performed using SPSS 27.0 for descriptive statistics, correlation analysis, and linear regression analysis. The mediation effects were tested using Model 6 from Hayes' PROCESS macro.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003e(1) OHL was positively correlated with both social support (r\u0026thinsp;=\u0026thinsp;0.649, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and SESS (r\u0026thinsp;=\u0026thinsp;0.731, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and negatively correlated with OHRQoL (r=-0.523, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) in MHD patients. (2) Mediation analysis revealed a significant direct effect of OHL on OHRQoL (effect size: -0.199). Both social support and SESS served as independent mediators in the relationship between OHL and OHRQoL, with indirect effect sizes of -0.135 and \u0026minus;\u0026thinsp;0.148, respectively. Furthermore, they played a serial mediating role, with an indirect effect size of -0.041.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003e Oral health literacy in MHD patients not only directly influences their OHRQoL but also exerts indirect effects through the independent mediating roles of social support and self-efficacy for oral health self-care, as well as their serial mediation. Clinical interventions should focus on synergistically enhancing patients' perceived social support and self-efficacy levels.\u003c/p\u003e","manuscriptTitle":"Oral Health Literacy and Oral Health-Related Quality of Life in Maintenance Hemodialysis Patients: The Serial Mediation of Social Support and Self-Efficacy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-30 12:58:17","doi":"10.21203/rs.3.rs-8040368/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4aa0b404-4eb0-4848-b869-553468a168f9","owner":[],"postedDate":"January 30th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-04T10:40:07+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-30 12:58:17","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8040368","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8040368","identity":"rs-8040368","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}