口腔健康状况不佳是心血管疾病住院和全因死亡率的风险指标吗？来自前瞻性45岁及以上研究中172630名参与者的研究结果。
Is poor oral health a risk marker for incident cardiovascular disease hospitalisation and all-cause mortality? Findings from 172 630 participants from the prospective 45 and Up Study.
作者信息
Joshy Grace, Arora Manish, Korda Rosemary J, Chalmers John, Banks Emily
机构信息
National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia.
Faculty of Dentistry, University of Sydney, Sydney, New South Wales, Australia Department of Preventive Medicine and the Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
出版信息
BMJ Open. 2016 Aug 30;6(8):e012386. doi: 10.1136/bmjopen-2016-012386.
OBJECTIVE
To investigate the relationship between oral health and incident hospitalisation for ischaemic heart disease (IHD), heart failure (HF), ischaemic stroke and peripheral vascular disease (PVD) and all-cause mortality.
DESIGN
Prospective population-based study of Australian men and women aged 45 years or older, who were recruited to the 45 and Up Study between January 2006 and April 2009; baseline questionnaire data were linked to hospitalisations and deaths up to December 2011. Study exposures include tooth loss and self-rated health of teeth and gums at baseline.
SETTING
New South Wales, Australia.
PARTICIPANTS
Individuals aged 45-75 years, excluding those with a history of cancer/cardiovascular disease (CVD) at baseline; n=172 630.
PRIMARY OUTCOMES
Incident hospitalisation for IHD, HF, ischaemic stroke and PVD and all-cause mortality.
RESULTS
During a median follow-up of 3.9 years, 3239 incident hospitalisations for IHD, 212 for HF, 283 for ischaemic stroke and 359 for PVD, and 1908 deaths, were observed. Cox proportional hazards models examined the relationship between oral health indicators and incident hospitalisation for CVD and all-cause mortality, adjusting for potential confounding factors. All-cause mortality and incident CVD hospitalisation risk increased significantly with increasing tooth loss for all outcomes except ischaemic stroke (ptrend<0.05). In those reporting no teeth versus ≥20 teeth left, risks were increased for HF (HR, 95% CI 1.97, 1.27 to 3.07), PVD (2.53, 1.81 to 3.52) and all-cause mortality (1.60, 1.37 to 1.87). The risk of IHD, PVD and all-cause mortality (but not HF or ischaemic stroke) increased significantly with worsening self-rated health of teeth and gums (ptrend<0.05). In those reporting poor versus very good health of teeth and gums, risks were increased for IHD (1.19, 1.03 to 1.38), PVD (1.66, 1.13 to 2.43) and all-cause mortality (1.76, 1.50 to 2.08).
CONCLUSIONS
Tooth loss and, to a lesser extent, self-rated health of teeth and gums, are markers for increased risk of IHD, PVD and all-cause mortality. Tooth loss is also a marker for increased risk of HF.
目的
研究口腔健康与缺血性心脏病（IHD）、心力衰竭（HF）、缺血性中风和外周血管疾病（PVD）的住院发生率以及全因死亡率之间的关系。
设计
对年龄在45岁及以上的澳大利亚男性和女性进行基于人群的前瞻性研究，这些人于2006年1月至2009年4月被纳入“45及以上研究”；基线调查问卷数据与截至2011年12月的住院和死亡情况相关联。研究暴露因素包括基线时的牙齿缺失情况以及自我评估的牙齿和牙龈健康状况。
地点
澳大利亚新南威尔士州。
参与者
年龄在45 - 75岁之间，排除基线时有癌症/心血管疾病（CVD）病史的个体；n = 172630。
主要结局
IHD、HF、缺血性中风和PVD的住院发生率以及全因死亡率。
结果
在中位随访3.9年期间，观察到3239例IHD住院、212例HF住院、283例缺血性中风住院、359例PVD住院以及1908例死亡。Cox比例风险模型检验了口腔健康指标与CVD住院发生率和全因死亡率之间的关系，并对潜在混杂因素进行了调整。除缺血性中风外，所有结局的全因死亡率和CVD住院风险均随牙齿缺失增加而显著升高（趋势P<0.05）。在报告无牙与剩余≥20颗牙的人群中，HF（风险比[HR]，95%置信区间[CI] 1.97，1.27至3.07）、PVD（2.53，1.81至3.52）和全因死亡率（1.60，1.37至1.87）的风险增加。IHD、PVD和全因死亡率（但不包括HF或缺血性中风）的风险随自我评估的牙齿和牙龈健康状况恶化而显著增加（趋势P<0.05）。在报告牙齿和牙龈健康状况差与非常好的人群中，IHD（1.19，1.03至1.38）、PVD（1.66，1.13至2.43）和全因死亡率（1.76，1.50至2.08）的风险增加。
结论
牙齿缺失以及在较小程度上自我评估的牙齿和牙龈健康状况是IHD、PVD和全因死亡率风险增加的标志。牙齿缺失也是HF风险增加的标志。
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