Division of Cancer Epidemiology & Genetics, National Cancer Institute, Bethesda, MD, USA.
Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran.
Int J Epidemiol. 2017 Dec 1;46(6):2028-2035. doi: 10.1093/ije/dyx056.
Previous studies have found associations between oral health and mortality, but the majority of previous studies have been conducted in high-income countries.
We used data from the Golestan Cohort Study, a study of 50 045 people aged 40 to 75 years in north eastern Iran, recruited from January 2004 to June 2008. Tooth loss and decayed, missing and filled teeth (DMFT) were assessed by trained physicians. Frequency of tooth brushing and use of dentures were self-reported. Cause-specific mortality was ascertained through March 2014. We calculated hazard ratios (HRs) and 95% confidence intervals (95% CIs) for the associations between the oral health variables, overall mortality and cause-specific mortality.
Participants with the greatest tooth loss had increased overall mortality (HR 1.43; 95% CI: 1.28, 1.61) compared with those with the least tooth loss; similar estimates were observed for DMFT score. For cause-specific mortality, an increased risk of death was found for tooth loss and mortality from cardiovascular disease (HR 1.33; 95% CI: 1.13, 1.56), cancer (HR 1.30; 95% CI: 1.03, 1.65) and injuries (HR 1.99; 95% CI: 1.28, 3.09). The associations between oral health and injury mortality were strongly attenuated after exclusion of participants with comorbid conditions at baseline. No statistical interaction was found between denture use and tooth loss or DMFT on mortality.
Poor oral health appears to predict overall and cause-specific mortality in populations in economic transition. Investigation of the underlying mechanisms might provide an important contribution to reducing mortality.
先前的研究已经发现了口腔健康与死亡率之间的关联，但大多数先前的研究都是在高收入国家进行的。
我们使用了来自伊朗东北部戈尔斯坦队列研究的数据，该研究纳入了 50045 名年龄在 40 至 75 岁之间的人群，招募时间为 2004 年 1 月至 2008 年 6 月。由经过培训的医生评估牙齿缺失和龋齿、缺失和补牙（DMFT）的情况。刷牙频率和使用假牙的情况则由参与者自我报告。通过 2014 年 3 月确定特定原因的死亡率。我们计算了口腔健康变量与全因死亡率和特定原因死亡率之间关联的风险比（HR）和 95%置信区间（95%CI）。
与牙齿缺失最少的参与者相比，牙齿缺失最多的参与者全因死亡率增加（HR 1.43；95%CI：1.28，1.61）；DMFT 评分也观察到类似的估计值。对于特定原因的死亡率，发现牙齿缺失与心血管疾病（HR 1.33；95%CI：1.13，1.56）、癌症（HR 1.30；95%CI：1.03，1.65）和损伤（HR 1.99；95%CI：1.28，3.09）的死亡风险增加。在排除基线时患有合并症的参与者后，口腔健康与损伤死亡率之间的关联明显减弱。未发现假牙使用与牙齿缺失或 DMFT 对死亡率有统计学交互作用。
在经济转型期的人群中，口腔健康状况较差似乎可以预测全因和特定原因的死亡率。对潜在机制的研究可能对降低死亡率做出重要贡献。
