Matsuyama Y, Aida J, Watt R G, Tsuboya T, Koyama S, Sato Y, Kondo K, Osaka K
1 Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan.
2 Department of Epidemiology and Public Health, University College London, London, UK.
J Dent Res. 2017 Aug;96(9):1006-1013. doi: 10.1177/0022034517713166. Epub 2017 Jun 12.
This study examined whether the number of teeth contributes to the compression of morbidity, measured as a shortening of life expectancy with disability, an extension of healthy life expectancy, and overall life expectancy. A prospective cohort study was conducted. A self-reported baseline survey was given to 126,438 community-dwelling older people aged ≥65 y in Japan in 2010, and 85,161 (67.4%) responded. The onset of functional disability and all-cause mortality were followed up for 1,374 d (follow-up rate = 96.1%). A sex-stratified illness-death model was applied to estimate the adjusted hazard ratios (HRs) for 3 health transitions (healthy to dead, healthy to disabled, and disabled to dead). Absolute differences in life expectancy, healthy life expectancy, and life expectancy with disability according to the number of teeth were also estimated. Age, denture use, socioeconomic status, health status, and health behavior were adjusted. Compared with the edentulous participants, participants with ≥20 teeth had lower risks of transitioning from healthy to dead (adjusted HR, 0.58 [95% confidence interval (CI), 0.50-0.68] for men and 0.70 [95% CI, 0.57-0.85] for women) and from healthy to disabled (adjusted HR, 0.52 [95% CI, 0.44-0.61] for men and 0.58 [95% CI, 0.49-0.68] for women). They also transitioned from disabled to dead earlier (adjusted HR, 1.26 [95% CI, 0.99-1.60] for men and 2.42 [95% CI, 1.72-3.38] for women). Among the participants aged ≥85 y, those with ≥20 teeth had a longer life expectancy (men: +57 d; women: +15 d) and healthy life expectancy (men: +92 d; women: +70 d) and a shorter life expectancy with disability (men: -35 d; women: -55 d) compared with the edentulous participants. Similar associations were observed among the younger participants and those with 1 to 9 or 10 to 19 teeth. The presence of remaining teeth was associated with a significant compression of morbidity: older Japanese adults' life expectancy with disability was compressed by 35 to 55 d within the follow-up of 1,374 d.
本研究探讨了牙齿数量是否对发病率压缩有影响,发病率压缩通过预期寿命缩短伴残疾、健康预期寿命延长以及总体预期寿命来衡量。进行了一项前瞻性队列研究。2010年,对日本126438名年龄≥65岁的社区居住老年人进行了自我报告的基线调查,85161人(67.4%)做出了回应。对功能残疾的发生情况和全因死亡率进行了1374天的随访(随访率 = 96.1%)。应用性别分层的疾病死亡模型来估计3种健康转变(健康到死亡、健康到残疾、残疾到死亡)的调整后风险比(HRs)。还根据牙齿数量估计了预期寿命、健康预期寿命和伴残疾预期寿命的绝对差异。对年龄、假牙使用情况、社会经济地位、健康状况和健康行为进行了调整。与无牙参与者相比,牙齿数≥20颗的参与者从健康转变为死亡的风险较低(男性调整后HR为0.58 [95%置信区间(CI),0.50 - 0.68],女性为0.70 [95% CI,0.57 - 0.85]),从健康转变为残疾的风险也较低(男性调整后HR为0.52 [95% CI,0.44 - 0.61],女性为0.58 [95% CI,0.49 - 0.68])。他们从残疾转变为死亡的时间也更早(男性调整后HR为1.26 [95% CI,0.99 - 1.60],女性为2.42 [95% CI,1.72 - 3.38])。在年龄≥85岁的参与者中,与无牙参与者相比,牙齿数≥20颗的参与者预期寿命更长(男性:+57天;女性:+15天),健康预期寿命更长(男性:+92天;女性:+70天),伴残疾预期寿命更短(男性:-35天;女性:-55天)。在年轻参与者以及牙齿数为1至9颗或10至19颗的参与者中也观察到了类似的关联。剩余牙齿的存在与发病率的显著压缩相关:在1374天的随访期内,日本老年成年人的伴残疾预期寿命被压缩了35至55天。
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