Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington.
Fred Hutchinson Cancer Research Center, Seattle, Washington.
Int J Cancer. 2020 Sep 15;147(6):1587-1596. doi: 10.1002/ijc.32941. Epub 2020 Mar 20.
Increasing evidence supports a positive association between periodontal disease and total cancer risk. We evaluated the association of clinically assessed periodontal disease and a consequence, edentulism with total cancer mortality in participants without a prior cancer diagnosis in a U.S. nationally representative population. Included were 6,034 participants aged ≥40 years without a prior cancer diagnosis who participated in the National Health and Nutrition Examination Survey III. Periodontal health was measured by trained dentists. Cancer deaths (n = 702) were ascertained during a median of 21.3 years of follow-up. Cox proportional hazards regression was used to estimate the association of periodontal disease and edentulism with total cancer mortality using no periodontal disease/dentate as the reference and adjusting for potential demographic, lifestyle including smoking and social factor confounders. Fifteen percent had periodontitis and 17% were edentulous. Periodontitis was not statistically significantly associated with risk of total cancer death after multivariable adjustment. Edentulism was associated with an increased risk of cancer mortality (hazard ratio = 1.50, 95% confidence interval = 1.12-2.00) after multivariable adjustment, including in men and women and in each racial/ethnic group studied. The positive association was observed in overweight/obese participants but not participants with normal body mass index, more strongly in prediabetic/diabetic participants than in participants without diabetes and in ever cigarette smokers but not in never cigarette smokers. In this U.S. nationally representative population, those with edentulism, but not periodontal disease, had a higher risk of total cancer death, especially in those with shared risk factors for periodontal disease and cancer.
越来越多的证据支持牙周病与总体癌症风险之间存在正相关性。我们评估了美国全国代表性人群中，未经癌症诊断的参与者中临床评估的牙周病和后果（失牙）与总体癌症死亡率之间的关联。该研究纳入了 6034 名年龄≥40 岁、未经癌症诊断的参与者，他们参加了第三次国家健康和营养调查。通过训练有素的牙医评估牙周健康状况。在中位随访 21.3 年后，确定癌症死亡人数（n=702）。使用 Cox 比例风险回归，使用无牙周病/有牙作为参考，并调整潜在的人口统计学、生活方式（包括吸烟）和社会因素混杂因素，估计牙周病和失牙与总体癌症死亡率的关联。15%的人患有牙周炎，17%的人失牙。在多变量调整后，牙周炎与总体癌症死亡风险无统计学显著相关性。失牙与癌症死亡率增加相关（风险比=1.50，95%置信区间=1.12-2.00），包括在男性和女性以及研究的每个种族/族裔群体中。在超重/肥胖参与者中观察到这种正相关性，但在体重指数正常的参与者中没有，在糖尿病前期/糖尿病患者中比在无糖尿病患者中更强，在曾经吸烟的人中，但不在从未吸烟的人中。在这个美国全国代表性人群中，失牙而不是牙周病的人，总体癌症死亡风险更高，尤其是在具有牙周病和癌症共同风险因素的人群中。
