Department of Epidemiology and Health Statistics, Public Health College, Qingdao University, Qingdao, China.
Jiafan Dental Clinic, Qingdao, China.
J Dent. 2020 May;96:103331. doi: 10.1016/j.jdent.2020.103331. Epub 2020 Apr 3.
Previous cohort studies have reported the significant association between tooth loss and functional disability in aging adults. This study aimed to examine whether eating and communication difficulties mediate this association.
Data from wave 7 (2014-2015) to wave 8 (2016-2017) of the English Longitudinal Study of Ageing (ELSA) were analyzed. Severe tooth loss was defined as "< 20 teeth remaining" at baseline. Eating and communication difficulties were assessed through a questionnaire. Onset of functional disability 2-year later was assessed by activities of daily living (ADL) scale and instrumental ADL (IADL) scale. Baron and Kenny's causal steps and Karlson/Holm/Breen (KHB) method were used to examine the mediating effect.
At baseline, 7,830 participants had no ADL disability and 7,678 participants had no IADL disability. The 2-year cumulative incidence of ADL disability and IADL disability were 7.5 % and 9.0 %, respectively. Severe tooth loss was associated with both incidence of ADL disability (OR = 1.40; 95 % CI = 1.13-1.74) and incidence of IADL disability (OR = 1.24; 95 % CI = 1.01-1.52). The mediating effect of eating difficulty on the association between severe tooth loss and ADL disability was 1.04 (95 % CI: 1.01, 1.06). The mediating effect of communication difficulty on the association between severe tooth loss and IADL disability was 1.05 (95 % CI: 1.02, 1.07).
Severe tooth loss is associated with incidence of functional disability in middle-aged and older English adults. Eating and communication difficulties play the role as mediators in these associations.
This prospective study contributes to elucidating parts of biological mechanism underlying tooth loss and functional disability in middle-aged and older adults. It suggests that oral health strategies aimed to protect teeth may be important in reducing the risk of functional disability.
先前的队列研究报告称，牙齿缺失与老年人的功能障碍之间存在显著关联。本研究旨在探讨进食和沟通困难是否在这种关联中起中介作用。
本研究对英国老龄化纵向研究（ELSA）第 7 波（2014-2015 年）和第 8 波（2016-2017 年）的数据进行了分析。基线时严重牙齿缺失定义为“剩余牙齿数<20 颗”。通过问卷评估进食和沟通困难。2 年后功能障碍的发病情况通过日常生活活动（ADL）量表和工具性日常生活活动（IADL）量表进行评估。采用 Baron 和 Kenny 的因果步骤和 Karlson/Holm/Breen（KHB）方法检验中介效应。
基线时，7830 名参与者无 ADL 残疾，7678 名参与者无 IADL 残疾。ADL 残疾和 IADL 残疾的 2 年累积发生率分别为 7.5%和 9.0%。严重牙齿缺失与 ADL 残疾发病（OR=1.40；95%CI=1.13-1.74）和 IADL 残疾发病（OR=1.24；95%CI=1.01-1.52）均相关。进食困难对严重牙齿缺失与 ADL 残疾之间关联的中介效应为 1.04（95%CI：1.01，1.06）。沟通困难对严重牙齿缺失与 IADL 残疾之间关联的中介效应为 1.05（95%CI：1.02，1.07）。
在英国中老年成年人中，严重牙齿缺失与功能障碍的发生有关。进食和沟通困难在这些关联中起中介作用。
本前瞻性研究有助于阐明中年人及老年人牙齿缺失与功能障碍之间部分生物学机制。它表明，旨在保护牙齿的口腔健康策略可能对降低功能障碍风险很重要。
