Zhang Xi, Liu Ben, Lynn Henry S, Chen Kexin, Dai Hongji
Clinical Research Unit, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Epidemiology and Biostatistics, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Molecular Cancer Epidemiology of Tianjin, Huanhuxi Road, Hexi District, Tianjin 300060, China.
EClinicalMedicine. 2022 Mar 5;45:101330. doi: 10.1016/j.eclinm.2022.101330. eCollection 2022 Mar.
There is a strong connection between oral health and overall wellness. We aim to examine the association between poor oral health and the risk of developing or dying of cancer, and whether the association differs by residential area.
Between 2004 and 2008, a total of 510,148 adults free of cancer were included from the China Kadoorie Biobank study and thereafter followed up to 2015. Poor oral health was assessed from a self-reported baseline questionnaire and defined as a combination of rarely brushing teeth and always gum bleeding. We used Cox proportional hazards models to estimate the hazard ratio (HR) of cancer risk and its associated 95% confidence interval (CI) according to oral health status.
Overall, 14.9% of participants (19.7% in rural areas and 8.8% in urban areas) reported poor oral health at baseline. After 4,602,743 person-years of follow-up, we identified 23,805 new cancer cases and 11,973 cancer deaths, respectively. Poor oral health was associated with higher risks of total cancer incidence (HR: 1.08, 95% CI: 1.04-1.12) and death (HR: 1.10, 95% CI: 1.05-1.16). For the site-specific cancers, poor oral health was significantly associated with higher risk of stomach cancer incidence (cases: 2964, HR: 1.10, 95% CI: 1.00-1.22), esophageal cancer incidence (cases: 2119, HR: 1.19, 95% CI: 1.07-1.33), esophageal cancer death (cases: 1238, HR: 1.29, 95% CI: 1.12-1.49), liver cancer incidence (cases: 2565, HR: 1.18, 95% CI: 1.06-1.32), and liver cancer death (cases: 1826, HR: 1.20, 95% CI: 1.05-1.36). This positive association was stronger among rural residents compared to urban residents (interaction test < 0.01).
Our findings indicate that poor oral health is associated with higher risk for cancers, especially digestive system cancers. Promotion of oral health in the general population, especially for rural residents, could have valuable public health significance in preventing major systemic diseases.
Supported by grants (2021YFC2500400, 2016YFC0900500, 2016YFC0900501, 2016YFC0900504) from the National Key Research and Development Program of China, grants from the Kadoorie Charitable Foundation in Hong Kong and grants grants (088158/Z/09/Z, 104085/Z/14/Z, 202922/Z/16/Z) from Wellcome Trust in the UK. CKB is supported by the Kadoorie Charitable Foundation (KCF) in Hong Kong.
口腔健康与整体健康之间存在紧密联系。我们旨在研究口腔健康状况不佳与患癌风险或癌症死亡风险之间的关联，以及这种关联是否因居住地区而异。
在2004年至2008年期间，中国嘉道理生物银行研究纳入了总共510148名无癌症的成年人，并随访至2015年。口腔健康状况不佳是根据自我报告的基线问卷进行评估的，定义为很少刷牙和经常牙龈出血。我们使用Cox比例风险模型根据口腔健康状况估计癌症风险的风险比（HR）及其相关的95%置信区间（CI）。
总体而言，14.9%的参与者（农村地区为19.7%，城市地区为8.8%）在基线时报告口腔健康状况不佳。经过4602743人年的随访，我们分别确定了23805例新癌症病例和11973例癌症死亡病例。口腔健康状况不佳与总体癌症发病率（HR：1.08，95%CI：1.04 - 1.12）和死亡（HR：1.10，95%CI：1.05 - 1.16）风险较高相关。对于特定部位的癌症而言，口腔健康状况不佳与胃癌发病率（病例数：2964，HR：1.10，95%CI：1.00 - 1.22）、食管癌发病率（病例数：2119，HR：1.19，95%CI：1.07 - 1.33）、食管癌死亡（病例数：1238，HR：1.29，95%CI：1.12 - 1.49）、肝癌发病率（病例数：2565，HR：1.18，95%CI：1.06 - 1.32）和肝癌死亡（病例数：1826，HR：1.20，95%CI：1.05 - 1.36）的风险显著升高相关。与城市居民相比，农村居民中的这种正相关更强（交互检验<0.01）。
我们的研究结果表明，口腔健康状况不佳与患癌风险较高相关，尤其是消化系统癌症。在普通人群中，特别是农村居民中促进口腔健康，对于预防主要的全身性疾病可能具有重要的公共卫生意义。
由中国国家重点研发计划资助（2021YFC2500400、2016YFC0900500、2016YFC0900501、2016YFC0900504）、香港嘉道理慈善基金会资助以及英国惠康信托基金会资助（088158/Z/09/Z、104085/Z/14/Z、202922/Z/16/Z）。中国嘉道理生物银行由香港嘉道理慈善基金会（KCF）资助。
