Faculty of Dentistry, University of Toronto, 124 Edward Street, Toronto, ON, M5G 1X3, Canada.
Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia.
Can J Public Health. 2023 Feb;114(1):125-137. doi: 10.17269/s41997-022-00675-z. Epub 2022 Sep 6.
The objective of this study is to simultaneously assess the associations between suboptimal oral health (SOH) and cardiovascular disease (CVD) and competing death (CD).
Ontario residents aged 40 years and over who participated in the Canadian Community Health Survey 2003 and 2007-2008 were followed until December 31, 2016 for the incidence of CVD or CD. SOH was assessed based on self-rated oral health and inability to chew. Multivariable competing risk analysis was adjusted for socioeconomic characteristics, behavioural factors and intermediate health outcomes.
The study sample included 36,176 participants. Over a median follow-up of 9.61 years, there were 2077 CVD events and 3180 CD events. The fully adjusted models indicate 35% (HR = 1.35, 95% CI: 1.12-1.64) increase in the risk of CVD and 57% (HR = 1.57, 95% CI: 1.33-1.85) increase in the risk of CD among those who reported poor oral health as compared to those who reported excellent oral health. The fully adjusted models also indicate 11% (HR = 1.11, 95% CI: 0.97-1.27) increase in the hazard of CVD and 37% (HR = 1.37, 95% CI: 1.24-1.52) increase in the hazard of CD among those who reported inability to chew.
This study provides important information to contextualize CVD risk among those with SOH. The competing risk analysis indicates that those with SOH may benefit from additional interventions to prevent CVD and CD. Accordingly, managing the risk of CVD among those with SOH should fall under a more comprehensive approach that aims at improving their overall health and well-being.
本研究旨在同时评估口腔健康状况不佳（SOH）与心血管疾病（CVD）和竞争死亡（CD）之间的关联。
本研究对参加了 2003 年和 2007-2008 年加拿大社区健康调查的安大略省 40 岁及以上居民进行了随访，随访至 2016 年 12 月 31 日，以记录 CVD 或 CD 的发病情况。SOH 基于自我评估的口腔健康状况和咀嚼困难情况进行评估。多变量竞争风险分析调整了社会经济特征、行为因素和中间健康结果。
研究样本包括 36176 名参与者。在中位随访时间为 9.61 年期间，发生了 2077 例 CVD 事件和 3180 例 CD 事件。完全调整后的模型表明，与自我报告口腔健康状况良好的人群相比，自我报告口腔健康状况不佳的人群 CVD 发病风险增加 35%（HR = 1.35，95%CI：1.12-1.64），CD 发病风险增加 57%（HR = 1.57，95%CI：1.33-1.85）。完全调整后的模型还表明，与自我报告能够正常咀嚼的人群相比，报告咀嚼困难的人群 CVD 发病风险增加 11%（HR = 1.11，95%CI：0.97-1.27），CD 发病风险增加 37%（HR = 1.37，95%CI：1.24-1.52）。
本研究为评估 SOH 人群的 CVD 风险提供了重要信息。竞争风险分析表明，SOH 人群可能受益于额外的干预措施，以预防 CVD 和 CD。因此，管理 SOH 人群的 CVD 风险应属于更全面的方法，旨在改善其整体健康和幸福感。
