IPUMS, Institute for Social Research and Data Innovation, University of Minnesota, Minneapolis, Minnesota.
Population Studies Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan.
Am J Prev Med. 2023 Jan;64(1):9-16. doi: 10.1016/j.amepre.2022.08.006. Epub 2022 Sep 21.
Evidence on the association between oral health and mortality is inconclusive, and few studies have accounted for the nonrandom selection bias in estimating their relationship. This study aims to investigate the link between oral health and mortality in community-dwelling older adults by adjusting for confounding factors with a doubly robust survival estimation.
Data came from the third National Health and Nutrition Examination Survey (1988-1994) and were linked to the National Death Index mortality data through December 2015. The analytic sample consisted of 4,880 adults aged ≥60 years. Oral health measures included objective clinical indicators (edentulism, periodontitis, and untreated dental caries) and self-rated oral health. Cox proportional hazards regression models and inverse probability weighting with regression adjustment for observational survival-time estimation were utilized to assess the relationship between oral health and mortality. Analyses were conducted in 2021.
Edentulism (average treatment effect= -26.13, 95% CI= -48.69, -3.57) was associated with a reduction in survival time. Periodontal conditions and dental caries were related to all-cause mortality in Cox models but became nonsignificant when inverse probability weighting with regression adjustment survival estimation was applied. Good self-rated oral health was significantly related to an increase in survival time (average treatment effect=21.50; 95% CI= 4.92, 38.07).
Both objective and subjective oral health are risk factors for mortality among older adults. Improving access to dental screening and treatment among community-dwelling older adults has the potential to reduce oral health‒related risks of mortality.
口腔健康与死亡率之间的关联证据尚无定论，并且很少有研究能够解释在估计两者关系时出现的非随机选择偏差。本研究旨在通过双重稳健生存估计来调整混杂因素，以调查社区居住的老年人中口腔健康与死亡率之间的联系。
数据来自第三次国家健康和营养检查调查（1988-1994 年），并通过国家死亡指数死亡率数据与 2015 年 12 月进行了链接。分析样本包括 4880 名年龄≥60 岁的成年人。口腔健康指标包括客观临床指标（失牙、牙周炎和未经治疗的龋齿）和自我评估的口腔健康。Cox 比例风险回归模型和观察生存时间估计的逆概率加权与回归调整用于评估口腔健康与死亡率之间的关系。分析于 2021 年进行。
失牙（平均处理效果=-26.13，95%CI=-48.69，-3.57）与生存时间缩短有关。牙周状况和龋齿在 Cox 模型中与全因死亡率相关，但在应用逆概率加权与回归调整生存估计时变得不显著。自我评估的良好口腔健康与生存时间的增加显著相关（平均处理效果=21.50；95%CI=4.92，38.07）。
客观和主观的口腔健康都是老年人死亡的风险因素。改善社区居住的老年人获得牙科筛查和治疗的机会，有可能降低与口腔健康相关的死亡风险。
