Beukers Nicky G F M, Su Naichuan, van der Heijden Geert J M G, Loos Bruno G
Department of Periodontology, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Department of Oral Public Health, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
J Clin Periodontol. 2023 Dec;50(12):1621-1632. doi: 10.1111/jcpe.13870. Epub 2023 Sep 2.
To investigate whether and which diseases co-occur with periodontitis (PD) to assess the prevalence of comorbidities and multimorbidity and to identify patterns and profiles of comorbidity and multimorbidity and the influence of demographic and lifestyle factors to identify distinct groups of multimorbid patients.
A database from the Academic Centre of Dentistry Amsterdam (ACTA) with 37,801 adult individuals containing information about demographic (age, sex, socio-economic position [SEP]) and lifestyle factors (smoking, alcohol use and addictive substance use) and PD and systemic diseases was constructed. PD assessment was based on clinical information by the use of claim codes and systemic diseases data were derived from self-reported medical history. For analyses, univariable and multivariable (adjusted for age, sex, SEP, smoking, alcohol use and addictive substance use) logistic regression analyses and cluster analysis were used.
Individuals with PD more often had one or multiple diseases. The adjusted odds ratio (OR) for PD patients having up to four systemic diseases ranged from 1.46 to 1.20. Co-occurrence of PD with several systemic diseases and a higher prevalence of multimorbidity was found (adjusted OR comorbidity = 1.36; 95% confidence interval (CI): 1.30-1.43; multimorbidity = 1.18; 95% CI: 1.11-1.25). Four clusters existed: cluster 1 was defined as a periodontal and systemically healthy group and cluster 4 as burdened with PD but not containing any systemic diseases. Individuals in cluster 1 were of the lowest age (44.9 [SD: 15.5]) and had the lowest prevalence of the lifestyle factors of smoking (13.6%) and alcohol use (3.9%). Clusters 2 and 3 contained both PD and had several systemic diseases but were different from each other. Cluster 2 contained 34.5% of PD individuals and had mainly respiratory tract, immune system and digestive system diseases. Cluster 3 contained 45.9% of PD individuals and had mainly cardiometabolic diseases. Cluster 2 had the highest prevalence of females (63.1%) and the highest prevalence of smokers (23.8%) and addictive substance users (8.9%). Cluster 3 included individuals of the highest age (63.5 [SD: 11.9]), and had highest prevalence of alcohol users (17.7%) and lowest prevalence of addictive substance users (3.8%).
This study shows that individuals with PD are more often burdened with comorbidity and multimorbidity. Presence of distinct clusters suggests overlap in pathophysiology between certain types of PD and specific systemic diseases. Therefore, PD can be considered as part of multimorbidity, as one of the systemic diseases co-occurring in certain groups of individuals.
研究牙周炎（PD）是否与其他疾病共病以及共病的具体疾病，以评估共病和多病共患的患病率，确定共病和多病共患的模式与特征，以及人口统计学和生活方式因素的影响，从而识别出不同的多病共患患者群体。
构建了一个来自阿姆斯特丹牙科学术中心（ACTA）的数据库，包含37,801名成年人的信息，内容涉及人口统计学（年龄、性别、社会经济地位[SEP]）和生活方式因素（吸烟、饮酒和成瘾物质使用）以及牙周炎和全身性疾病。牙周炎评估基于使用索赔代码的临床信息，全身性疾病数据来自自我报告的病史。分析时采用单变量和多变量（根据年龄、性别、SEP、吸烟、饮酒和成瘾物质使用进行调整）逻辑回归分析以及聚类分析。
患有牙周炎的个体更常患有一种或多种疾病。牙周炎患者患有多达四种全身性疾病的调整优势比（OR）在1.46至1.20之间。发现牙周炎与几种全身性疾病共病，且多病共患的患病率更高（调整后的共病OR = 1.36；95%置信区间（CI）：1.30 - 1.43；多病共患 = 1.18；95% CI：1.11 - 1.25）。存在四个聚类：聚类1被定义为牙周和全身健康组，聚类4被定义为患有牙周炎但不包含任何全身性疾病。聚类1中的个体年龄最小（44.9 [标准差：15.5]），吸烟（13.6%）和饮酒（3.9%）等生活方式因素的患病率最低。聚类2和聚类3都患有牙周炎且有几种全身性疾病，但彼此不同。聚类2包含34.5%的牙周炎个体，主要患有呼吸道、免疫系统和消化系统疾病。聚类3包含45.9%的牙周炎个体，主要患有心脏代谢疾病。聚类2中女性患病率最高（63.1%），吸烟者（23.8%）和成瘾物质使用者（8.9%）的患病率也最高。聚类3包括年龄最大的个体（63.5 [标准差：11.9]），饮酒者患病率最高（17.7%），成瘾物质使用者患病率最低（3.8%）。
本研究表明，患有牙周炎的个体更常受到共病和多病共患的困扰。不同聚类的存在表明某些类型的牙周炎与特定全身性疾病在病理生理学上存在重叠。因此，牙周炎可被视为多病共患的一部分，是某些个体群体中同时出现的全身性疾病之一。
