Lishui Hospital, Zhejiang University School of Medicine, Hangzhou, China.
J Periodontol. 2024 Jun;95(6):571-581. doi: 10.1002/JPER.23-0277. Epub 2023 Oct 4.
The association between tooth loss and all-cause and cardiovascular mortality requires further investigation.
This study included 17993 participants from the National Health and Nutrition Examination Surveys (NHANES) 1999-2004 and 2009-2014. Weighted multivariable Cox proportional hazard models were used to assess the association between tooth loss and all-cause and cardiovascular mortality. Restricted cubic splines (RCS) were incorporated in the models to explore potential nonlinear relationships.
Over a median follow-up of 116 months, 2152 participants died, including 625 cardiovascular deaths. Compared to participants without missing teeth, participants with 11-19 missing teeth had the highest risk of all-cause mortality (hazard ratio [HR] 1.89, 95% confidence interval [CI] 1.43-2.51), while participants with 6-10 missing teeth had the highest risk of cardiovascular mortality (HR 2.51, 95% CI 1.68-3.76). RCS analyses revealed nonlinear associations between number of missing teeth and all-cause (p < 0.001) and cardiovascular (p = 0.001) mortality. With < 10 missing teeth, each additional missing tooth increased all-cause and cardiovascular mortality by 6% (HR 1.06, 95% CI 1.03-1.09) and 9% (HR 1.09, 95% CI 1.03-1.15), respectively. However, when the number of missing teeth was ≥10, the risk of mortality did not continue to increase with more missing teeth. A significant interaction was found between tooth loss and age (p < 0.001 for both outcomes).
We observed an inverted L-shaped association between tooth loss and mortality, wherein risks increased with more missing teeth until 10, but did not continue increasing thereafter. The association was stronger in adults < 65 years old.
牙齿缺失与全因和心血管死亡率之间的关系需要进一步研究。
本研究纳入了 1999 年至 2004 年和 2009 年至 2014 年全国健康和营养调查（NHANES）中的 17993 名参与者。使用加权多变量 Cox 比例风险模型评估牙齿缺失与全因和心血管死亡率之间的关系。模型中纳入了限制立方样条（RCS）来探索潜在的非线性关系。
在中位随访 116 个月期间，有 2152 名参与者死亡，包括 625 例心血管死亡。与无缺牙的参与者相比，缺失 11-19 颗牙齿的参与者全因死亡率风险最高（风险比 [HR] 1.89，95%置信区间 [CI] 1.43-2.51），而缺失 6-10 颗牙齿的参与者心血管死亡率风险最高（HR 2.51，95% CI 1.68-3.76）。RCS 分析显示，牙齿缺失数量与全因（p<0.001）和心血管（p=0.001）死亡率之间存在非线性关系。缺失<10 颗牙齿时，每增加一颗缺失牙，全因和心血管死亡率分别增加 6%（HR 1.06，95% CI 1.03-1.09）和 9%（HR 1.09，95% CI 1.03-1.15）。然而，当缺失牙齿数量≥10 颗时，随着缺失牙齿数量的增加，死亡率风险不再继续增加。在这两种结果中，均观察到牙齿缺失与年龄之间存在显著的交互作用（p<0.001）。
我们观察到牙齿缺失与死亡率之间呈倒 L 形关系，缺失牙齿数量增加会增加风险，直到达到 10 颗，但此后不再继续增加。这种关联在<65 岁的成年人中更强。
