牙齿缺失介导老年人吸烟与痴呆症风险增加之间的关联：日本老年学和老年医学学会前瞻性队列研究
Tooth loss mediates the association between smoking and an increased risk of dementia among older adults: The JAGES prospective cohort study.
作者信息
Kusama Taro, Takeuchi Kenji, Kiuchi Sakura, Tamada Yudai, Tabuchi Takahiro, Osaka Ken
机构信息
Division of Statistics and Data Science, Liaison Center for Innovative Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan.
Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan.
出版信息
J Clin Periodontol. 2024 Dec;51(12):1610-1618. doi: 10.1111/jcpe.13959. Epub 2024 Feb 7.
AIM
Tooth loss has various causes; however, its cause-specific effects on health outcomes remain unclear. This study evaluated whether the association between past/current smoking and risk of dementia was mediated by tooth loss.
MATERIALS AND METHODS
This 9-year-follow-up prospective cohort study targeted adults aged ≥65 years. Dementia incidence during 2013-2019, smoking status (never, past/current) in 2010 and the number of remaining teeth (≤19, ≥20) in 2013 were the outcome, exposure and mediator, respectively. We used causal mediation analysis to fit the Cox proportional hazards model and estimated the hazard ratio (HR) and 95% confidence interval (CI) of the natural indirect effect (NIE) of smoking on dementia incidence through tooth loss and their mediated proportions.
RESULTS
Among 32,986 participants (mean age 72.6 years [1 SD = 5.4]; men 48.4%), the dementia incidence during follow-up was 2.11/100 person-years. Tooth loss significantly mediated the association between past/current smoking and dementia incidence; the NIE of fewer remaining teeth for past/current smokers compared to never smokers was HR = 1.03 (95% CI: 1.02-1.05), and the mediated proportion was 18.0%.
CONCLUSIONS
Tooth loss significantly mediates the association between past/current smoking and an increased risk of dementia among older adults.
目的
牙齿缺失有多种原因；然而，其特定原因对健康结果的影响仍不明确。本研究评估过去/当前吸烟与痴呆症风险之间的关联是否由牙齿缺失介导。
材料与方法
这项为期9年的随访前瞻性队列研究针对年龄≥65岁的成年人。2013 - 2019年期间的痴呆症发病率、2010年的吸烟状况（从不吸烟、过去/当前吸烟）以及2013年剩余牙齿数量（≤19颗、≥20颗）分别作为结局、暴露因素和中介变量。我们使用因果中介分析来拟合Cox比例风险模型，并估计吸烟通过牙齿缺失对痴呆症发病率的自然间接效应（NIE）的风险比（HR）和95%置信区间（CI）及其中介比例。
结果
在32986名参与者中（平均年龄72.6岁[标准差1 = 5.4]；男性占48.4%），随访期间痴呆症发病率为2.11/100人年。牙齿缺失显著介导了过去/当前吸烟与痴呆症发病率之间的关联；与从不吸烟者相比，过去/当前吸烟者剩余牙齿较少的NIE为HR = 1.03（95% CI：1.02 - 1.05），中介比例为18.0%。
结论
牙齿缺失显著介导了过去/当前吸烟与老年人痴呆症风险增加之间的关联。
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