Ruan Zengliang, Xie Jianfeng, Yu Jingru, Yin Li, Nesheli Dariush Nasrollahzadeh, Ye Weimin
Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, and Department of Epidemiology & Biostatistics, School of Public Health, Southeast University, Nanjing, China.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels Väg 12a, 17165, Solna, Stockholm, Sweden.
BMC Med. 2025 Jul 21;23(1):434. doi: 10.1186/s12916-025-04273-x.
Poor dental health has been linked to an increased risk of gastric cancer (GC), but previous studies were limited by their retrospective design and relatively small sample size.
We followed a nationwide cohort of 5,888,034 Swedish adults over the age of 19 who visited a dentist between 2009 and 2016. Additionally, a nested case-control study was conducted by comparing incident GC cases to their siblings. Cox regression analyses, using attained age as the timescale and adjusting for potential confounders, were performed to evaluate the association between various dental health conditions and the risk of GC. In addition, we stratified our analyses by sex and age and conducted various sensitivity analyses to ensure the robustness of our findings.
Over an average follow-up of 6.4 years, we identified 3993 new GC cases, including 1241 cardia GC and 2752 non-cardia GC. Compared to individuals with healthy teeth, those with periodontitis had an 11% and 25% increased risk of GC and cardia GC, respectively. The positive associations between odontogenic inflammation and the risk of GC were consistent in sibling-controlled analyses. We also observed a dose-response relationship between the number of remaining teeth and the risk of GC, with fewer teeth associated with higher risks. Additionally, we did not find significant interactions between dental inflammatory conditions and the number of remaining teeth in relation to the risk of GC or its subtypes. Our findings were consistent across different sex and age subgroups and in sensitivity analyses.
This study provides the largest prospective cohort study evidence to date, along with the first sibling-controlled comparisons, supporting the association between poor dental health and GC risk. Promoting dental health in the general population could have significant public health implications in preventing this disease.
口腔健康不佳与胃癌（GC）风险增加有关，但以往的研究受回顾性设计和相对较小的样本量所限。
我们追踪了2009年至2016年间去看牙医的5888034名19岁以上瑞典成年人的全国性队列。此外，通过将新发GC病例与其兄弟姐妹进行比较，开展了一项巢式病例对照研究。采用达到的年龄作为时间尺度并对潜在混杂因素进行调整，进行Cox回归分析，以评估各种口腔健康状况与GC风险之间的关联。此外，我们按性别和年龄对分析进行分层，并进行了各种敏感性分析，以确保我们研究结果的稳健性。
在平均6.4年的随访期内，我们确定了3993例新发GC病例，包括1241例贲门GC和2752例非贲门GC。与牙齿健康的个体相比，患有牙周炎的个体患GC和贲门GC的风险分别增加了11%和25%。在兄弟姐妹对照分析中，牙源性炎症与GC风险之间的正相关关系是一致的。我们还观察到剩余牙齿数量与GC风险之间存在剂量反应关系，牙齿越少风险越高。此外，我们没有发现牙齿炎症状况和剩余牙齿数量之间在GC或其亚型风险方面存在显著的相互作用。我们的研究结果在不同性别和年龄亚组以及敏感性分析中都是一致的。
本研究提供了迄今为止最大规模的前瞻性队列研究证据，以及首次兄弟姐妹对照比较，支持口腔健康不佳与GC风险之间的关联。在普通人群中促进口腔健康可能对预防这种疾病具有重大的公共卫生意义。
