Garcia R I, Krall E A, Vokonas P S
VA Dental Longitudinal Study and Normative Aging Study, U.S. Department of Veterans Affairs Outpatient Clinic, Boston, MA. USA.
Ann Periodontol. 1998 Jul;3(1):339-49. doi: 10.1902/annals.1998.3.1.339.
(The role that oral conditions may play as risk factors or indicators for various medical outcomes, including mortality, is not well understood. We have examined the relationship of periodontal disease to mortality from all causes in the VA Dental Longitudinal Study and Normative Aging Study, a prospective cohort study of the determinants of disease in aging men. Subjects were screened for entry into the closed-panel cohort in the mid-1960s, based on good medical health. They are not VA patients. We have used proportional hazards regression models to assess the relationship of periodontal health status at baseline to all-cause mortality over a 25+-year follow-up period. A total of 804 dentate subjects who were alive and medically healthy through their first follow-up exam were used in the analysis; of these, 166 died during subsequent follow-up through December 1996. Survival was calculated in years from baseline exam to death or censoring (most recent study examination date). To define periodontal health status at baseline, we separately used radiographic alveolar bone loss (ABL) (person-level scores of mean whole-mouth % ABL, measured with a Schei ruler using full-mouth series of periapical films) and periodontal clinical probing depths. Covariates included age at baseline, and assessments at baseline of smoking and alcohol use, education, body mass index, serum cholesterol, white blood cell count, blood pressure, family history of heart disease, and number of teeth present. We found that periodontal status at baseline was a significant and independent predictor of mortality in this cohort, while controlling for other recognized predictors in multivariate models. For each 20% increment in mean whole-mouth ABL, the subject's risk of death increased by 51% (RR = 1.51; 95% CI = 1.11-2.04). The increase in risk attributable to periodontal status was found to be similar in magnitude to, and independent of that attributable to cigarette smoking in this cohort. While the increased risk due to smoking was 1.52-fold (95% CI = 1.06-2.19), being in the population quintile with highest ABL scores (i.e., worst periodontal status) was associated with a 1.85 fold increase in risk (95% CI = 1.25-2.74) using multivariate analyses. The hypothesis that chronic oral infections, as in periodontitis, may have important systemic sequelae merits further investigation in prospective controlled studies.
口腔状况作为包括死亡率在内的各种医学结果的风险因素或指标所起的作用尚未得到充分理解。在退伍军人事务部牙科纵向研究和规范衰老研究中，我们研究了牙周疾病与全因死亡率之间的关系，这是一项关于老年男性疾病决定因素的前瞻性队列研究。受试者于20世纪60年代中期基于良好的健康状况被筛选进入封闭队列。他们不是退伍军人事务部的患者。我们使用比例风险回归模型来评估基线时的牙周健康状况与25年以上随访期内全因死亡率之间的关系。分析中使用了804名在首次随访检查时存活且身体健康的有牙受试者；其中，166人在随后的随访至1996年12月期间死亡。生存时间从基线检查到死亡或截尾（最近的研究检查日期）以年计算。为了定义基线时的牙周健康状况，我们分别使用了放射学牙槽骨丧失（ABL）（使用根尖片全口系列用Schei尺测量的全口平均ABL百分比的个体水平评分）和牙周临床探诊深度。协变量包括基线年龄，以及基线时对吸烟、饮酒、教育程度、体重指数、血清胆固醇、白细胞计数、血压、心脏病家族史和现存牙齿数量的评估。我们发现，在多变量模型中控制其他公认的预测因素时，基线时的牙周状况是该队列中死亡率的显著且独立的预测因素。全口平均ABL每增加20%，受试者的死亡风险增加51%（风险比=1.51；95%置信区间=1.11 - 2.04）。在该队列中，归因于牙周状况的风险增加幅度与归因于吸烟的风险增加幅度相似且相互独立。虽然吸烟导致的风险增加为1.52倍（95%置信区间=1.06 - 2.19），但使用多变量分析，处于ABL评分最高的人群五分位数（即最差的牙周状况）与风险增加1.85倍相关（95%置信区间=1.25 - 2.74）。慢性口腔感染（如牙周炎）可能产生重要的全身后果这一假设值得在前瞻性对照研究中进一步探讨。
