Impact of periodontitis on mortality

Background + Aims

• Periodontitis, a chronic inflammatory disease affecting the supporting structures of the teeth, has been linked to various systemic health issues, including cardiovascular disease and diabetes. Given the increasing prevalence of both diabetes and periodontal disease, understanding their interplay is crucial for public health.
• Previous research has suggested that periodontitis may exacerbate diabetes complications and contribute to increased morbidity and mortality.
• The primary aim of this study is to evaluate the association between periodontitis and all-cause as well as cause-specific mortality among US adults with diabetes. This includes understanding how varying degrees of periodontal disease may influence mortality risks.

Materials + Methods

• The study utilised a cross-sectional design based on data from the National Health and Nutrition Examination Survey (NHANES), which monitors the health and nutritional status of the non-institutionalized US population. The analysis focused on a nationally representative sample of US adults diagnosed with diabetes, ensuring a diverse demographic representation. The study utilised complex sampling techniques to account for the NHANES design, applying weighted analyses to ensure representativeness. Various statistical tests, including t-tests and chi-squared tests, were used to compare characteristics across periodontal statuses.
• Information on periodontal health was collected through clinical examinations, while diabetes status was determined via self-reports and medical records. Participants were categorised based on the severity of periodontitis, using established clinical criteria to define moderate and severe cases.
• Directed acyclic graphs (DAGs) were employed to identify potential confounders, including age, sex, race/ethnicity, socioeconomic status, smoking status, alcohol consumption, dietary quality, and body mass index (BMI).
• Two sensitivity analyses were conducted to assess the robustness of the findings, including handling missing data and excluding participants with certain health conditions.

Results

• Among the 4,297 adults with diabetes aged 30 years and older, the weighted prevalence of moderate periodontitis was 39.4%, while severe periodontitis was 6.2%. Participants with moderate/severe periodontitis were generally older (mean age 59.6 years), predominantly male (60.1%), and had a higher proportion of non-Hispanic Black individuals (18.4%). A lower proportion of participants with moderate/severe periodontitis reported high socioeconomic status (24.5% vs. 38.7% in those with no/mild periodontitis).
• During a median follow-up of 15.41 years, 1,701 all-cause deaths were recorded, including 597 cardiovascular diseases (CVD)-related, 292 cancer-related, and 205 diabetes-related deaths. After adjusting for confounders, moderate/severe periodontitis was significantly associated with increased all-cause mortality and specific causes of death, particularly CVD-related mortality.
• The analysis revealed that participants with moderate/severe periodontitis had a higher risk of mortality compared to those with no/mild periodontitis, indicating a potential link between periodontal health and longevity.
• Sensitivity analyses confirmed the consistency of results, reinforcing the association between periodontitis and increased mortality risks in adults with diabetes.

Limitations