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Abstract：
BACKGROUND: Poor oral health has been linked to various systemic diseases, including multiple cancer types, but studies of its association with lung cancer have been inconclusive.
METHODS: We examined the relationship between dental status and lung cancer incidence and mortality in the Golestan Cohort Study, a large, prospective cohort of 50,045 adults in northeastern Iran. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between three dental health measures (i.e., number of missing teeth; the sum of decayed, missing, or filled teeth (DMFT); and toothbrushing frequency) and lung cancer incidence or mortality with adjustment for multiple potential confounders, including cigarette smoking and opium use. We created tertiles of the number of lost teeth/DMFT score in excess of the loess adjusted, age- and sex-specific predicted numbers, with subjects with the expected number of lost teeth/DMFT or fewer as the reference group.
RESULTS: During a median follow-up of 14 years, there were 119 incident lung cancer cases and 98 lung cancer deaths. Higher DMFT scores were associated with a progressively increased risk of lung cancer (linear trend, p = 0.011). Compared with individuals with the expected DMFT score or less, the HRs were 1.27 (95% CI: 0.73, 2.22), 2.15 (95% CI: 1.34, 3.43), and 1.52 (95% CI: 0.81, 2.84) for the first to the third tertiles of DMFT, respectively. The highest tertile of tooth loss also had an increased risk of lung cancer, with a HR of 1.68 (95% CI: 1.04, 2.70) compared with subjects with the expected number of lost teeth or fewer (linear trend, p = 0.043). The results were similar for lung cancer mortality and did not change substantially when the analysis was restricted to never users of cigarettes or opium. We found no associations between toothbrushing frequency and lung cancer incidence or mortality.
CONCLUSIONS: Poor dental health indicated by tooth loss or DMFT, but not lack of toothbrushing, was associated with increased lung cancer incidence and mortality in this rural Middle Eastern population.
METHODS: We examined the relationship between dental status and lung cancer incidence and mortality in the Golestan Cohort Study, a large, prospective cohort of 50,045 adults in northeastern Iran. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between three dental health measures (i.e., number of missing teeth; the sum of decayed, missing, or filled teeth (DMFT); and toothbrushing frequency) and lung cancer incidence or mortality with adjustment for multiple potential confounders, including cigarette smoking and opium use. We created tertiles of the number of lost teeth/DMFT score in excess of the loess adjusted, age- and sex-specific predicted numbers, with subjects with the expected number of lost teeth/DMFT or fewer as the reference group.
RESULTS: During a median follow-up of 14 years, there were 119 incident lung cancer cases and 98 lung cancer deaths. Higher DMFT scores were associated with a progressively increased risk of lung cancer (linear trend, p = 0.011). Compared with individuals with the expected DMFT score or less, the HRs were 1.27 (95% CI: 0.73, 2.22), 2.15 (95% CI: 1.34, 3.43), and 1.52 (95% CI: 0.81, 2.84) for the first to the third tertiles of DMFT, respectively. The highest tertile of tooth loss also had an increased risk of lung cancer, with a HR of 1.68 (95% CI: 1.04, 2.70) compared with subjects with the expected number of lost teeth or fewer (linear trend, p = 0.043). The results were similar for lung cancer mortality and did not change substantially when the analysis was restricted to never users of cigarettes or opium. We found no associations between toothbrushing frequency and lung cancer incidence or mortality.
CONCLUSIONS: Poor dental health indicated by tooth loss or DMFT, but not lack of toothbrushing, was associated with increased lung cancer incidence and mortality in this rural Middle Eastern population.
摘要：
背景：口腔健康不良与各种全身性疾病有关，包括多种癌症类型，但是关于其与肺癌的关系的研究尚无定论。
方法：我们在Golestan队列研究中检查了牙齿状况与肺癌发病率和死亡率之间的关系，一个大的,伊朗东北部50,045名成年人的前瞻性队列。Cox比例风险模型用于估计三种牙齿健康措施之间的关联的风险比（HR）和95％置信区间（CI）（即，缺失牙齿的数量；腐烂的总和，失踪,或填充牙齿(DMFT)；和刷牙频率)和肺癌发病率或死亡率，并调整多种潜在的混杂因素，包括吸烟和鸦片的使用。我们创造了牙齿缺失数/DMFT分数超过黄土调整后的分数，年龄和性别特定的预测数字，以预期缺失牙齿/DMFT数量或更少的受试者作为参照组。
结果：在14年的中位随访中，有119例肺癌事件和98例肺癌死亡。较高的DMFT评分与肺癌风险逐渐增加相关(线性趋势，p=0.011)。与预期DMFT得分或更低的个体相比，HR为1.27（95%CI：0.73，2.22），2.15（95%CI：1.34，3.43），和1.52（95%CI：0.81，2.84）对于DMFT的第一至第三三分位数，分别。牙齿脱落率最高的人群也增加了患肺癌的风险，HR为1.68（95％CI：1.04，2.70），与预期的牙齿脱落数量或更少（线性趋势，p=0.043)。肺癌死亡率的结果相似，当分析仅限于从不吸烟或鸦片使用者时，结果没有实质性变化。我们发现刷牙频率与肺癌发病率或死亡率之间没有关联。
结论：牙齿脱落或DMFT表明牙齿健康状况不佳，但不缺乏刷牙，与中东农村人群肺癌发病率和死亡率增加相关。
方法：我们在Golestan队列研究中检查了牙齿状况与肺癌发病率和死亡率之间的关系，一个大的,伊朗东北部50,045名成年人的前瞻性队列。Cox比例风险模型用于估计三种牙齿健康措施之间的关联的风险比（HR）和95％置信区间（CI）（即，缺失牙齿的数量；腐烂的总和，失踪,或填充牙齿(DMFT)；和刷牙频率)和肺癌发病率或死亡率，并调整多种潜在的混杂因素，包括吸烟和鸦片的使用。我们创造了牙齿缺失数/DMFT分数超过黄土调整后的分数，年龄和性别特定的预测数字，以预期缺失牙齿/DMFT数量或更少的受试者作为参照组。
结果：在14年的中位随访中，有119例肺癌事件和98例肺癌死亡。较高的DMFT评分与肺癌风险逐渐增加相关(线性趋势，p=0.011)。与预期DMFT得分或更低的个体相比，HR为1.27（95%CI：0.73，2.22），2.15（95%CI：1.34，3.43），和1.52（95%CI：0.81，2.84）对于DMFT的第一至第三三分位数，分别。牙齿脱落率最高的人群也增加了患肺癌的风险，HR为1.68（95％CI：1.04，2.70），与预期的牙齿脱落数量或更少（线性趋势，p=0.043)。肺癌死亡率的结果相似，当分析仅限于从不吸烟或鸦片使用者时，结果没有实质性变化。我们发现刷牙频率与肺癌发病率或死亡率之间没有关联。
结论：牙齿脱落或DMFT表明牙齿健康状况不佳，但不缺乏刷牙，与中东农村人群肺癌发病率和死亡率增加相关。
