目的:在美国具有全国代表性的成人糖尿病(DM)样本中,确定牙齿脱落是否会影响全因和特定原因的死亡率。
方法:这项前瞻性队列研究包括8,207名30岁或以上的参与者,所有患者均被诊断患有糖尿病,并于1999年至2018年参加了国家健康和营养检查调查(NHANES).牙齿脱落被分层为28颗牙齿(完整),20-27颗牙齿(牙齿脱落),9-19颗牙齿(缺乏功能),1-8颗牙齿(严重牙齿脱落)和无牙症。根据牙齿脱落估计糖尿病参与者的全因和特定原因死亡率的风险比(HR)和95%置信区间(CIs),使用多变量cox比例风险回归模型。分析了死亡率与平均牙齿缺失水平四分位数之间的关系,以最低四分位数作为比较的基线。
结果:在6.92年的中位随访期间,记录了2,317例死亡。经过多变量调整后,较高的牙齿缺失水平与较高的全因风险显著且非线性相关,糖尿病患者的CVD相关和DM相关死亡率。与参考组的平均牙齿缺失水平相比,最高四分位数显示风险显著增加:全因死亡率(HR,2.11;95%CI,1.53-2.91,P趋势<0.001),CVD相关死亡率(HR,3.24,95%CI,1.54-6.85,P趋势<0.001)和DM相关死亡率(HR,2.78,95%CI,1.15-6.68,P趋势<0.001)。
结论:牙齿脱落与全因风险增加相关,美国成人糖尿病患者的CVD相关死亡率和糖尿病死亡率。
OBJECTIVE: To determine whether tooth loss affects all-cause and cause-specific mortality in a nationally representative sample of adults with diabetes mellitus (DM) in the United States.
METHODS: This prospective cohort study involved 8207 participants aged 30 years or older at baseline, all diagnosed with diabetes mellitus and enrolled in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018. Tooth loss was stratified into 28 teeth (complete), 20-27 teeth (tooth loss), 9-19 teeth (lacking functional), 1-8 teeth (severe tooth loss) and edentulism. To estimate hazard ratios (HRs) and 95 % confidence intervals (CIs) for all-cause and specific-cause mortality in diabetes mellitus participants according to tooth loss, multivariate cox proportional hazards regression models were used. Relationships between mortality and quartiles of mean tooth loss levels were analyzed, with the lowest quartile as the baseline for comparisons.
RESULTS: During a median of 6.92 years of follow-up, 2317 deaths were documented. After multivariate adjustments, higher tooth loss levels were significantly and non-linearly associated with higher risks of all-cause, CVD-related and DM-related mortality among participants with DM. When compared with the reference group of mean tooth loss levels, the highest quartile showed significantly increased risks: all-cause mortality (HR, 2.11; 95 % CI, 1.53-2.91, P-trend < 0.001), CVD-related mortality (HR, 3.24, 95 % CI, 1.54-6.85, P-trend < 0.001) and DM-related mortality (HR, 2.78, 95 % CI, 1.15-6.68, P-trend < 0.001).
CONCLUSIONS: Tooth loss is associated with an increased risk of all-cause, CVD-related and diabetes mellitus mortality among adults with diabetes mellitus in the US.
CONCLUSIONS: This study presents evidence for physicians and dentists that higher tooth loss was significantly associated with increased risk of all-cause, CVD-related and diabetes mellitus mortality in a dose-response manner among adults with diabetes mellitus. Therefore, assessment of survival in individuals with diabetes mellitus could pay attention to the tooth loss.