Combined association of cognitive impairment and poor oral health on mortality risk in older adults: Results from the NHANES with 15 years of follow‐up

Abstract

Background: Cognitive impairment and poor oral health are frequently seen among older adults. Both conditions have been identified as risk factors for mortality. However, the combined associations of cognitive impairment and poor oral health with mortality have not been well studied and are therefore the aim of this cohort study. Methods: We analyzed data from the National Health and Nutrition Examination Survey (1999 linked with mortality data obtained from the 2015 public-use linked mortality file. Cognitive impairment was defined as a digit symbol substitution test score lower than the lowest quartile. Oral health status was assessed based on presence of untreated caries, moderate to severe periodontitis, and edentulism. The combined effects of caries/periodontitis or edentulism and cognitive impairment on all-cause and cardiometabolic mortality were examined using the Cox proportional hazard models after adjusting for potential confounders including demographic characteristics, lifestyle, biomarkers, and comorbidities. Results:In total, 1973 participants were enrolled in the prospective study. At a median follow-up of 13.4 years, 978 participants had died (264 deaths because of cardiometabolic disease). Cognitive impairment, periodontitis, and edentulism were each found to be significant predictors of all-cause mortality. Caries, however, was not significantly related to mortality. When analyzing these predictors in combination, a diagnosis of cognitive impairment and periodontitis was associated with an 83.1% increase in all-cause mortality risk and an 87.7% increase in cardiometabolic mortality risk compared with healthy controls. Similarly, the risk for all-cause mortality was highest in cases where impaired cognition and edentulism co-occurred (adjusted hazard ratio = 1.701, 1.338-2.161).

Periodontitis and cognitive impairment in older adults: The mediating role of mitochondrial dysfunction

“…We categorized the race or ethnicity as non‐Hispanic White, non‐Hispanic Black, and others (including Mexican American, other Hispanic, and other races [e.g., multi‐racial]); 2) behavioral factors (smoking status [non‐smoker, former smoker, or current smoker], alcohol intake [≥12 drinks/year or <12 drinks/year], and dental visit [<1 year, 1–3 years, or >3 years]); and 3) health conditions (diabetes mellitus, hypertension, dyslipidemia, obesity, abdominal adiposity, cardiovascular disease, and cancer). We described the detailed definitions and categories of health conditions in Supplementary Table S1 in the online Journal of Periodontology , as the previous study 33 …”

“…We described the detailed definitions and categories of health conditions in Supplementary Table S1 in the online Journal of Periodontology , as the previous study. 33 …”

Denture wearing status, cardiovascular health profiles, and mortality in edentulous patients: A prospective study with a 27-year follow-up

“…More research is therefore necessary on the association between chewing function and general health in the edentulous population. Recent studies have linked edentulism to mortality in the older population [8,9]. It was reported that the edentulism-mortality link (16.1%) could be partly explained by the elevated cardiovascular risk [8].…”

“…Recent studies have linked edentulism to mortality in the older population [8,9]. It was reported that the edentulism-mortality link (16.1%) could be partly explained by the elevated cardiovascular risk [8]. Thus, the mortality risk of edentulous older adults might arise from a complex interplay of oral diseases (e.g., periodontal infections and severe caries lesions) that eventually can cause general health problems, including higher cardiovascular risk factors.…”

Serum α-Klotho associated with oral health among a nationally representative sample of US adults

“…Oral health, enabling natural eating, speaking, smiling, and socializing, plays a vital role in overall health ( 5 , 6 ). Deterioration of oral health can lead to various adverse health outcomes, such as cardiovascular diseases ( 7 ), cognitive impairment ( 8 ), disability ( 9 ), and all-cause mortality ( 10 ). However, studies have suggested that dental diseases could be prevented and reversed ( 11 , 12 ).…”