All-cause and cause-specific mortality in US adults with periodontal diseases: A prospective cohort study

Abstract

Aim: This prospective cohort study investigated the association between periodontal diseases (PDs) and all-cause and cause-specific mortality. Materials and Methods: We utilized adult participants recruited from six National Health and Nutrition Examination Survey cycles (1999–2014) and linked mortality data from the National Death Index up to December 2019. Baseline clinical periodontal examinations were performed by trained and calibrated examiners. All-cause and cause-specific mortality was modelled through multivariable Cox proportional hazards and Fine–Gray models to account for competing risks. All models were adjusted for demographic and lifestyle variables, clinical measurements and comorbidities. Results: Overall, 15,030 participants were included, with a median length of follow-up of 9 years. Risk of all-cause mortality was 22% greater in people with PD than the control group (adjusted hazard ratio [HR]: 1.22, 95% confidence interval [CI]: 1.12–1.31). Risks of mortality by cardiovascular diseases (CVD), respiratory disease and diabetes were highest in participants with severe PD (CVD—sub-distribution HR [SHR]: 1.38, 95% CI: 1.16–1.64; respiratory—SHR: 1.62, 95% CI: 1.07–2.45; diabetes—SHR: 1.68, 95% CI: 1.12–2.53). Conclusions: Severe PD is associated with all-cause and cause-specific mortality among US adults after multivariable adjustment.