Jiayun Lu1, Ina Zaimi2, John R Barber1, Corinne E Joshu3, Anna E Prizment4, James D Beck5, Elizabeth A Platz3, Dominique S Michaud6. 1. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. 2. Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, MA. 3. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD. 4. Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN; University of Minnesota Masonic Cancer Center, Minneapolis, MN. 5. Department of Dental Ecology, School of Dentistry, University of North Carolina, Chapel Hill, NC. 6. Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, MA. Electronic address: Dominique.Michaud@tufts.edu.
Abstract
PURPOSE: Severe periodontal disease and edentulism have been previously reported to be significantly associated with cancer risk and mortality, including in the Atherosclerosis Risk in Communities study (2018); however, complex sources of confounding by socioeconomic status (SES), and characteristics correlated with SES, could have been present in earlier analyses. METHODS: To capture life course SES and its correlates, we generated a propensity score and included it, along with other potential confounders such as smoking and obesity, into a Cox regression model to examine the association between periodontal disease and cancer risk. In addition, we stratified the model with the propensity score by low and high SES. All statistical tests were two-sided. RESULTS: Compared with our previous study, the associations for severe periodontitis and cancer incidence remained comparable after weighting by the propensity score (e.g., for total cancer: before weighting, hazard ratio = 1.24, 95% confidence interval = 1.07-1.42 vs. after weighting, hazard ratio = 1.23, 95% confidence interval = 1.05-1.44 when comparing severe periodontitis to no or mild periodontitis). Associations were comparable in low and high SES strata and statistically significant among participants with high SES. CONCLUSIONS: Complex sources of confounding by SES and its correlates are unlikely to fully account for the positive associations observed for periodontal disease and edentulism and cancer risk.
PURPOSE: Severe periodontal disease and edentulism have been previously reported to be significantly associated with cancer risk and mortality, including in the Atherosclerosis Risk in Communities study (2018); however, complex sources of confounding by socioeconomic status (SES), and characteristics correlated with SES, could have been present in earlier analyses. METHODS: To capture life course SES and its correlates, we generated a propensity score and included it, along with other potential confounders such as smoking and obesity, into a Cox regression model to examine the association between periodontal disease and cancer risk. In addition, we stratified the model with the propensity score by low and high SES. All statistical tests were two-sided. RESULTS: Compared with our previous study, the associations for severe periodontitis and cancer incidence remained comparable after weighting by the propensity score (e.g., for total cancer: before weighting, hazard ratio = 1.24, 95% confidence interval = 1.07-1.42 vs. after weighting, hazard ratio = 1.23, 95% confidence interval = 1.05-1.44 when comparing severe periodontitis to no or mild periodontitis). Associations were comparable in low and high SES strata and statistically significant among participants with high SES. CONCLUSIONS: Complex sources of confounding by SES and its correlates are unlikely to fully account for the positive associations observed for periodontal disease and edentulism and cancer risk.
Authors: April P Carson; Kathryn M Rose; Diane J Catellier; Jay S Kaufman; Sharon B Wyatt; Ana V Diez-Roux; Gerardo Heiss Journal: Ann Epidemiol Date: 2006-10-05 Impact factor: 3.797
Authors: Randi E Foraker; Mehul D Patel; Eric A Whitsel; Chirayath M Suchindran; Gerardo Heiss; Kathryn M Rose Journal: Am Heart J Date: 2012-11-20 Impact factor: 4.749
Authors: Xiaodan Mai; Michael J LaMonte; Kathleen M Hovey; Jo L Freudenheim; Christopher A Andrews; Robert J Genco; Jean Wactawski-Wende Journal: Cancer Causes Control Date: 2015-12-10 Impact factor: 2.506
Authors: Ngozi N Nwizu; James R Marshall; Kirsten Moysich; Robert J Genco; Kathleen M Hovey; Xiaodan Mai; Michael J LaMonte; Jo L Freudenheim; Jean Wactawski-Wende Journal: Cancer Epidemiol Biomarkers Prev Date: 2017-08 Impact factor: 4.254
Authors: Dominique S Michaud; Jiayun Lu; Alexandra Y Peacock-Villada; John R Barber; Corinne E Joshu; Anna E Prizment; James D Beck; Steven Offenbacher; Elizabeth A Platz Journal: J Natl Cancer Inst Date: 2018-08-01 Impact factor: 13.506