Noriko Nakazawa1, Taro Kusama1,2, Upul Cooray1, Takafumi Yamamoto1,3, Sakura Kiuchi1, Hazem Abbas1, Tatsuo Yamamoto4, Katsunori Kondo5,6, Ken Osaka1, Jun Aida2,7. 1. Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan, 4-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan. 2. Division for Regional Community Development, Liaison Center for Innovative Dentistry, Graduate School of Dentistry, Tohoku University, Sendai, Japan, 4-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan. 3. Department of Health Promotion, National Institute of Public Health, Saitama, Japan, 2-3-6 Minami, Wako-shi, Saitama, 351-0197, Japan. 4. Department of Dental Sociology, Kanagawa Dental University, Yokosuka, Japan, 82 Inaokacho, Yokosuka, Kanagawa, 238-8580, Japan. 5. Center for Preventive Medical Sciences, Chiba University, Chiba, Japan, 1-33, Yayoicho, Inage-ku, Chiba-shi, Chiba, 263-8522, Japan. 6. Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan, 7-430, Morioka-cho, Obu, Aichi, 474-8511, Japan. 7. Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549 Japan.
Abstract
BACKGROUND: Oral diseases are preventable and modifiable, but highly prevalent, and cause worse oral status. Particularly, tooth loss has increased in aging societies. However, studies on population-attributable risks of modifiable risk factors for mortality have neglected oral status. This study aimed to investigate the impact of modifiable risk factors on mortality, including oral status. METHODS: This cohort study used the Japan Gerontological Evaluation Study (JAGES) data, including participants aged ≥65 years. The outcome was death between August 2010 to March 2017. We calculated the hazard ratios (HRs) and population attributable fraction (PAF) of modifiable risk factors (oral status, hypertension, depression, heart disease, diabetes, physical activity, smoking status, and alcohol drinking history) for mortality. RESULTS: Analyses included 24,175 men and 27,888 women (mean age: 73.8 [6.0] and 74.2 [6.1], respectively). In men, after adjusting for covariates, having no teeth showed the highest hazard ratio (hazard ratio [HR]=1.67, 95% confidence interval [CI]=1.51-1.86) among the modifiable risk factors, and the PAF for the number of teeth (18.2%) was the second largest following age. In women, having no teeth had the third largest HR (HR=1.37, 95%CI=1.19-1.56) following current and former smoking. The PAF for the number of teeth (8.5%) was the sixth largest, which was larger than that of smoking status (4.8%). CONCLUSIONS: In the older population, the HR and PAF of the number of teeth on mortality were sufficiently large compared with other modifiable risk factors, especially in men. Therefore, maintaining good oral status should be included more in global health policies.
BACKGROUND: Oral diseases are preventable and modifiable, but highly prevalent, and cause worse oral status. Particularly, tooth loss has increased in aging societies. However, studies on population-attributable risks of modifiable risk factors for mortality have neglected oral status. This study aimed to investigate the impact of modifiable risk factors on mortality, including oral status. METHODS: This cohort study used the Japan Gerontological Evaluation Study (JAGES) data, including participants aged ≥65 years. The outcome was death between August 2010 to March 2017. We calculated the hazard ratios (HRs) and population attributable fraction (PAF) of modifiable risk factors (oral status, hypertension, depression, heart disease, diabetes, physical activity, smoking status, and alcohol drinking history) for mortality. RESULTS: Analyses included 24,175 men and 27,888 women (mean age: 73.8 [6.0] and 74.2 [6.1], respectively). In men, after adjusting for covariates, having no teeth showed the highest hazard ratio (hazard ratio [HR]=1.67, 95% confidence interval [CI]=1.51-1.86) among the modifiable risk factors, and the PAF for the number of teeth (18.2%) was the second largest following age. In women, having no teeth had the third largest HR (HR=1.37, 95%CI=1.19-1.56) following current and former smoking. The PAF for the number of teeth (8.5%) was the sixth largest, which was larger than that of smoking status (4.8%). CONCLUSIONS: In the older population, the HR and PAF of the number of teeth on mortality were sufficiently large compared with other modifiable risk factors, especially in men. Therefore, maintaining good oral status should be included more in global health policies.