Abstract
Objective
The objective of this study is to simultaneously assess the associations between suboptimal oral health (SOH) and cardiovascular disease (CVD) and competing death (CD).
Methods
Ontario residents aged 40 years and over who participated in the Canadian Community Health Survey 2003 and 2007–2008 were followed until December 31, 2016 for the incidence of CVD or CD. SOH was assessed based on self-rated oral health and inability to chew. Multivariable competing risk analysis was adjusted for socioeconomic characteristics, behavioural factors and intermediate health outcomes.
Results
The study sample included 36,176 participants. Over a median follow-up of 9.61 years, there were 2077 CVD events and 3180 CD events. The fully adjusted models indicate 35% (HR = 1.35, 95% CI: 1.12–1.64) increase in the risk of CVD and 57% (HR = 1.57, 95% CI: 1.33–1.85) increase in the risk of CD among those who reported poor oral health as compared to those who reported excellent oral health. The fully adjusted models also indicate 11% (HR = 1.11, 95% CI: 0.97–1.27) increase in the hazard of CVD and 37% (HR = 1.37, 95% CI: 1.24–1.52) increase in the hazard of CD among those who reported inability to chew.
Conclusion
This study provides important information to contextualize CVD risk among those with SOH. The competing risk analysis indicates that those with SOH may benefit from additional interventions to prevent CVD and CD. Accordingly, managing the risk of CVD among those with SOH should fall under a more comprehensive approach that aims at improving their overall health and well-being.
Résumé
Objectif
L’objectif de la présente étude est d’évaluer simultanément les liens entre la santé bucco-dentaire sous-optimale et les maladies cardiovasculaires (MCV) et le décès concurrent (DC).
Méthodes
Les résidents de l’Ontario de 40 ans et plus ayant participé à l’Enquête sur la santé dans les collectivités canadiennes 2003 et 2007-2008 ont fait l’objet d’un suivi évaluant les risques de MCV ou de DC. La santé bucco-dentaire sous-optimale a fait l’objet d’une évaluation axée sur l’autoévaluation de l’état de santé bucco-dentaire et l’incapacité à mastiquer. L’analyse multivariable des risques concurrents a été adaptée aux caractéristiques socioéconomiques, aux facteurs comportementaux et aux résultats intermédiaires en matière de santé.
Résultats
L’échantillon à l’étude comprenait 36 176 participants. Après un suivi médian de 9,61 ans, 2 077 incidents de MCV et 3 180 DC ont été recensés. La modélisation complète indique une hausse des risques de MCV de 35 % (indice de risque (IR) = 1,35, intervalle de confiance (IC) à 95 % : 1,12-1,64) et une hausse des risques de DC de 57 % (IR = 1,57, IC à 95 % : 1,33-1,85) parmi les participants ayant signalé une piètre santé bucco-dentaire comparativement aux personnes ayant déclaré une excellente santé bucco-dentaire. La modélisation complète indique également une hausse des risques de MCV de 11 % (IR = 1,11, IC à 95 % : 0,97-1,27) et une hausse des risques de DC de 37 % (IR = 1,37, IC à 95 % : 1,24-1,52) parmi les participants ayant déclaré une incapacité à mastiquer.
Conclusion
La présente étude fournit d’importants renseignements nous permettant de contextualiser les risques de MCV chez les personnes ayant une piètre santé bucco-dentaire. L’analyse des risques concurrents indique que les personnes ayant une santé bucco-dentaire sous-optimale pourraient bénéficier d’interventions supplémentaires afin de prévenir les MCV et les DC. Par conséquent, la gestion des risques de MCV chez les personnes ayant une santé bucco-dentaire sous-optimale devrait relever d’une approche plus globale visant à améliorer la santé et le bien-être en général.
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Availability of data and material
The dataset from this study is held securely in coded form at ICES. While legal data-sharing agreements between ICES and data providers (e.g., healthcare organizations and government) prohibit ICES from making the dataset publicly available, access may be granted to those who meet pre-specified criteria for confidential access, available at www.ices.on.ca/DAS (email: das@ices.on.ca). The full dataset creation plan and underlying analytic code are available from the authors upon request, understanding that the computer programs may rely upon coding templates or macros that are unique to ICES and are therefore either inaccessible or may require modification.
Change history
21 September 2022
A Correction to this paper has been published: https://doi.org/10.17269/s41997-022-00700-1
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Acknowledgements
We thank Green Shield Canada for their generous financial support. Special thanks to Mr. Alexander Kopp and Ms. Andrea Pang from ICES for their massive efforts to create the complex dataset for this study. This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health (MOH) and the Ministry of Long-Term Care (MLTC). This study also received funding from Green Shield Canada (GSC). Parts of this material are based on data and information compiled and provided by Ontario Ministry of Health (MOH). The analyses, conclusions, opinions and statements expressed herein are solely those of the authors and do not reflect those of the funding or data sources; no endorsement is intended or should be inferred. Parts of this report are based on Ontario Registrar General (ORG) information on deaths, the original source of which is Service Ontario. The views expressed therein are those of the authors and do not necessarily reflect those of ORG or the Ministry of Government Services. Adapted from Statistics Canada, the Canadian Community Health Survey data, (2003 and 2007-2008). This does not constitute an endorsement by Statistics Canada of this product.
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Contributions
All authors conceptualized the study and study design and guided the creation of the study dataset. Musfer Aldossri performed data analysis and wrote the first draft of the manuscript. All authors commented on previous versions of the manuscript and read and approved the final manuscript.
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Ethical approval to conduct this study was obtained from the Research Ethics Board at the University of Toronto (protocol number: 00036110).
Conflict of interest
Carlos Quiñonez receives consulting income for dental care–related issues from Green Shield Canada.
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Aldossri, M., Saarela, O., Rosella, L. et al. Suboptimal oral health and the risk of cardiovascular disease in the presence of competing death: a data linkage analysis. Can J Public Health 114, 125–137 (2023). https://doi.org/10.17269/s41997-022-00675-z
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DOI: https://doi.org/10.17269/s41997-022-00675-z
Keywords
- Cardiovascular diseases
- Coronary heart disease
- Cerebrovascular disorders
- Mouth diseases
- Periodontal diseases
- Tooth loss