EPIDEMIOLOGY

Associations between tooth loss and mortality patterns in the Glasgow Alumni Cohort

Yu-Kang Tu^1,2, Bruna Galobardes³, George Davey Smith³, Peter McCarron⁴, Mona Jeffreys⁵, Mark S Gilthorpe²

¹ Leeds Dental Institute, University of Leeds, Leeds, UK
² Biostatistics Unit, Centre for Epidemiology and Biostatistics, University of Leeds, Leeds, UK
³ Department of Social Medicine, University of Bristol, Bristol, UK
⁴ Department of Epidemiology and Public Health, Queen’s University Belfast, Belfast, UK
⁵ Centre for Public Health Research, Massey University, Wellington, New Zealand

Correspondence to:
Dr Y-K Tu
Biostatistics Unit, Centre for Epidemiology & Biostatistics, University of Leeds, 30/32 Hyde Terrace, Leeds LS2 9LN, UK; y.k.tu{at}leeds.ac.uk

Objective: To use data from the Glasgow Alumni Cohort to investigate whether oral health in young adulthood is independently associated with later life cardiovascular disease (CVD) and cancer mortality.

Methods and results: Of the original cohort (n = 15 322), 12 631 subjects were traced through the National Health Service Central Register. Of these, 9569 men and 2654 women were 30 years or younger at baseline. During up to 57 years of follow-up, 1432 deaths occurred among subjects with complete data, including 509 deaths from CVD and 549 from cancer. After adjusting for potential confounders, no substantial association was found between the number of missing teeth (as a continuous variable) and all-cause mortality (hazard ratio (HR) for each extra missing tooth = 1.01; 95% confidence interval (CI) 1.00 to 1.02), CVD mortality (HR = 1.01; 95% CI 0.99 to 1.03) or cancer mortality (HR = 1.00; 95% CI 0.98 to 1.02). When the number of missing teeth was treated as a categorical variable, there was evidence that students with nine or more missing teeth at baseline had an increased risk of CVD (HR = 1.35; 95% CI 1.03 to 1.77) compared with those with fewer than five missing teeth. When the number of missing teeth was transformed using fractional polynomials, there seemed to be a non-linear relation between missing teeth and CVD mortality.

Conclusions: Although some evidence was found to support the relation between tooth loss and CVD mortality, causal mechanisms underlying this association remain uncertain.

Abbreviations: BMI, body mass index; CHD, coronary heart disease; CVD, cardiovascular disease; HR, hazard ratio; ICD, International Classification of Diseases

Keywords: tooth loss; cardiovascular diseases; stroke; coronary heart diseases; mortality

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