口腔就诊行为、口腔健康和全因死亡率之间的关系:基于人群的队列研究  

Association among dental visit behavior,oral health,and all-cause mortality:A population-based cohort study

作　　者：朱轶娜 许克惠 万美辰 贾帅林 李婧 马赛 牛丽娜 ZHU Yi-na;XU Ke-hui;WAN Mei-chen;JIA Shuai-lin;LI Jing;MA Sai;NIU Li-na(State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration,National Clinical Research Center for Oral Diseases,Shaanxi Key Laboratory of Stomatology,Department of Prosthodontics,School of Stomatology,The Fourth Military Medical University,Xi'an 710032,China)

机构地区：[1]口颌系统重建与再生全国重点实验室,国家口腔疾病临床医学研究中心,陕西省口腔医学重点实验室,空军军医大学口腔医院修复科,陕西西安710032

出　　处：《牙体牙髓牙周病学杂志》2025年第2期96-105,共10页Chinese Journal of Conservative Dentistry

基　　金：国家杰出青年科学基金(82325012);陕西省创新能力支撑计划项目(2020TD-033);陕西省自然科学基础研究计划资助项目(2024JC-YBQN-0980);国家口腔疾病临床医学研究中心一般基金项目(LCB202209)。

摘　　要：目的:探究口腔就诊行为、口腔健康与全因死亡率之间的相关性。方法:分析美国国家健康与营养调查数据库1999年至2004年和2011年至2018年共计36174名参与者的临床数据。口腔健康状况使用牙周健康状况、牙体健康状况和牙列完整性这三个指标进行评估。口腔就诊行为频率由最近一次口腔就诊至今的时间间隔评估。采用Cox比例风险回归模型估算死亡风险的危险比率及95%置信区间,通过中介分析探究口腔就诊行为在口腔健康状况欠佳与全因死亡率之间的中介作用。结果:30%的人群患有轻度至重度牙周炎,38.9%的人群至少有15个龋齿,21.2%的人群至少有15个牙齿缺失,超过50%的人群最后一次口腔就诊行为发生于1年以内。经过平均9.03年的随访,共发现6012例死亡病例。口腔健康状况不佳与全因死亡率较高有关。最近一次口腔就诊行为发生于1年内与全因死亡率降低相关。无论口腔健康状况如何,参与者均能从良好的口腔就诊行为中获益。中介分析发现,口腔就诊行为对牙周炎、龋齿、牙齿缺失和全因死亡率之间的关联具有中介作用。口腔就诊行为的中介作用在60岁以上的参与者中最为明显,但在60岁以下的参与者中并不明显。结论:促进良好的口腔就诊行为对预防与口腔健康相关的全身健康风险具有的公共卫生意义。年轻群体通过良好的口腔就诊行为改善全因死亡率的作用有限,应探索其他切实可行的措施。AIM:The association between oral health and various systemic diseases has been extensively investigated.However,little is known whether dental visit mitigates the oral health-related risk for mortality.METHODS:A total of 36174 participants from the US National Health and Nutrition Examination Survey were followed up from 1999 to 2004 and 2011 to 2018.Oral health was evaluated according to the status of periodontitis,dental caries,and tooth loss,respectively.Dental visit behavior was defined as the time interval of last dental visit.Cox proportional hazards models were used to estimate the hazard ratios and 95%confidence intervals of the mortality risk.Mediation analyses were used to examine the mediation role of dental visit behavior in the association between poor oral health and mortality.RESULTS:Overall,30%of the population had mild to severe periodontitis,38.9%had at least 15 teeth with dental caries,21.2%had at least 15 teeth lost,and more than 50%of the population had their last dental visit within 1 year.After the mean follow-up period of 9.03 years,6012 deaths were identified.Poor oral health was associated with a higher risk for all-cause mortality.Last dental visit within 1 year was associated with a reduced risk for all-cause mortality.The benefit of good dental visit behavior was seen in participants with different oral health conditions.Mediation analysis found that dental visit behavior mediated the associations between periodontitis,dental caries,tooth loss,and all-cause mortality.Mediation of dental visit behavior was most notable in participants over 60 years of age,and was not apparent in participants younger than 60.Similar results were identified when cardiovascular diseases mortality or cancer mortality was considered.CONCLUSION:Promotion of good dental visit behavior has valuable public health significance in preventing oral health-related risk for systemic health.Other practical measures should be explored to reduce the risk for impaired overall health in young population with severe oral d

关 键 词：口腔就诊行为 口腔健康 全因死亡率 口腔诊疗 牙周治疗 

分 类 号：R78[医药卫生—口腔医学]