IJE Advance Access originally published online on January 19, 2005
International Journal of Epidemiology 2005 34(2):467-474; doi:10.1093/ije/dyh375
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Published by Oxford University 2005
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Tooth loss is associated with increased risk of total death and death from upper gastrointestinal cancer, heart disease, and stroke in a Chinese population-based cohort
1 Cancer Prevention Studies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA.
2 Cancer Institute (Hospital), Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
3 Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA.
* Corresponding author. 6116 Executive Boulevard, Room 705, Bethesda, MD 20892, USA. E-mail: abnetc{at}mail.nih.gov
Background Tooth loss has previously been associated with a higher risk of cancer, heart disease, and stroke, but the role of confounding by smoking remains an issue.
Methods We conducted a cohort study including 29 584 healthy, rural Chinese adults who were participants in a chemoprevention trial from 1986 through 1991 and who have been followed-up through 2001. We categorized tooth loss for each subject as less than or equal to or greater than the median number of teeth lost for other subjects of the same age at baseline. Mortality outcomes were categorized as follows: total death (n = 9362), upper gastrointestinal (GI) cancer death (n = 2625), other cancer death (n = 514), heart disease death (n = 1932), and fatal stroke (n = 2866).
Results Individuals with greater than the age-specific median number of teeth lost had statistically significant 13% increased risk of total death [95% confidence interval (CI) 9–18%], 35% increased risk of upper GI cancer death (95% CI 14–59%), 28% increased risk of heart disease death (95% CI 17–40%), and 12% increased risk of stroke death (95% CI 2–23%), but no significantly increased risk of death from cancer at other sites. These elevated risks were present in male smokers, male non-smokers, and females, nearly all never-smokers.
Conclusions In this Asian population, tooth loss significantly increased the risk of total death and death from upper GI cancer, heart disease, and stroke. These associations were not limited to tobacco smokers.
Keywords Death, gastrointestinal neoplasms, heart diseases, cerebrovascular accident, tooth loss, cohort studies, China
Accepted 6 October 2004
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