Missing teeth, mortality, and hospitalization: A population-based cohort analysis from the Canadian Health Measures Survey and linked databases.

BACKGROUND

The association between oral health and general health is not yet fully understood. This study examines the association between missing teeth, mortality, and hospitalization outcomes.

DATA AND

METHODS

This cohort study utilized time-to-event data from the Canadian Health Measures Survey Cycle 1 (2007 to 2009) linked to death and hospital discharge records. Participants with clinically assessed tooth counts were followed up to 2019. Cox proportional hazards models were used, treating missing teeth as either categorical or continuous exposures, adjusting for socioeconomic and health-related factors.

RESULTS

In participants aged 20 to 79 years, 3,450 records were linked to mortality data (n=300 deaths) and 2,250 to hospitalization data (n=650 with at least one hospital stay). Missing teeth were associated with elevated all-cause and cancer mortality in unadjusted models, but not after covariate adjustment. After adjusting for key risk factors, including age and sex, participants with five or more missing teeth had a 76% higher risk of all-cause hospitalization (hazard ratio [HR] 1.76, 95% confidence interval [CI]: 1.41 to 2.20) and a 120% higher risk of circulatory-related hospitalization (HR 2.20, 95% CI: 1.09 to 4.45). Respiratory hospitalizations were also linked to missing teeth. No significant links were found with hospitalizations for digestive diseases or cancer.

INTERPRETATION: Missing teeth is associated with hospitalization in Canadian adults. These findings highlight that oral health may play a role or serve as an indicator of overall health and health service use among Canadian adults.