Severe Tooth Loss and Cardiovascular Disease Among Older Adults in Hawai'i: A Cross-Sectional Study of Behavioral Risk Factor Surveillance System Data from 2012 to 2020.

Despite mounting evidence of the link between oral health and systemic health, there are limited studies on individual- and community-level race/ethnic and socioeconomic correlates of tooth loss and cardiovascular disease (CVD), particularly with regard to Asian and Indigenous populations. This cross-sectional study examined the association between severe tooth loss and CVD and the individual- and community-level sociodemographic correlates of CVD in Hawai'i, where Native Hawaiian and Asian populations are predominant, utilizing 5 waves of even year data from the Hawai'i Behavioral Risk Factor Surveillance System collected between 2012 and 2020. Weighted Poisson regression was used to estimate the unadjusted and adjusted prevalence of CVD. Independent variables included demographic variables (age, sex, race and ethnicity), socioeconomic status indicators (education, annual household income, health insurance), and health-related variables (BMI, smoking status, diabetes). A significant association was revealed between severe tooth loss and CVD, which persisted (but was attenuated) with adjustment for sociodemographic and health variables. There were also disparities in CVD prevalence by race and ethnicity (Native Hawaiians had a higher prevalence than White respondents, even after adjustment) and community. The tooth loss-CVD linkage, and racial/ethnic disparities in the prevalence of CVD, point to the importance of a holistic, multi-level approach to public health and collaboration between medical and dental health professionals.