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SES and correlated factors do not explain the association between periodontal disease, edentulism, and cancer risk.

TitleSES and correlated factors do not explain the association between periodontal disease, edentulism, and cancer risk.
Publication TypeJournal Article
Year of Publication2019
AuthorsLu J, Zaimi I, Barber JR, Joshu CE, Prizment AE, Beck JD, Platz EA
Secondary AuthorsMichaud DS
JournalAnn Epidemiol
Volume38
Pagination35-41
Date Published2019 10
ISSN1873-2585
KeywordsAdult, Aged, Aged, 80 and over, Female, Humans, Incidence, Jaw, Edentulous, Male, Middle Aged, Mouth, Edentulous, Neoplasms, Obesity, Periodontal Diseases, Periodontitis, Propensity Score, Proportional Hazards Models, Residence Characteristics, Risk Factors, Smoking, Social Class, Socioeconomic Factors
Abstract

PURPOSE: Severe periodontal disease and edentulism have been previously reported to be significantly associated with cancer risk and mortality, including in the Atherosclerosis Risk in Communities study (2018); however, complex sources of confounding by socioeconomic status (SES), and characteristics correlated with SES, could have been present in earlier analyses.

METHODS: To capture life course SES and its correlates, we generated a propensity score and included it, along with other potential confounders such as smoking and obesity, into a Cox regression model to examine the association between periodontal disease and cancer risk. In addition, we stratified the model with the propensity score by low and high SES. All statistical tests were two-sided.

RESULTS: Compared with our previous study, the associations for severe periodontitis and cancer incidence remained comparable after weighting by the propensity score (e.g., for total cancer: before weighting, hazard ratio = 1.24, 95% confidence interval = 1.07-1.42 vs. after weighting, hazard ratio = 1.23, 95% confidence interval = 1.05-1.44 when comparing severe periodontitis to no or mild periodontitis). Associations were comparable in low and high SES strata and statistically significant among participants with high SES.

CONCLUSIONS: Complex sources of confounding by SES and its correlates are unlikely to fully account for the positive associations observed for periodontal disease and edentulism and cancer risk.

DOI10.1016/j.annepidem.2019.08.005
Alternate JournalAnn Epidemiol
PubMed ID31540766
PubMed Central IDPMC6812627
Grant ListR01 CA207110 / CA / NCI NIH HHS / United States
HHSN268201700001I / HL / NHLBI NIH HHS / United States
HHSN268201700001I / HL / NHLBI NIH HHS / United States
HHSN268201700005I / HL / NHLBI NIH HHS / United States
HHSN268201700004I / HL / NHLBI NIH HHS / United States
HHSN268201700002I / HL / NHLBI NIH HHS / United States
U01 CA164975 / CA / NCI NIH HHS / United States
R01 DE021418 / DE / NIDCR NIH HHS / United States
R01 DE013986 / DE / NIDCR NIH HHS / United States
P30 CA006973 / CA / NCI NIH HHS / United States