Association of oral health with risk of incident micro and macrovascular complications: A prospective cohort study of 24,862 people with diabetes

Alice A Gibson; Emma Cox; Joanne Gale; Maria E Craig; Shalinie King; Clara K Chow; Stephen Colagiuri; Natasha Nassar

doi:10.1016/j.diabres.2023.110857

Association of oral health with risk of incident micro and macrovascular complications: A prospective cohort study of 24,862 people with diabetes

Diabetes Res Clin Pract. 2023 Sep:203:110857. doi: 10.1016/j.diabres.2023.110857. Epub 2023 Aug 9.

Authors

Alice A Gibson¹, Emma Cox², Joanne Gale³, Maria E Craig⁴, Shalinie King⁵, Clara K Chow⁶, Stephen Colagiuri⁷, Natasha Nassar⁸

Affiliations

¹ Menzies Centre for Health Policy and Economics, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, NSW, Australia. Electronic address: alice.gibson@sydney.edu.au.
² Menzies Centre for Health Policy and Economics, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, NSW, Australia.
³ Menzies Centre for Health Policy and Economics, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia.
⁴ Charles Perkins Centre, The University of Sydney, NSW, Australia; Discipline of Paediatrics & Child Health, School of Clinical Medicine, UNSW Medicine & Health, Sydney, NSW, Australia.
⁵ Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; Sydney Dental School, Faculty of Medicine and Heath, The University of Sydney, NSW, Australia.
⁶ Charles Perkins Centre, The University of Sydney, NSW, Australia; Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; Department of Cardiology, Westmead Hospital, NSW, Australia.
⁷ Charles Perkins Centre, The University of Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, NSW, Australia.
⁸ Menzies Centre for Health Policy and Economics, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, NSW, Australia; Child Population and Translational Health Research, The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, NSW, Australia.

PMID: 37563015
DOI: 10.1016/j.diabres.2023.110857

Abstract

Aims: To investigate the association between self-reported oral health and incident micro and macrovascular diabetes complications.

Methods: This prospective cohort study linked data from the 45 and Up Study, Australia, to administrative health records. The participants were 24,862 men and women, aged ≥45 years, with diabetes at baseline (2006-2009). The oral health of participants was assessed by questionnaire. Incident diabetes complications were determined using hospitalisation data and claims for medical services up until 2019. Hazard ratios for the association between oral health and incident complications were calculated using multivariable cox proportional hazards models.

Results: Almost 60 % of participants had <20 teeth, and 38 % rated their teeth and gums as fair or poor. Compared with those with ≥20 teeth, those with 0 teeth had an increased risk of cardiovascular disease (aHR 1.24, 95 % CI: 1.15, 1.35), lower limb (aHR 1.22, 95 % CI: 1.11, 1.33) and kidney (aHR 1.19, 95 % CI: 1.11, 1.29) complications. Individuals with 1-9 teeth had an increased risk of eye complications (aHR 1.14, 95 % CI: 1.07, 1.22). The associations were generally consistent for poor self-rated teeth and gums.

Conclusions: Self-reported oral health measures may be a marker of elevated risk of complications in people with diabetes.

Keywords: Cardiovascular disease; Cohort study; Diabetes complications; Diabetes mellitus; Epidemiology; Oral health; Tooth loss.