Frailty mediated the association between tooth loss and mortality in the oldest old individuals: a cohort study

Front Public Health. 2024 Jan 24:11:1285226. doi: 10.3389/fpubh.2023.1285226. eCollection 2023.

Abstract

Introduction: Tooth loss is associated with increased mortality risk; however, the mechanism underlying this is still not clear. The objective of this study was to explore whether frailty mediates the association between tooth loss and mortality risk among the oldest old individuals.

Methods: The participants were followed up from 1998 to 2018 in the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Frailty was constructed following a standard procedure. Mortality, frailty, and tooth loss were applied as the outcome, mediator, and independent variables, respectively. The Cox model was fitted, including possible confounders, for causal mediation analysis. A total effect (TE), an average causal mediation effect (ACME), an average direct effect (ADE), and a proportion mediated (PM) effect were calculated.

Results: During the 129,936 person-years at risk, 31,899 individuals with a mean age of 91.79 years were included. The TE and ADE of severe tooth loss on mortality were 0.12 (95% CI: 0.08, 0.15) and 0.09 (95% CI: 0.05, 0.13); the ACME of frailty was 0.03 (95% CI: 0.02, 0.03) with 21.56% of the TE being mediated.

Discussion: This study illustrated that tooth loss is associated with mortality, and frailty appeared to mediate the relationship. It is recommended that oral health indicators and frailty status be incorporated into routine geriatric assessments to promote optimal oral health and non-frailty status.

Keywords: cohort studies; inflammation; nutrition; oral medicine; public health.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Frailty*
  • Humans
  • Longevity
  • Longitudinal Studies
  • Tooth Loss* / epidemiology

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study was supported by the fund of the “San-ming” Project of Medicine in Shenzhen (NO.SZSM201812088), the Scientific Research Foundation of Shenzhen Health Economics Association (202304), and the construction and verification of a risk assessment model for venous thromboembolism (JCYJ20190809111017163).