Periodontitis and the risk of all‐cause and cause‐specific mortality among US adults with diabetes: A population‐based cohort study

Abstract Aim To evaluate the association between periodontitis, all‐cause and cause‐specific mortality, and its prognostic utility among adults with diabetes. Materials and Methods Periodontal health records were retrieved from the NHANES database for 4297 participants with diabetes aged >30 years at baseline during 1988–1994, 1999–2004 and 2009–2014. Multivariable Cox proportional hazards regression model was applied to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) for moderate/severe periodontitis with all‐cause and cause‐specific mortality in participants with diabetes. Area under the curve (AUC) was used to assess predictive value. Results During a median follow‐up of 15.41 years, 1701 deaths occurred. After multivariate adjustments, moderate/severe periodontitis was significantly associated with increased risk of all‐cause (HR: 1.27; 95% CI: 1.07–1.50; p = .005) and cardiovascular disease (CVD)‐related (HR: 1.35, 95% CI: 1.03–1.76, p = .031) mortality in participants with diabetes. The absolute risk difference based on the cumulative incidence information was 0.022 (5‐year, 95% CI: 0.021–0.023) and 0.044 (10‐year, 95% CI: 0.041–0.048). Periodontitis improved the prediction of all‐cause (AUC: 0.652; 95% CI: 0.627–0.676) and CVD‐related (AUC: 0.649; 95% CI: 0.624–0.676) mortality over standard risk factors (all‐cause: AUC: 0.631; 95% CI: 0.606–0.656; CVD‐related: AUC: 0.629; 95% CI: 0.604–0.655). Conclusions Moderate/severe periodontitis is associated with an increased risk of all‐cause and CVD‐related mortality in adults with diabetes. Periodontitis might represent a marker for residual risk.